Coexistent Hypothyroidism, Psychosis, and Severe Obsessions in an Adolescent: A 10-Year Follow-up

Abstract

This chronology suggests that the optimal treatment in this patient probably required three components: a Selective Serotonin Reuptake Inhibitor, (SSRI) risperidone, and LT4 (300 g daily). Each component was apparently necessary but not sufficient individually for the optimal response. The relapse after the discontinuation of fluvoxamine and risperidone (but not LT4) suggests the presence of a primary psychiatric disorder (OCD with depression). The failure to improve without an adequate dosage of LT4 suggests that hypothyroidism was probably an aggravating factor. This case illustrates the diagnostic difficulty in distinguishing between obsessions, depressive ruminations, and delusions in children and the need to consider hypothyroidism in the differential diagnosis of the sudden worsening of OCD, or in cases of new-onset psychosis in children and adolescents.

Hypothyroidism presenting as child psychosis. A rare finding.

“…Another report was by Chung 2 2010 who reported an unusual case of myxoedema madness in a 12 year old. A report by Bhatara 3 1994 presented a 13 year old with possible psychosis due to hypothyroidism whose symptoms improved with levothyroxine ,however a 10 year follow up by Bhatara 4 demonstrated that the child had a primary psychiatric disorder(OCD with depression) because he relapsed after discontinuation of SSRI and risperidone despite adequate doses of levothyroxine. Hypothyroidism was considered to be an aggravating factor.…”

Severe Hypothyroidism Presenting with Acute Mania and Psychosis: A Case Report and Literature Review

“…In 1949, Asher reported 14 cases of psychosis with hypothyroidism, 9 of which recovered with thyroid hormone treatment alone [2]. Numerous cases have since linked psychosis to hypothyroidism [2,[6][7][8][9][10][11][12].The majority of these cases were managed with a combination of antipsychotic medication and thyroid replacement, however in some cases maintenance therapy included thyroid replacement alone. There was no correlation between the degree of hypothyroidism and the severity of psychiatric symptoms [2].…”

A Case of Acute Psychosis in an Adolescent Male

“…It has been described in patients with Cushing's syndrome [9], hyperthyroidism [10], and hypothyroidism in pediatric and adult patients [11]. It has not been associated with PHPT in the pediatric age group.…”