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Mohamed MFH, Danjuma M, Mohammed M, Mohamed S, Siepmann M, Barlinn K, Suwileh S, Abdalla L, Al-Mohanadi D, Silva Godínez JC, Elzouki AN, Siepmann T. Myxedema Psychosis: Systematic Review and Pooled Analysis. Neuropsychiatr Dis Treat 2021; 17:2713-2728. [PMID: 34447249 PMCID: PMC8382967 DOI: 10.2147/ndt.s318651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The term myxedema psychosis (MP) was introduced to describe the occurrence of psychotic symptoms in patients with untreated hypothyroidism, but the optimal assessment and treatment of this condition are unclear. We aimed to synthesize data from the literature to characterize the clinical presentation and management of MP. METHODS We performed a systematic review according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines in PubMed (Medline), Embase, Google Scholar, and Cochrane databases, including observational studies, case series, and case reports published from 1/1/1980 to 31/12/2019 in the English language. Descriptive statistics along with univariate and multivariate analysis were used for data synthesis. RESULTS Out of 1583 articles screened, 71 case reports met our inclusion criteria providing data on 75 MP cases. The median age at diagnosis was 42 years [32-56]. About 53% had no prior hypothyroidism diagnosis. Delusions occurred in 91%, with a predominance of persecutory ideas (84%), while hallucinations occurred in 78%. Physical symptoms and signs of hypothyroidism were absent in 37% and 26%, respectively. If symptoms occurred, nonspecific fatigue was seen most frequently (63%). The median thyroid-stimulating hormone value was 93 mIU/L [60-139]. Thyroid peroxidase antibodies were found positive in 75% (23/33) of reported cases. Creatinine kinase was reported abnormal in seven cases. Cranial imaging (CT or MRI) and electroencephalogram were normal in 89%, 75%, and 73% of the cases reported. The majority of patients were treated orally with thyroxine in combination with short-term antipsychotics. More than 90% of them showed complete recovery. Univariate analysis revealed a trend towards a shorter duration of psychosis with IV thyroid hormone therapy (p= 0.0502), but the effect was not consistent in a multivariate analysis. CONCLUSION While we identified a substantial lack of published research on MP, our pooled analysis of case observations suggests that the condition presents a broad spectrum of psychiatric and physical symptoms lending support to the value of screening for thyroid dysfunction in patients with first-ever psychosis. PROSPERO REGISTRATION NUMBER CRD42020160310.
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Affiliation(s)
- Mouhand F H Mohamed
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Mohammed Danjuma
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | | | - Samreen Mohamed
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Martin Siepmann
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Salah Suwileh
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Lina Abdalla
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Juan Carlos Silva Godínez
- Department of Surgery, National Medical Center Siglo XXI, Mexican Social Security Institute, Mexico City, Mexico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Abdel-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Timo Siepmann
- Department of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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