Myxedema madness complicating postoperative follow-up of thyroid cancer

Allo, Yanina Jimena Morosan; Rosmarin, Melanie; Urrutia, Agustina; Faingold, María Cristina; Musso, Carla; Brenta, Gabriela

doi:10.1590/2359-3997000000090

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…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%

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: 99%

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Mohamed¹,

Mahgoub

Sardar

et al. 2019

BMJ Case Rep

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“…5 A presentation of myxedema psychosis is often seen in patients with longstanding Hashimoto thyroiditis, after thyroidectomy, or with medication noncompliance. 1,2 Progressively worsening symptoms of hypothyroidism can include fatigue, cold intolerance, decreased concentration, weight gain, hoarse voice, and constipation ( Figure). Severe symptoms can include hypotension, hyponatremia, or hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…Reported levels have ranged from 21.9 mIU/L to 122.2 mIU/L. [1][2][3][4][5][6][7][8] Hypothyroidism can be found in 0.3% to 0.4% of people, and subclinical hypothyroidism in 4.30% to 8.5%. 9 Despite the high incidence of hypothyroidism, hypoventilation, hypothermia, and hypotension, which can be severe and life threatening in some cases.…”

Section: Discussionmentioning

confidence: 99%

Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis

Mavroson¹,

Patel²,

Akker³

2017

Journal of Osteopathic Medicine

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Myxedema psychosis is uncommon in patients with primary hypothyroidism. Most often, this disease state can be found in patients with Hashimoto thyroiditis or after total thyroidectomy. Chronic hypothyroidism can lead to an insidious onset of psychiatric symptoms in patients, such as dementia, delirium, psychosis, hallucinations, and coma. A 31-year-old man with an unremarkable medical history was brought to the psychiatric emergency department for new-onset aggression, paranoid behavior, and hallucinations for 4 days. Initial test results showed a thyroid-stimulating hormone level of 306.0 mIU/L and a free thyroxin level of 0.24 ng/dL. No other clinical or laboratory abnormalities were found. A diagnosis of myxedema psychosis was established, and the patient was treated with tapering doses of intravenous hydrocortisone and 0.1 mg of intravenous levothyroxine daily. On hospital day 3, his mental status began to improve, and he was discharged on day 4. Myxedema psychosis is rarely the initial presenting symptom of hypothyroidism, especially in the absence of other abnormal clinical or laboratory findings.

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“…Following levothyroxine initiation, the severe hypothyroidism had almost completely resolved, and within 4 months of treatment, the psychopharmacologic medications were tapered to discontinuation with complete resolution of psychiatric symptoms. 21 These case reports illustrate the presentation of an infrequently diagnosed medical condition masquerading as a psychosis in individuals with no prior history of mental illness. The sudden onset of psychosis with no prior history flagged the cases for additional follow-up.…”

Section: Casesmentioning

confidence: 98%

“…Much less frequently reported is a clinical condition referred to as myxedema madness , a severe psychosis related to significant hypothyroidism. 1 , 20 , 21 Recent case reports highlighted the presentation of this change in cognition and onset of psychiatric symptoms.…”

Section: Casesmentioning

confidence: 99%

Medical mimics: Differential diagnostic considerations for psychiatric symptoms

McKee

Brahm

2016

Mental Health Clinician

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Patients with underlying medical disease can present to the health care system with psychiatric symptoms predominating. Identification of an underlying medical condition masquerading as a psychiatric disorder can be challenging for clinicians, especially in patients with an existing psychiatric condition. The term medical mimic or secondary psychosis has been used to describe this clinical situation. Diagnostic categories from The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, that may encompass medical mimics include substance-induced disorders, which includes medications, and unspecified mental disorder due to another medical condition in situations where the clinician may lack needed information for a complete diagnosis. At this time, there is no single diagnostic test or procedure available to differentiate primary versus secondary psychosis on the basis of psychopathology presentation alone. When considering a diagnosis, clinicians should evaluate for the presence of atypical features uncharacteristic of the psychiatric symptoms observed; this may include changes in functionality and/or age of onset and symptom presentation severity. The purpose of this work is to provide a structured clinical framework for evaluation for medical mimics, identify groups considered to be at highest risk for medical mimics, and present common syndromic features suggestive of a medical mimic. Selected case scenarios are used to illustrate key concepts for evaluating and assessing a patient presenting with acute psychiatric symptomatology to improve judgment in ruling out potential medical causality.

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Myxedema madness complicating postoperative follow-up of thyroid cancer

Cited by 8 publications

References 21 publications

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis

Medical mimics: Differential diagnostic considerations for psychiatric symptoms

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