Psychotic episode due to Hashimoto's thyroiditis

M, Nazou; Parlapani, Eleni; Ei, Nazlidou; Athanasis, P.; Vp, Bozikas

doi:10.22365/jpsych.2016.272.144

Cited by 6 publications

(6 citation statements)

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“…Neuropsychiatric manifestations may be the first presenting features of hypothyroidism as highlighted by our case,4 12–16 and the diagnosis may be simply overlooked. Hockings CA et al also described the case of an adolescent who presented with psychiatric manifestations as the first presentation of hypothyroidism12.…”

Section: Discussionmentioning

confidence: 73%

“…Myxedema psychosis can respond as quickly as within days to a few weeks to thyroxine replacement 6 12–14 16–18. Some physicians use anti-psychotic treatment for a short period to control the psychosis symptoms at the beginning of the illness; these medications can be safely discontinued on follow-up after ensuring that there is no recurrence of symptoms 17…”

Section: Discussionmentioning

confidence: 99%

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Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Mohamed¹,

Mahgoub

Sardar

et al. 2019

BMJ Case Rep

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Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Mohamed¹,

Mahgoub

Sardar

et al. 2019

BMJ Case Rep

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“…The cerebrospinal fluid (CSF) exam is usually not performed; however, when attempted, it is generally unremarkable, while mild CSF protein elevation is also rarely reported [5,12,17,23,24]. MRI and electroencephalogram are mostly insignificant [5,14,23,25,26]. Notably, the patient had evidence of rhabdomyolysis-another infrequent association with hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

Sardar

Habib

Sukik

et al. 2020

Case Reports in Psychiatry

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Background. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing mood swings, psychomotor slowing, and fatigue; however, in rare instances, it may lead to or induce acute psychosis, a condition referred to as myxedema psychosis (MP). We report a case of myxedema psychosis and present a literature review discussing its presentation, diagnosis, management, and prognosis. Case Presentation. A 36-year-old lady presented with one-week history of persecutory and paranoid delusions, along with visual and auditory hallucinations. She had no prior history of psychiatric illnesses. She underwent total thyroidectomy three years before the current presentation due to papillary thyroid cancer. She was not on regular follow-up, nor any specific therapy. On examination, she was agitated and violent. There were no signs of myxedema, and the physical exam was unremarkable. The initial workup showed a mild elevation in serum creatinine. Additional investigations revealed a high thyroid-stimulating hormone (TSH) of 56.6 mIU/L, low free T4<0.5 pmol/L, elevated creatine kinase of 3601 U/L, and urine dipstick positive for blood, suggestive of myoglobinuria. MRI of the head was unremarkable. We diagnosed her as a case of myxedema psychosis and mild rhabdomyolysis. She was started on oral thyroxine 100 mcg/day, fluoxetine 20 mg daily, and as-needed haloperidol. She was closely followed and later transferred to the Psychiatry Hospital for further management. Within one week, her symptoms improved completely, and she was discharged off antipsychotics with additional scheduled follow-ups to monitor TFTs and observe for any recurrence. Discussion and Conclusion. Myxedema psychosis is a rare presentation of hypothyroidism—a common endocrine disorder. Scarce data are describing this entity; hence, there is currently a lack of awareness amongst clinicians regarding proper identification and management. Moreover, the atypical nature of presentations occasionally adds to a diagnostic dilemma. Thus, any patient with new-onset psychosis should be screened for hypothyroidism, and awareness of this entity must be emphasized amongst clinicians and guideline makers.

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“…After diagnosis, antithyroid and antipsychotic treatment was initiated to patients and the psychotic state was completely improved in more than half of the patients over an 11-year follow-up period [27]. Similarly, cases of Hashimoto thyroiditis [28] and subacute thyroiditis [29] with psychotic episodes have been reported.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Thyroid Hormone Levels and Crime Type: A Controlled Study in Prisoners

Acar

Ülgen

2020

International Journal of Endocrinology

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Various factors cause aggression, which can be related to imbalance of T3 and T4 hormones, which can act as neurotransmitters and are reported to be elevated during aggression. This indicates changes in the hypothalamic-pituitary-thyroid axis that cause long-term changes in aggressive behaviour, especially in criminals. Moreover, mental and behavioural disorders possibly occur in individuals with impairment in thyroid hormone balance. The main rationale for this study was to asses if high T3, high T4, and low TSH hormones may have an effect on aggression-related crime tendency. Furthermore, the study aimed to measure levels of thyroid hormones in prisoners and to examine relationships of the hormone levels with crime rates. Our study was conducted in Ankara Sincan Closed Prisons. The study group consisted of 208 male volunteers who were imprisoned and the control group included 82 male volunteers who were not imprisoned. Prisoners in the study group were divided into two groups: those who committed aggression-related crime (Group A, n = 96) and prisoners convicted of other crimes (Group B, n = 112). Pulse rates, T3, T4, and thyroid-stimulating hormone (TSH) levels, and theT3/T4 ratio were measured in these prisoners. Data were analysed using the Wilcoxon rank sum test and chi-square Fisher’s exact test to test for any statistically significant differences. Results showed that toxic goitre rates, T3 and T4 values, and pulse rates were significantly higher in Group A than in the control group. Significant increase in T3 and T4 levels and the presence of toxic goitre were associated with aggression-related crime. These examinations should be performed on prisoners in general, especially those convicted of violent crimes. Additional rehabilitation and research programs should also be developed for such patients.

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Psychotic episode due to Hashimoto's thyroiditis

Cited by 6 publications

References 0 publications

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

Relationship between Thyroid Hormone Levels and Crime Type: A Controlled Study in Prisoners

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