Psychose aigüe secondaire à une dysthyroïdie: à propos de 2 cas

Aarab, Chadya; Hammani, Zakaria; Aalouane, Rachid; Yassari, Mohsine; Rammouz, Ismaïl

doi:10.11604/pamj.2016.25.216.10247

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Thyroidectomies with intrathoracic extent requiring neck dissection due to malignant neck nodes mostly involved central neck dissection of level VI (21% of patients), followed by neck node levels II, V, III and IV, which are draining sites of thyroid carcinoma neck node metastasis. This is consistent with the NCCN (2023) recommendation 18 that clinically positive and/or biopsy-proven nodal metastases be treated with formal compartmental resection in the central neck with unilateral or bilateral level VI dissection, and in the lateral compartment, a formal modified radical neck dissection including levels II, III, IV, and V.…”

Section: Discussionsupporting

confidence: 87%

“…Patients experiencing post-operative delirium from thyroidectomy are rare, limited to case reports. 18,25 Other documented complications from local literature include postoperative hemorrhage, and respiratory failure. 7 The local study of Villaluna and Desales showed that the histopathologic results of intrathoracic goiters were mostly multinodular adenomatous goiters (50%) and follicular adenomas (7%) 7 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical Management of Goiter with Intrathoracic Extension at the Philippine General Hospital Department of Otolaryngology Head and Neck Surgery

Mendoza,

Del Mundo - Madrid

2023

Philipp J Otolaryngol Head Neck Surg

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Objective: To describe the demographic and clinical characteristics of patients diagnosed with intrathoracic thyroid masses managed surgically in our institution, determine associated factors affecting eventual operative approaches for these patients, and assess postoperative outcomes and complications associated with surgical intervention. Methods: Design: Retrospective descriptive case series Setting:Tertiary National University Hospital Participants: 24 patients Results: The mean age of patients diagnosed with intrathoracic goiters was 55.71 years old, with a 1:1.4 male to female ratio; with most having an intrathoracic extent of Huins Grade 1 (67%) compared to others having Huins Grade 2-3. Majority of patients pre-operatively had a Fine Needle Aspiration (FNA) Bethesda Thyroid Nodule Classification of Category II (benign); 79% of total patients underwent excision of thyroid mass utilizing a transcervical approach alone. As Intrathoracic Extension (ITE) grade increased, additional transthoracic approaches were performed; duration of operation, average estimated blood loss, length of hospital stay was also noted to increase. Majority of post operative surgical histopathology results revealed malignant thyroid masses, in contrast to pre-operative FNA. Post-operative transient hypocalcemia was the most reported immediate complication. Conclusions: Management of intrathoracic goiter is often multidisciplinary. Referral to the thoracic vascular service is warranted for access to the thoracic inlet. Classification by grade of intrathoracic goiters is helpful to determine the most appropriate operative approach and maybe predictive of intraoperative and postoperative outcomes. Postoperative histopathology across all ITE grades mostly yield malignant results; hence, preoperative FNA results should be used with caution.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Surgical Management of Goiter with Intrathoracic Extension at the Philippine General Hospital Department of Otolaryngology Head and Neck Surgery

Mendoza,

Del Mundo - Madrid

2023

Philipp J Otolaryngol Head Neck Surg

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“…But there is minimal literature available for the acute states of hypothyroidism following total thyroidectomy that would have led to psychosis. With best of our efforts, we could find only two case reports of psychosis in patients who underwent thyroidectomy, and only one in which patient developed psychosis in the immediate postoperative period [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Psychosis Consequent to Total Thyroidectomy: An Etiological Conundrum

Kaushal

Rajan

Aneja

et al. 2020

Cureus

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Total thyroidectomy has evolved from a vilipended surgery owing to its high mortality to one with commonly performed surgery with minimal complications. After a total thyroidectomy many patients are left hypothyroid and/or hypoparathyroid, and thus prone to develop neuropsychiatric complications. Although anxiety and depression are the common manifestations, acute psychosis consequent to total thyroidectomy is rarely reported. Herein, we present the case of a 55-year-old female with a massive neck swelling diagnosed as papillary carcinoma of thyroid with bilateral metastatic cervical lymph nodes for which total thyroidectomy with bilateral modified neck dissection was performed. Postoperatively, she developed symptoms of altered sensorium, disorientation, insomnia, agitation, and delusions of persecution as well as suffered from two episodes of generalized seizures. Initially, suspected to be delirium, the persistence of the psychotic symptoms led to revision of diagnosis to psychotic disorder due to another general medical condition. The acute neuropsychiatric manifestations consequent to major thyroid surgeries may seldom leave the surgeon by surprise. Hence, a multidisciplinary liaising for major thyroid surgeries is the need of hour to avert severe emergencies.

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“…L'hypothyroïdie peut s'exprimer par un tableau dépressif associant un ralentissement du débit verbal, une diminution des performances intellectuelles, une fatigabilité, une diminution de l'appétit et une apathie. La « folie myxoedémateuse », décrite pour la première fois en 1949 [1], réalise un tableau d'état psychotique confusodélirant et hallucinatoire ou d'état mélancolique fréquemment stuporeux, plus rarement d'hypomanie [5]. Cette dernière forme est rarement observée et peu décrite dans la littérature, ce qui souligne l'originalité de notre observation.…”

Section: Discussionunclassified

“…Ces symptômes persistent bien souvent plus longtemps que les troubles somatiques [9]. Aussi, il est estimé dans la littérature que 10 % des patients présentent des symptômes neuropsychiatriques résiduels [5,13,14], justifiant alors une prescription d'antipsychotique au long cours.…”

Section: Discussionunclassified