Psychosis in a 15 Year Old Hypothyroid Girl: Myxoedematous Madness?

Chalk, John N.

doi:10.3109/00048679109064450

Cited by 10 publications

(4 citation statements)

References 2 publications

(1 reference statement)

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“…It has been shown that patients with subclinical hypothyroidism may also present disorders of thought, suggesting that psychosis in some cases is not related to advanced disease (18). Although reports on several cases of myxedema madness have illustrated that psychosis is usually preceded by months or years of clinical symptoms of hypothyroidism (1,7,(19)(20)(21)(22)(23)(24)(25), there have been few cases reported in the literature (26,27) where psychiatric manifestations occurred in the setting of acute overt hypothyroidism (Table 2). Similarly, our patient also presented symptoms of mania in the context of a hypothyroid state of recent onset.…”

Section: Discussionmentioning

confidence: 99%

Myxedema madness complicating postoperative follow-up of thyroid cancer

Allo

Rosmarin

Urrutia

et al. 2015

Arch. Endocrinol. Metab.

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SUMMARYAlthough hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen ® ) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine withdrawal for the follow-up of thyroid cancer.

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Section: Discussionmentioning

confidence: 99%

Myxedema madness complicating postoperative follow-up of thyroid cancer

Allo

Rosmarin

Urrutia

et al. 2015

Arch. Endocrinol. Metab.

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“…The syndrome of psychosis resulting from hypothyroidism, recognized in adults since 1888 ("myxedema madness," Asher 1949), is now also documented in children (Smith and Beattie 1998) and adolescents (Chalk 1991;Bhatara et al 1993;Dali-Gottfried and Luder 2000). The psychosis in hypothyroidism is nonspecific, reflecting a final common pathway (Whybrow and Bauer 2000).…”

Section: Introductionmentioning

confidence: 94%

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

Bhatara¹,

Alshari²,

Warhol³

et al. 2004

Journal of Child and Adolescent Psychopharmacology

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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.

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“…As early as 1888, the Committee on Myxoedema of the Clinical Society of London published 109 cases of recorded mental changes in myxoedema. Asher in 1949 stated that myxoedema is a frequently missed cause of psychosis [1].…”

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confidence: 99%

“…In our literature search we found two case reports on children with unusual presentation of hypothyroidism. Chalk described the case of a 15-year-old girl who presented with a sudden onset of psychotic illness thought to be related to marked hypothyroidism [2]. She responded well to thyroid replacement.…”

mentioning

confidence: 99%