Acute psychotic episode in a patient with thyrotoxicosis factitia

Silva, Joaquim Alves da; Almeida, Jaime; Corrêa, Bernardo; Narigão, Miguel; Xavier, Miguel

doi:10.1136/bcr.08.2008.0676

Cited by 4 publications

(2 citation statements)

References 14 publications

(19 reference statements)

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“…Two cases of acute psychotic episodes in patients with thyrotoxicosis factitia and subacute thyroiditis have been reported [8,9]. In both cases, psychotic features occurred abruptly and resolved with resolution of the thyrotoxic state.…”

Section: Discussionmentioning

confidence: 99%

Subacute thyroiditis presenting as acute psychosis: a case report and literature review

Lee

Park

et al. 2013

Korean J Intern Med

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We describe herein an unusual case of subacute thyroiditis presenting as acute psychosis. An 18-year-old male presented at the emergency department due to abnormal behavior, psychomotor agitation, sexual hyperactivity, and a paranoid mental state. Laboratory findings included an erythrocyte sedimentation rate of 36 mm/hr (normal range, 0 to 9), free T4 of 100.0 pmol/L (normal range, 11.5 to 22.7), and thyroid stimulating hormone of 0.018 mU/L (normal range, 0.35 to 5.5). A technetium-99m pertechnetate scan revealed homogeneously reduced activity in the thyroid gland. These results were compatible with subacute thyroiditis, and symptomatic conservative management was initiated. The patient's behavioral abnormalities and painful neck swelling gradually resolved and his thyroid function steadily recovered. Although a primary psychotic disorder should be strongly considered in the differential diagnosis, patients with an abrupt and unusual onset of psychotic symptoms should be screened for thyroid abnormalities. Furthermore, transient thyroiditis should be considered a possible underlying etiology, along with primary hyperthyroidism.

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Section: Discussionmentioning

confidence: 99%

Subacute thyroiditis presenting as acute psychosis: a case report and literature review

Lee

Park

et al. 2013

Korean J Intern Med

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“…Given her psychotic state and known anxiety while thyrotoxic, a replacement strategy of a lower initial l -T 4 dose with gradual uptitration was chosen. The rationale for that decision was that several case reports have described the precipitation of psychosis or mania by l -T 4 replacement in hypothyroid patients (3, 4). Moreover, she received risperidone for several days as an inpatient.…”

Section: Treatmentmentioning

confidence: 99%

Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

Larouche

Snell

Morris

2015

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryMyxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism.Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease.Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging.Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically.The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers.Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

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