Acute Psychosis Consequent to Total Thyroidectomy: An Etiological Conundrum

Abstract

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.

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

“…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 .…”