Primary Hypothyroidism Associated with Acute Mania: Case Series and Literature Review

Khemka, D.; Ali, Jalaa Abu; Koch, Christian A.

doi:10.1055/s-0031-1277137

Cited by 29 publications

(27 citation statements)

References 21 publications

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“…The potential mechanisms of action include the interaction of thyroid hormones and neurotransmitters. It has been shown that an enhanced activity of the enzyme tyrosine hydroxylase is related to increased concentrations of dopamine (DA) in the brain of hypothyroid rats, thereby leading to the manifestation of mania due to monoamine excess (10)(11)(12). Another hypothesis is based on serotonin activity.…”

Section: Discussionmentioning

confidence: 99%

“…Another hypothesis is based on serotonin activity. It has been reported that in the limbic system of the rat, hypothyroidism can cause a decrease in serotonin with the consequent up-regulation of dopamine postsynaptic receptors and increased dopamine activity in the brain, resulting in maniac symptoms (12,13). Furthermore, thyroid hormones have a modulating impact on the brain catecholamine system, regulating β-adrenergic receptor sensitivity, so that changes in hormone levels, as seen in hypothyroidism, might increase catecholamine action with major risk of mania in vulnerable individuals (14).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, thyroid hormones have a modulating impact on the brain catecholamine system, regulating β-adrenergic receptor sensitivity, so that changes in hormone levels, as seen in hypothyroidism, might increase catecholamine action with major risk of mania in vulnerable individuals (14). Therefore, the influence of an impairment of the thyroid system on neurotransmitters (particularly serotonin and norepinephrine), which play a major role in the regulation of mood and behavior, may contribute to the mechanisms of mood modulation (12,15).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Myxedema madness complicating postoperative follow-up of thyroid cancer

Allo

Rosmarin

Urrutia

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYAlthough hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen ® ) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine withdrawal for the follow-up of thyroid cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Myxedema madness complicating postoperative follow-up of thyroid cancer

Allo

Rosmarin

Urrutia

et al. 2015

Arch. Endocrinol. Metab.

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“…In the literature, cases with manic episodes related to primary hypothyroidism have been reported rarely (5,6).…”

Section: Introductionmentioning

confidence: 99%

Psychosis related with Hashimoto thyroiditis: a case report

Ağaçhanlı¹,

Balaban²,

Yazar³

et al. 2016

Dusunen Adam

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Psychosis related with Hashimoto thyroiditis: a case reportHashimoto's thyroiditis is an autoimmune disease characterized with inflammation of the thyroid gland.Psychiatric symptoms frequently accompany Hashimoto's thyroiditis. Major depression is the most common affective disorder with the prevalence of 33-43%. Psychotic disorders may accompany at 5% rate. In this case report; a patient, recently diagnosed with hypothyroidism and involved into a psychotic process due to his hypothyroidism, is discussed. The patient's refusal of oral intake and lack of parenteral preparation of thyroxine in our country were the factors that made the treatment more complicated. The aim of this case report is to emphasize the importance of the routine laboratory examinations especially during the first admission to the hospital, and to underline difficulty of thyroid replacement therapy due to lack of preparation of parenteral thyroxine in our country in patients who do not or can not get medications orally.

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“…2 Clinical and subclinical hypothyroidism are sometimes observed in psychiatric disorders. For example, these endocrine states may be associated with developmental delay or mental retardation, 3 mood or cognitive disturbance in the elderly, 4 dementia, 5 psychosis, 6 depression, 7 bipolar disorder, 8 rapid-cycling mood disorder, 9 and other conditions. Hypothyroidism may also be an adverse outcome of lithium therapy.…”

mentioning

confidence: 99%