Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Mohamed, Mouhand; Mahgoub, Ali B; Sardar, Sundus; Elzouki, Abdel‐Naser

doi:10.1136/bcr-2019-231579

Cited by 11 publications

(17 citation statements)

References 29 publications

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Section: Discussionmentioning

confidence: 99%

“… 14 In addition, in the case of hypothyroidism, the conversion rate of thyroxine to t3 increased significantly. 13 2. Hypothyroidism is associated with increased activity of brain neurotransmitters dopamine and adrenal catecholamines.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothyroidism is associated with increased activity of brain neurotransmitters dopamine and adrenal catecholamines. 13 3. Autoimmune thyroid disease (AITD) is the main cause of hypothyroidism, and the production of autoantibodies against the normal components of the thyroid axis is the main cause of mental disorders.…”

Section: Discussionmentioning

confidence: 99%

“…12 Mohamed et al reported a case of hypothyroidism complicated with acute psychosis and concurrent rhabdomyolysis gradually returned to normal mental symptoms after treatment with thyroxine and olanzapine. 13 The mechanism of neuropsychiatric symptoms caused by hypothyroidism in humans is still unclear, and the current possible mechanisms are as follows: 1. Animal experiments have confirmed that triiodothyronine (T3) receptors are mainly concentrated in the amygdala and hippocampus, which plays a key role in the integration of emotions and behaviors.…”

Section: Dovepressmentioning

confidence: 99%

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Hypothyroidism and Complicated Sick Sinus Syndrome and Acute Severe Psychiatric Disorder: A Case Report

Huang

Lei

et al. 2021

IMCRJ

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Background: Thyroxine is closely related to cardiovascular diseases, such as coronary heart disease, ventricular arrhythmia, atrioventricular block, myocardial systolic weakness, pericardial effusion, low cardiac output and hypertension. Previous studies have also found that hypothyroidism can also lead to mental disorders. Here, we present a rare case of severe hypothyroidism patient accompanied by sick sinus syndrome (SSS) as a cardiovascular manifestation needing cardiac pacing and severe mental disorders. Case Presentation: A 42-year-old female patient, previously healthy, was referred to our hospital because of bradycardia complicated with sick sinus syndrome which requiring cardiac pacing and severe mental disorders. Her clinical features along with laboratory findings strongly suggested that the patient had severe hypothyroidism with sick sinus syndrome and mental disorders, both of which were reversible and successfully treated with levothyroxine. Conclusion: This is the first reported case of hypothyroidism with sick sinus syndrome requiring pacemakers and psychiatric disorders, and the symptoms can be improved and reversed after thyroxine supplementation. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or sick sinus syndrome, especially if combined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Dovepressmentioning

confidence: 99%

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Hypothyroidism and Complicated Sick Sinus Syndrome and Acute Severe Psychiatric Disorder: A Case Report

Huang

Lei

et al. 2021

IMCRJ

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“…After excluding plausible causes that may explain her presentation, we diagnosed the patient as a case of acute psychosis related to hypothyroidism (myxedema psychosis). Given the likely diagnosis and our previous experience with a similar case [5], we initiated oral therapy with thyroid hormone replacement (L-thyroxine 100 μg/day). Our colleagues from psychiatry suggested adding fluoxetine 20 mg daily and haloperidol only as needed for agitation.…”

Section: Case Presentationmentioning

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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Acute psychosis unveiling diagnosis of hypothyroidism: A case report

Bhattarai

Kunwar

Rijal

et al. 2022

Annals of Medicine &Amp; Surgery

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Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Cited by 11 publications

References 29 publications

Hypothyroidism and Complicated Sick Sinus Syndrome and Acute Severe Psychiatric Disorder: A Case Report

Hypothyroidism and Complicated Sick Sinus Syndrome and Acute Severe Psychiatric Disorder: A Case Report

Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism

Acute psychosis unveiling diagnosis of hypothyroidism: A case report

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