1
|
Omri M, Ferhi M, Lentz N, Oliveira Galvao M, Hamm O. Myxedema Psychosis: Diagnostic Challenges and Management Strategies in Hypothyroidism-Induced Psychosis. Cureus 2024; 16:e57259. [PMID: 38686274 PMCID: PMC11056817 DOI: 10.7759/cureus.57259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
Myxedema psychosis (MP), a rare psychiatric manifestation of hypothyroidism, presents significant diagnostic and therapeutic challenges. This case report details the presentation, diagnosis, and successful management of a 60-year-old woman with MP, who was initially admitted to the psychiatric department for new-onset psychosis following the cessation of hormone replacement therapy after a subtotal thyroidectomy performed 20 years prior. Despite the rarity of psychosis as an initial presentation of hypothyroidism, this case underscores the critical importance of considering endocrine disorders in the differential diagnosis of unexplained psychotic symptoms. The clinical findings included a polymorphic delusional system and auditory hallucinations, without significant abnormalities on magnetic resonance imaging. Elevated thyroid-stimulating hormone (TSH) levels confirmed hypothyroidism, leading to the diagnosis of MP. Treatment with l-thyroxine resulted in complete resolution of symptoms in three weeks, highlighting the efficacy of hormone replacement therapy. This case contributes to the limited literature on MP and echoes the need for awareness among clinicians to ensure timely and accurate diagnosis and treatment.
Collapse
Affiliation(s)
- Moujib Omri
- Psychiatry and Psychotherapy Department, Klinikum Mutterhaus der Borromäerinnen, Trier, DEU
| | - Mohamed Ferhi
- Psychiatry Department, Ibn El Jazzar University Hospital, Kairouan, TUN
| | - Nina Lentz
- Psychiatry and Psychotherapy Department, Klinikum Mutterhaus der Borromäerinnen, Trier, DEU
| | | | - Oliver Hamm
- Psychiatry and Psychotherapy Department, Klinikum Mutterhaus der Borromäerinnen, Trier, DEU
| |
Collapse
|
2
|
Yilmaz D, Baykan O, Baykan H. The frequency of thyroid dysfunction in patients with a diagnosis of depressive disorder. Niger J Clin Pract 2023; 26:1575-1578. [PMID: 37929538 DOI: 10.4103/njcp.njcp_72_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Objective Thyroid dysfunctions are among the most common endocrine disorders in society. An increase or decrease in thyroid hormone levels may present with neurological and/or psychiatric symptoms. In this study, we aimed both to determine the prevalence of this disorder in our region by determining the frequency of thyroid dysfunction in patients diagnosed with major depressive disorder in our outpatient clinic and to raise awareness during the evaluation process of patients. Material and Method Thyroid-stimulating hormone (TSH) levels of 1035 patients diagnosed with major depressive disorder in our hospital between January 2020 and January 2022 were retrospectively scanned from the hospital information management system and those outside the reference ranges (0.38-5.33 mIU/L) were determined. Results It was observed that TSH was not within the reference ranges in approximately 7% of the patients diagnosed with depressive disorder. 1035 patients were included in the study. When the blood results of 1035 patients included in the study were examined retrospectively, 32 of them had TSH values below 0.38 mIU/L. TSH value was found to be above 5.33 mIU/L in 44 of them. Conclusion Obtained data have shown that thyroid dysfunctions can be encountered frequently in patients presenting with depressive complaints. It is thought that the evaluation of patients with depressive complaints in terms of thyroid dysfunction, and the treatment of the underlying thyroid dysfunction will contribute to the regression of psychiatric symptoms.
Collapse
Affiliation(s)
- D Yilmaz
- Mental Health and Diseases, Balikesir University, Faculty of Medicine, Balikesir, Turkey
| | - O Baykan
- Department of Medical Biochemistry, Balikesir University, Faculty of Medicine, Balikesir, Turkey
| | - H Baykan
- Mental Health and Diseases, Balikesir University, Faculty of Medicine, Balikesir, Turkey
| |
Collapse
|
3
|
Muacevic A, Adler JR, Shukla S, Kumar S. Neuropsychiatric Manifestations of Thyroid Diseases. Cureus 2023; 15:e33987. [PMID: 36811059 PMCID: PMC9938951 DOI: 10.7759/cureus.33987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Thyroid disorders are known to cause neuropsychiatric manifestations. Various neuropsychiatric manifestations are depression, dementia, mania, and autoimmune Hashimoto encephalopathy. Numerous investigations carried out in the previous 50-60 years have been evaluated critically. The pathophysiology of neuropsychiatric symptoms of thyroid diseases is described in the current study and its link with autoimmune Hashimoto encephalopathy is also discussed. Furthermore, this paper also describes the association between thyroid-stimulating hormones and cognitive impairment. Hypothyroidism is associated with depression and mania, and hyperthyroidism is linked with dementia and mania. The association between Graves' disease and various mental disorders such as depressive and anxiety disorders is also discussed. The aim of this study is to review the relationship between various neuropsychiatric disorders and thyroid diseases. A literature search from the PubMed database to find various neuropsychiatric manifestations of thyroid disorders in the adult population was conducted. According to the review of the studies, cognitive impairment can result from thyroid disease. It has not been possible to demonstrate how hyperthyroidism can hasten the process of developing dementia. However, subclinical hyperthyroidism, thyroid-stimulating hormone (TSH) levels below the normal range, and high free thyroxine (T4) levels all raise the risk of dementia in the elderly. Additionally, the potential mechanisms underlying this association have been examined. A quick summary of the research on mania as a clinical symptom of hypothyroidism and its likely causes and pathogenesis is also reviewed. There is no dearth of evidence that describes various neuropsychiatric manifestation in thyroid disorders.
Collapse
|
4
|
Sahu RK, Rana A. Hashimoto's encephalopathy presenting with psychotic symptoms. Ind Psychiatry J 2023; 32:193-194. [PMID: 37274593 PMCID: PMC10236672 DOI: 10.4103/ipj.ipj_242_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/22/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Raj K. Sahu
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, New Delhi, India
| | - Ajayveer Rana
- Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Dilshad Garden, New Delhi, India
| |
Collapse
|
5
|
Chan EC. Sustained remission of psychotic symptoms secondary to hypothyroidism (myxedema psychosis) after 6 months of treatment primarily with levothyroxine: a case report. J Med Case Rep 2022; 16:378. [PMID: 36261867 PMCID: PMC9581551 DOI: 10.1186/s13256-022-03626-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Psychotic symptoms associated with hypothyroidism, also known as “myxedema psychosis,” are a treatable cause of psychosis often associated with complete recovery. While most cases receive both thyroxine and a short course of antipsychotics, some reports indicate that symptoms can resolve without antipsychotic treatment, though follow-up in these cases has often been short or not reported. This is one of the first case reports demonstrating sustained remission of psychotic symptoms at 6 months in a case of myxedema psychosis treated with minimal antipsychotic medication. Case presentation We describe the case of a 40-year-old Caucasian woman who was brought to hospital with a 7-day history of anxiety and decreased sleep and 1 day of disorganized speech, paranoid delusions, and auditory hallucinations. After being admitted to psychiatry for management, screening blood work revealed elevated thyroid-stimulating hormone. The patient was initiated on treatment with levothyroxine and low doses of antipsychotics. Her symptoms resolved on the third day of her admission with ongoing symptomatic remission at 6 months follow-up. Conclusions The identification of myxedema psychosis is important owing to the implications on treatment and prognosis of the disorder. Our case suggests that sustained symptom resolution may occur with little to no antipsychotic treatment, though these findings are preliminary and additional study is needed before definitive conclusions on the optimal approach can be made.
Collapse
Affiliation(s)
- Eric C Chan
- Department of Psychiatry, University of Calgary, 1403 - 29th Street NW, Calgary, AB, T2N 2T9, Canada. .,Mathison Centre for Mental Health, Calgary, Canada.
| |
Collapse
|
6
|
Bhattarai HB, Kunwar GJ, Rijal A, Shah S, Uprety M, Subedi A, Singh PB, Khanal S, Shah BB, Rupakheti A. Acute psychosis unveiling diagnosis of hypothyroidism: A case report. Ann Med Surg (Lond) 2022; 82:104565. [PMID: 36268381 PMCID: PMC9577433 DOI: 10.1016/j.amsu.2022.104565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Hypothyroidism is a common condition in the general population that presents a wide array of medical, neurological and psychiatric symptoms. However, hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis (MP) and is often missed by many physicians. Case presentation Here we report a case of a 36-years-old female who presented with a one-week history of abnormal behavior, delusions and hallucinations. Investigations revealed a high thyroid-stimulating-hormone (TSH)of 78.60 mlU/mL and low free thyroxine (FT4) of 0.64 pmol/L. Diagnosed with hypothyroidism, she was treated with oral thyroid hormone replacement (l-thyroxine 75 μg/day) with antipsychotics and her symptoms settled within days. She was discharged off antipsychotics and advised to adhere to thyroxine replacement and to follow up for Thyroid function test (TFT). Discussion Myxedema psychosis is an uncommon manifestation of the common endocrine disease hypothyroidism. The atypical nature of presentations occasionally complicates diagnostics. When approaching a 'first-episode psychosis,’ it is essential to perform a complete organic screen consistently. Conclusion Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. Hypothyroidism rarely leads to acute psychosis, termed myxedema psychosis. Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism. When approaching a 'first-episode psychosis,’ it is essential to perform a complete organic screen consistently.
Collapse
|
7
|
Deficiency of Thyroid Hormone Reduces Voltage-Gated Na + Currents as Well as Expression of Na +/K +-ATPase in the Mouse Hippocampus. Int J Mol Sci 2022; 23:ijms23084133. [PMID: 35456949 PMCID: PMC9031557 DOI: 10.3390/ijms23084133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
Mice lacking functional thyroid follicular cells, Pax8−/− mice, die early postnatally, making them suitable models for extreme hypothyroidism. We have previously obtained evidence in postnatal rat neurons, that a down-regulation of Na+-current density could explain the reduced excitability of the nervous system in hypothyroidism. If such a mechanism underlies the development of coma and death in severe hypothyroidism, Pax8−/− mice should show deficits in the expression of Na+ currents and potentially also in the expression of Na+/K+-ATPases, which are necessary to maintain low intracellular Na+ levels. We thus compared Na+ current densities in postnatal mice using the patch-clamp technique in the whole-cell configuration as well as the expression of three alpha and two beta-subunits of the Na+/K+-ATPase in wild type versus Pax8−/− mice. Whereas the Na+ current density in hippocampal neurons from wild type mice was upregulated within the first postnatal week, the Na+ current density remained at a very low level in hippocampal neurons from Pax8−/− mice. Pax8−/− mice also showed significantly decreased protein expression levels of the catalytic α1 and α3 subunits of the Na+/K+-ATPase as well as decreased levels of the β2 isoform, with no changes in the α2 and β1 subunits.
Collapse
|
8
|
Kim JH, Lee HS, Kim YH, Kwon MJ, Kim JH, Min CY, Yoo DM, Choi HG. The Association Between Thyroid Diseases and Alzheimer's Disease in a National Health Screening Cohort in Korea. Front Endocrinol (Lausanne) 2022; 13:815063. [PMID: 35321339 PMCID: PMC8936176 DOI: 10.3389/fendo.2022.815063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Thyroid dysfunction is linked to an increased risk of cognitive impairment. However, studies on the relationships between thyroid diseases and Alzheimer's disease (AD) have reported conflicting results. We investigated the associations between several thyroid diseases and AD in a nested case-control study. Methods A total of 1,977 participants with AD were identified by claims data from 2002-2015 among a random sample of half a million people in the Korean National Health Insurance database. We recruited 16,473 age- and sex-matched (1:4 ratio) control participants and applied conditional logistic regression to estimate the relationships between thyroid diseases and AD, with adjustments for potential confounders, such as basic demographics, lifestyle factors, and various medical conditions or comorbidities. Results The prevalence rates of hypothyroidism (odds ratio [OR]=1.14, 95% confidence interval [CI]=1.00-1.30), thyroiditis (OR=1.22, 95% CI=1.05-1.40), and hyperthyroidism (OR=1.13, 95% CI=1.01-1.28) were significantly higher in participants with AD than in control participants after adjustment for confounders. Conclusion In this large national sample, we found significant relationships between several thyroid diseases and AD. Despite of the need for further investigation, these findings could better support to appreciate the pathophysiology of AD.
Collapse
Affiliation(s)
- Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, South Korea
| | - Heui Seung Lee
- Department of Neurosurgery, Hallym University College of Medicine, Anyang, South Korea
| | - Yoo Hwan Kim
- Department of Neurology, Hallym University College of Medicine, Anyang, South Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University College of Medicine, Anyang, South Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Chan Yang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, South Korea
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
| |
Collapse
|
9
|
Lipkes C, Haider S, Rashid A, Angarita GA, Riley S. First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto's Thyroiditis: A Case Report. Front Psychiatry 2022; 13:863898. [PMID: 35401262 PMCID: PMC8987109 DOI: 10.3389/fpsyt.2022.863898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
This case report describes a woman with no psychiatric history and previously diagnosed Hashimoto's thyroiditis who presented to the psychiatric emergency department with a first episode of psychosis. The initial workup for organic causes of psychosis revealed an astronomically high thyroid stimulating hormone (TSH) (> 1,000 μIU/mL) out of proportion to the patient's minimal physical symptoms of hypothyroidism. Additionally the patient's head imaging showed an enlarged pituitary, a rare, but reversible, presentation of chronically untreated primary hypothyroidism. The patient was transferred to a medical unit to receive IV thyroid hormone replacement as well as an adjunctive antipsychotic to assist with remission of her distressing auditory hallucinations and persecutory delusions. This case highlights the importance of a thorough medical workup for causes of new onset psychosis and the need for further consensus in the literature regarding choice of antipsychotic and duration of treatment for psychosis secondary to hypothyroidism.
Collapse
Affiliation(s)
- Celeste Lipkes
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Department of Mental Health, Charles George Veterans Affairs Medical Center, Asheville, NC, United States
| | - Shanzay Haider
- Department of Endocrinology, Yale University School of Medicine, New Haven, CT, United States
| | - Ali Rashid
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Gustavo A Angarita
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven CT, United States
| | - Sarah Riley
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
10
|
Pattaravimonporn N, Chaikijurajai T, Chamroonrat W, Sriphrapradang C. Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report. Case Rep Oncol 2021; 14:1596-1600. [PMID: 34950002 PMCID: PMC8647114 DOI: 10.1159/000520128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
Neuropsychiatric symptoms, especially acute psychosis (often referred to as myxedema madness or psychosis), are rare but possible clinical presentations of patients with hypothyroidism. A 42-year-old woman with papillary thyroid carcinoma and recent total thyroidectomy had developed flat affect, paranoid delusion, and visual and auditory hallucination during inpatient admission for elective radioactive iodine treatment. On admission, her history and physical exam did not reveal symptoms and signs of significant hypothyroidism. Other medical causes of acute psychosis were excluded, and the patient was immediately treated with thyroid hormone replacement therapy. Subsequently, her thyroid function normalized, and her psychotic symptoms gradually improved. Although there is a lack of classic signs and symptoms of hypothyroidism, myxedema madness should be recognized as one of the potentially treatable causes of acute psychosis.
Collapse
Affiliation(s)
- Nutnicha Pattaravimonporn
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thanat Chaikijurajai
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Internal Medicine Residency Program, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Wichana Chamroonrat
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Bennett B, Mansingh A, Fenton C, Katz J. Graves' disease presenting with hypomania and paranoia to the acute psychiatry service. BMJ Case Rep 2021; 14:e236089. [PMID: 33563685 PMCID: PMC7875261 DOI: 10.1136/bcr-2020-236089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 11/29/2022] Open
Abstract
This manuscript describes the case of a young woman, with no prior psychiatric history, who developed hypomania and paranoia as the principal presenting features of Graves' disease. After starting treatment with carbimazole and propranolol, symptoms resolved without the use of antipsychotic drugs. Close liaison between psychiatry and endocrinology services was essential. This demonstrates that treating underlying thyrotoxicosis in patients presenting with psychiatric symptoms may lead to recovery without the use of antipsychotic medication. While agitation, irritability and mood lability are well-recognised thyrotoxic symptoms, psychosis is a rare presenting feature of Graves' disease. All patients with agitation, delirium or psychiatric symptoms should have thyroid function checked as part of initial tests screening for organic disease. In new or relapsing psychiatric conditions, it is important to ask patients, their carers or relatives about symptoms of hypothyroidism or thyrotoxicosis.
Collapse
Affiliation(s)
- Benjamin Bennett
- Endocrinology Department, Royal Free London NHS Foundation Trust, Herts, UK
| | - Ajay Mansingh
- Springwell Centre, Barnet Enfield and Haringey Mental Health NHS Trust, Herts, UK
| | - Cormac Fenton
- Liaison Psychiatry, Royal Free London NHS Foundation Trust, Herts, UK
| | - Jonathan Katz
- Endocrinology Department, Royal Free London NHS Foundation Trust, Herts, UK
| |
Collapse
|
13
|
Yu CH, Ko YY, Kao YH, Lin CJ, Chang HY. Symptomatic hypothyroidism manifesting psychotic relapse in a patient with schizophrenia: A case report. TAIWANESE JOURNAL OF PSYCHIATRY 2021. [DOI: 10.4103/tpsy.tpsy_42_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Severe Hypothyroidism Manifested as Acute Mania With Psychotic Features: A Case Report and Review of the Literature. J Psychiatr Pract 2020; 26:417-422. [PMID: 32936589 DOI: 10.1097/pra.0000000000000497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypothyroidism is associated with a wide array of medical, neurological, and psychiatric symptoms. Severe hypothyroidism may present as myxedema coma, a medical emergency. In addition, patients may present with myxedema psychosis, a psychiatric emergency manifested as hyperactive encephalopathy, hallucinations, delusions, and suicidal ideation. In rare instances, patients may present with symptoms of mania with psychosis. We present the case of a 26-year-old woman with no known psychiatric history who presented with gradual onset of altered mental status, distractibility, decreased need for sleep, pressured speech, and religious and paranoid delusions. Her medical history was significant for a surgically absent thyroid gland and nonadherence to thyroid hormone. The patient was found to have a severely elevated level of thyroid-stimulating hormone, low level of triiodothyronine, and undetectable thyroxine. Thyroid ultrasound demonstrated a surgically absent thyroid gland. The patient's metabolic panel and random serum cortisol level were normal. Rapid plasma reagin was nonreactive, and toxin screening was negative. It was concluded that severe hypothyroidism was the cause of the patient's mania with psychotic features, given her thyroid hormone levels and lack of history of a psychiatric or substance use disorder. Thyroid hormone monitoring and treatment of hypothyroidism is necessary in all patients who have undergone surgical excision of the thyroid gland. All patients presenting with a first episode mania should be screened for thyroid dysfunction. The preferred treatment includes an atypical antipsychotic and thyroid replacement therapy. Rapid resolution of symptoms can occur with combined levothyroxine and liothyronine. Correction of hypothyroidism improves response to antipsychotics.
Collapse
|
15
|
Myxedema Psychosis: Neuropsychiatric Manifestations and Rhabdomyolysis Unmasking Hypothyroidism. Case Rep Psychiatry 2020; 2020:7801953. [PMID: 32655962 PMCID: PMC7327602 DOI: 10.1155/2020/7801953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background. Hypothyroidism is a prevalent endocrine disorder, often presenting with a spectrum of symptoms reflecting a hypothyroid state. It is also generally linked to causing mood swings, psychomotor slowing, and fatigue; however, in rare instances, it may lead to or induce acute psychosis, a condition referred to as myxedema psychosis (MP). We report a case of myxedema psychosis and present a literature review discussing its presentation, diagnosis, management, and prognosis. Case Presentation. A 36-year-old lady presented with one-week history of persecutory and paranoid delusions, along with visual and auditory hallucinations. She had no prior history of psychiatric illnesses. She underwent total thyroidectomy three years before the current presentation due to papillary thyroid cancer. She was not on regular follow-up, nor any specific therapy. On examination, she was agitated and violent. There were no signs of myxedema, and the physical exam was unremarkable. The initial workup showed a mild elevation in serum creatinine. Additional investigations revealed a high thyroid-stimulating hormone (TSH) of 56.6 mIU/L, low free T4 < 0.5 pmol/L, elevated creatine kinase of 3601 U/L, and urine dipstick positive for blood, suggestive of myoglobinuria. MRI of the head was unremarkable. We diagnosed her as a case of myxedema psychosis and mild rhabdomyolysis. She was started on oral thyroxine 100 mcg/day, fluoxetine 20 mg daily, and as-needed haloperidol. She was closely followed and later transferred to the Psychiatry Hospital for further management. Within one week, her symptoms improved completely, and she was discharged off antipsychotics with additional scheduled follow-ups to monitor TFTs and observe for any recurrence. Discussion and Conclusion. Myxedema psychosis is a rare presentation of hypothyroidism—a common endocrine disorder. Scarce data are describing this entity; hence, there is currently a lack of awareness amongst clinicians regarding proper identification and management. Moreover, the atypical nature of presentations occasionally adds to a diagnostic dilemma. Thus, any patient with new-onset psychosis should be screened for hypothyroidism, and awareness of this entity must be emphasized amongst clinicians and guideline makers.
Collapse
|
16
|
Mohamed MF, Siepmann T, Suwileh S, Mohammed MH, Mohamed S, Abdalla LO, Elzouki AN, Mahmoud MH, Al-Mohanadi D, Danjuma M. Myxedema psychosis: A protocol for a systematic review and a pooled analysis. Medicine (Baltimore) 2020; 99:e20778. [PMID: 32590756 PMCID: PMC7328932 DOI: 10.1097/md.0000000000020778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Myxedema psychosis (MP) is a rare presentation of hypothyroidism. Although known for >70 years, a significant lack of systematic literature describing this condition exists. This limits the clinician's ability to identify and manage this entity properly. Hence, we aimed to systematically review the literature and summarize the presentation, diagnosis, management, and outcomes of this rare entity. METHODS Systematic review following PRISMA guidance. We will perform a comprehensive search of PubMed, Medline, Embase, Google Scholar (first 300 hits), and Cochrane databases for published observational studies, case series, and case reports. We will use descriptive statistics to provide summary estimates of demographics, common presenting features, laboratory test results, imaging findings, treatment administered, and outcomes. Moreover, continuous variables will be compared by the Wilcoxon Mann Whitney test, whereas categorical variables will be assessed by the χ test. Bivariate and multivariate regression will be performed to assess risk factors associated with poor outcome. A scoping review revealed that a meta-analysis might not be feasible owing to the paucity of systematic studies describing the condition. RESULTS This is the first systematic review examining this rare entity. Thus, the result of which will be significant. We hope that this review will help in identifying relevant predictive clinical or laboratory characteristics. Additionally, it identifies the best treatment strategies. The findings of this review will help increase our knowledge of this condition so as to recognize this condition promptly. Also, it will assist in differentiating MP from masqueraders, such as Hashimoto encephalopathy (HE). The results of this review will be published in a peer-reviewed journal. CONCLUSION This is the first systematic review exploring MP demographics, diagnosis treatment, and outcomes. The information gathered by this review will be necessary for patients, clinicians, researchers, and guideline makers. PROSPERO REGISTRATION NUMBER CRD42020160310.
Collapse
Affiliation(s)
- Mouhand F.H. Mohamed
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
- Dresden International University Division of Health Care Sciences Center for Clinical Research and Management Education Dresden
| | - Timo Siepmann
- Dresden International University Division of Health Care Sciences Center for Clinical Research and Management Education Dresden
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Salah Suwileh
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Lina O. Abdalla
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University
| | | | - Dabia Al-Mohanadi
- Primary Health Care Centers
- Endocrine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Danjuma
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University
| |
Collapse
|
17
|
Clinical Response to Thyroidectomy in Three Cases of Refractory Hashimoto’s Encephalopathy—a Potential Therapy. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02476-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
18
|
Leal JC, Beito AH. Ramifications of untreated hypothyroidism: case report of cognitive impairment and acute psychosis in an elderly female. Ann Gen Psychiatry 2020; 19:48. [PMID: 32944055 PMCID: PMC7487797 DOI: 10.1186/s12991-020-00300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
Hypothyroidism is a common condition in the general population. While myxedema is a known complication, we present a case highlighting a late-onset presentation of psychosis with confounding cognitive impairment in a patient who believed she no longer needed thyroid replacement medication because of her advanced age.
Collapse
Affiliation(s)
- Janette C Leal
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Allison H Beito
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| |
Collapse
|
19
|
Mohamed MF, Mahgoub AB, Sardar S, Elzouki AN. Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism. BMJ Case Rep 2019; 12:12/10/e231579. [PMID: 31586959 DOI: 10.1136/bcr-2019-231579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.
Collapse
Affiliation(s)
| | - Ali B Mahgoub
- Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- General Internal Medicine, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar
| |
Collapse
|
20
|
Köhl S, Lutchmaya M, Ray P. Troubles psychiques révélant une hypothyroïdie profonde. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
21
|
Huang X, Zhang H, Qu C, Liu Y, Bian C, Xu Y. Depression and Insomnia Are Closely Associated with Thyroid Hormone Levels in Chronic Hepatitis B. Med Sci Monit 2019; 25:2672-2678. [PMID: 30973843 PMCID: PMC6475122 DOI: 10.12659/msm.914444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Depression and insomnia in chronic hepatitis B (CHB) patients affect the quality of life, disease diagnosis, and mortality. CHB patients are more likely to have psychological disorders, but the underlying mechanisms have not been elucidated. This study investigated the incidence of depression in patients with CHB and sought to identify risk factors for depression and insomnia in these patients, focusing on changes in liver function and thyroid hormone levels. Material/Methods This cross-sectional cohort study used the Hamilton Depression Scale and Athens Insomnia Scale to assess the depressive and insomnia states, respectively, of 209 CHB patients. Liver function, thyroid hormone levels, hepatitis B surface antigen, hepatitis B e-antigen, and hepatitis B virus-deoxyribonucleic acid load were evaluated. Liver cirrhosis was assessed by imaging (color Doppler ultrasound and computed tomography). A multivariate logistic regression model was used to analyze the correlation among various factors and depression and insomnia. Results Subclinical and clinical depressive states were found in 23.9% and 5.3% and subclinical and clinical insomnia in 11% and 35.4% of patients, respectively. Depression and insomnia severity were significantly correlated with low FT3 (<3.5 mol/L). The odds ratios of low FT3 for subclinical and clinical depression and clinical insomnia were 3.07 (95% confidence interval (CI), 1.248–7.568), 7.85 (95% CI, 1.839–33.547), and 3.91 (95% CI, 1.417–10.789), respectively. Conclusions CHB patients are prone to depression and insomnia. FT3 reduction may be a risk factor for depression and insomnia. In clinical settings, more attention needs to be paid to the mental state of patients with FT3 reduction.
Collapse
Affiliation(s)
- Xinyu Huang
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Huaying Zhang
- Department of Digestive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Chao Qu
- Hepatobiliary and Pancreatic Surgery Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Yu Liu
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Cheng Bian
- Department of Infectious Diseases, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Yonghong Xu
- Department of Digestive Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| |
Collapse
|
22
|
Abstract
BACKGROUND Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10-15% of people aged over 80 years are prescribed levothyroxine replacement therapy. MAIN BODY The prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group. CONCLUSIONS Current evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.
Collapse
Affiliation(s)
- Owain Leng
- Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Gateshead, NE9 6SX UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ UK
| |
Collapse
|
23
|
A Case of Violent Suicide Attempt in a Context of Myxedema Psychosis following Radioiodine Treatment in a Patient with Graves' Disease. Case Rep Psychiatry 2019; 2019:4972760. [PMID: 30729057 PMCID: PMC6343151 DOI: 10.1155/2019/4972760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/30/2018] [Accepted: 12/14/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported. However, less attention has been paid to suicidal behavior in these patients. Case Report We report a case of suicide attempt by self-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves' disease. On clinical examination remarkable signs of myxedema were found and blood investigations showed hypothyroidism with an extremely high thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptoms at the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapid physical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse after early discontinuation of the antipsychotic treatment. Discussion The most distinctive feature of our case is that the violent suicide attempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors, psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically consider ordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violent suicide attempts) are present and may result in premature transfer to psychiatric units.
Collapse
|
24
|
Churilov LP, Sobolevskaya PA, Stroev YI, Utekhin VJ, Gvozdetsky AN, Mikhailova LR, Shoenfeld Y, Gilburd B, Blank M. ON THE PATHOGENESIS OF PSYCHIC DISORDERS IN HASHIMOTO'S THYROIDITIS. PATHOPHYSIOLOGY 2018. [DOI: 10.1016/j.pathophys.2018.07.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
25
|
Medvei VC, Cattell WR. Mental Symptoms Presenting in Phaeochromocytoma: A Case Report and Review. J R Soc Med 2018; 81:550-1. [PMID: 3054110 PMCID: PMC1291775 DOI: 10.1177/014107688808100923] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- V C Medvei
- Department of Nephrology, St Bartholomew's Hospital, London
| | | |
Collapse
|
26
|
Duval F, Mokrani MC, Erb A, Gonzalez Opera F, Calleja C, Paris V. Relationship between chronobiological thyrotropin and prolactin responses to protirelin (TRH) and suicidal behavior in depressed patients. Psychoneuroendocrinology 2017; 85:100-109. [PMID: 28843902 DOI: 10.1016/j.psyneuen.2017.07.488] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND So far, investigations of the relationships between suicidality and the activity of the thyrotropic and lactotropic axes are scarce and have yielded conflicting results. METHODS We studied the thyrotropin (TSH) and prolactin (PRL) responses to 0800h and 2300h protirelin (TRH) stimulation tests, carried out on the same day, in 122 euthyroid DSM-5 major depressed inpatients with suicidal behavior disorder (SBD) (either current [n=71], or in early remission [n=51]); and 50 healthy hospitalized controls. RESULTS Baseline TSH and PRL measurements did not differ across the 3 groups. In SBDs in early remission, the TSH and PRL responses to TRH tests (expressed as the maximum increment above baseline value after TRH [Δ]) were indistinguishable from controls. Current SBDs showed (1) lower 2300h-ΔTSH and lower ΔΔTSH values (differences between 2300h-ΔTSH and 0800h-ΔTSH) than controls and SBDs in early remission; and (2) lower baseline free thyroxine (FT4B) levels than controls. In the current SBD group, ΔΔPRL values (differences between 2300h-ΔPRL and 0800h-ΔPRL) were correlated negatively with lethality. Moreover, in current SBDs (1) violent suicide attempters (n=15) showed lower FT4B levels, lower TSH-TRH responses (both at 0800h and 2300h), and lower ΔΔTSH and ΔΔPRL values than controls, while (2) non-violent suicide attempters (n=56) showed lower ΔΔTSH values than controls and higher TSH-TRH responses (both at 0800h and 2300h) than violent suicide attempters. CONCLUSIONS Our results suggest that central TRH secretion is not altered in depressed patients with SBD in early remission. The findings that current SBDs exhibit both decreased FT4B levels and decreased evening TSH responses (and consequently, decreased ΔΔTSH values) support the hypothesis that hypothalamic TRH drive is reduced-leading to an impaired TSH resynthesis in the pituitary during the day after the morning TRH challenge. In violent suicide attempters, the marked abnormalities of TRH test responses might indicate a greatest reduction in hypothalamic TRH drive. These results further strengthen the possibility that a deficit in central TRH function may play a key role in the pathogenesis of suicidal behavior.
Collapse
Affiliation(s)
- Fabrice Duval
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France.
| | | | - Alexis Erb
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
| | | | - Cécile Calleja
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
| | - Véronique Paris
- Pôle 8/9 Psychiatry, APF2R, Centre Hospitalier, Rouffach, France
| |
Collapse
|
27
|
Shlykov MA, Rath S, Badger A, Winder GS. 'Myxoedema madness' with Capgras syndrome and catatonic features responsive to combination olanzapine and levothyroxine. BMJ Case Rep 2016; 2016:bcr-2016-215957. [PMID: 27613262 DOI: 10.1136/bcr-2016-215957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of an elderly woman with hypothyroidism and no psychiatric history who presented with new onset of psychosis, paranoia, catatonic features and Capgras syndrome (CS). This case illustrates the spectrum of neuropsychiatric symptoms that may accompany hypothyroidism and the importance of considering thyroid dysfunction as a primary contributor to severe psychiatric symptoms, especially in previously stable patients. We demonstrate the effectiveness of combination levothyroxine and olanzapine, with its favourable cardiac profile, in the treatment of myxoedema madness. Antipsychotics can be weaned once psychiatric symptoms resolve and hormone levels are stabilised.
Collapse
Affiliation(s)
| | - Swapnil Rath
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Alison Badger
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
28
|
Wells CEC. Symposium on Neurological Abnormalities Found in Association with Various Forms of Macrocytic Anæmia. Proc R Soc Med 2016. [DOI: 10.1177/003591576505800933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
29
|
Das M, Kayal AK, Goswami M, Basumatary LJ, Bhowmick S, Synmon B. Spectrum of Hashimoto's encephalopathy – An experience from the North East India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Ueno S, Tsuboi S, Fujimaki M, Eguchi H, Machida Y, Hattori N, Miwa H. Acute psychosis as an initial manifestation of hypothyroidism: a case report. J Med Case Rep 2015; 9:264. [PMID: 26577152 PMCID: PMC4650306 DOI: 10.1186/s13256-015-0744-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022] Open
Abstract
Introduction Hypothyroidism is one of the most important causes of treatable dementia, and psychosis occasionally associated with it is known as myxedema madness. We report a case of a 90-year-old patient who developed myxedema madness acutely without overt clinical symptoms and signs suggestive of hypothyroidism. Case presentation A 90-year-old Japanese man, a general practitioner, was admitted to our emergency room because of acute-onset lethargy, delusions, and hallucinations. He had been actively working until 3 days before the admission. Upon admission, his general physical examination was unremarkable. However, a blood investigation showed the presence of hypothyroidism, and computed tomography revealed pleural effusion and ascites. Electroencephalography revealed diffuse slow waves with a decrease of α-wave activity. A single-photon emission computed tomography scan revealed a decrease of cerebral blood flow in both frontal lobes. The patient was soon treated with thyroid hormone replacement therapy. Following normalization of his thyroid function, both pleural effusion and ascites diminished and his electroencephalographic activity improved simultaneously; however, he did not recover from his psychosis. Conclusions Myxedema madness should be kept in mind in the differential diagnosis of acute psychosis in elderly patients, particularly the oldest patients as in our case, because manifestations of hypothyroidism often may be indistinguishable from the aging process.
Collapse
Affiliation(s)
- Shinichi Ueno
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Satoko Tsuboi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Motoki Fujimaki
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Hiroto Eguchi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Yutaka Machida
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Hideto Miwa
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima, Tokyo, 177-8521, Japan.
| |
Collapse
|
31
|
Larouche V, Snell L, Morris DV. Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism. Endocrinol Diabetes Metab Case Rep 2015; 2015:150087. [PMID: 26525086 PMCID: PMC4626654 DOI: 10.1530/edm-15-0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/02/2015] [Indexed: 11/26/2022] Open
Abstract
Myxoedema 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.
Collapse
Affiliation(s)
- V Larouche
- Resident, Internal Medicine Residency Training Program, Department of Medicine, McGill University , Montreal, Quebec , Canada
| | - L Snell
- Division of General Internal Medicine, McGill University Health Centre , Montreal, Quebec, H4A 3J1 , Canada
| | - D V Morris
- Division of Endocrinology, McGill University Health Centre , Montreal, Quebec, H4A 3J1 , Canada
| |
Collapse
|
32
|
Abstract
Hypothyroidism is commonly associated with a variety of psychiatric conditions, most commonly depression and cognitive impairment, but up to 5% to 15% of symptomatically hypothyroid patients may develop a nonaffective psychosis, classically referred to as "myxedema madness." We report the case of a woman who developed Capgras syndrome in the context of hypothyroidism, and whose psychosis rapidly resolved with levothyroxine supplementation. To date, very few cases of Capgras syndrome related to hypothyroidism have been reported. The pathophysiology of this condition remains unclear but it may be related to global cerebral hypometabolism or possibly to increased cerebral dopamine. Given the robust response of "myxedema madness" to thyroid replacement, psychiatrists should remain vigilant for covert hypothyroidism in patients with psychosis and atypical histories or presentations.
Collapse
|
33
|
Launer J. In celebration of medical essayists. Postgrad Med J 2015; 91:608. [PMID: 26404788 DOI: 10.1136/postgradmedj-2015-133717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
34
|
Morosán Allo YJ, Rosmarin M, Urrutia A, Faingold MC, Musso C, Brenta G. Myxedema madness complicating postoperative follow-up of thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:359-63. [PMID: 26331326 DOI: 10.1590/2359-3997000000090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/23/2014] [Indexed: 11/21/2022]
Abstract
Although 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.
Collapse
Affiliation(s)
| | | | | | | | - Carla Musso
- Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR
| | | |
Collapse
|
35
|
Ritchie M, Yeap BB. Thyroid hormone: Influences on mood and cognition in adults. Maturitas 2015; 81:266-75. [DOI: 10.1016/j.maturitas.2015.03.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
|
36
|
Hazen EP, Sherry NA, Parangi S, Rabito CA, Sadow PM. Case records of the Massachusetts General Hospital. Case 10-2015. A 15-year-old girl with Graves’ disease and psychotic symptoms. N Engl J Med 2015; 372:1250-8. [PMID: 25806918 DOI: 10.1056/nejmcpc1314239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
37
|
Shera IA, Vyas A, Bhat MS, Yousuf Q. Unusual case of Hashimoto's encephalopathy and pseudo-obstruction in a patient with undiagnosed hypothyroidism: a case report. J Med Case Rep 2014; 8:296. [PMID: 25194644 PMCID: PMC4168993 DOI: 10.1186/1752-1947-8-296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 07/12/2014] [Indexed: 11/13/2022] Open
Abstract
Introduction Hashimoto’s encephalopathy is a relatively rare condition associated with an elevated concentration of circulating serum anti-thyroid antibodies, and is usually responsive to steroid therapy. However, hypothyroidism is a rare cause of pseudo-obstruction so here we present a case report of Hashimoto’s encephalopathy with gut pseudo-obstruction in an undiagnosed hypothyroid patient. Case presentation A diagnosis of unknown aetiology of encephalopathy with gut dysmotility in an undiagnosed profound hypothyroidism case associated with cognitive decline and behavioural disorder was made in a 60-year-old Indian man. The associated clinical and laboratory features led to the final diagnosis of overt hypothyroidism with Hashimoto’s encephalopathy with gut pseudo-obstruction. Conclusions Hashimoto’s encephalopathy is a rare disorder presenting with acute or sub acute encephalopathy of unknown aetiology so there are considerable chances of misdiagnosing it. The unusualness of this case is that since hypothyroidism is a rare cause of intestinal pseudo-obstruction, and presented concomitant with Hashimoto’s encephalopathy, that itself is a rare entity. Intestinal pseudo-obstruction is a potentially serious complication that must be recognized and treated promptly with adequate thyroid hormone therapy.
Collapse
Affiliation(s)
- Irfan A Shera
- Department of General Medicine Rama Medical College Hospital & Research Centre, Ghaziabad 245304, UP, India.
| | | | | | | |
Collapse
|
38
|
Carter Y, Sippel RS, Chen H. Hypothyroidism after a cancer diagnosis: etiology, diagnosis, complications, and management. Oncologist 2014; 19:34-43. [PMID: 24309982 PMCID: PMC3903058 DOI: 10.1634/theoncologist.2013-0237] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/12/2013] [Indexed: 01/18/2023] Open
Abstract
Hypothyroidism is a common disease that is easily treated in the majority of cases, when readily diagnosed; however, presentation of an aggregate of its symptoms is often clinically overlooked or attributed to another disease and can potentially be lethal. Already prevalent in older women, its occurrence in younger patients is rising as a result of radiation therapy, radioactive iodine therapy, and newer antineoplastic agents used to manage various malignancies. The presence of nonspecific constitutional symptoms and neuropsychiatric complaints in cancer patients can be attributed to a myriad of other diagnoses and therapies. Thyroid dysfunction can be easily overlooked in cancer patients because of the complexity of cancer's clinical picture, particularly in the pediatric population. Underdiagnosis can have important consequences for the management of both hypothyroidism and the malignancy. At minimum, quality of life is adversely affected. Untreated hypothyroidism can lead to heart failure, psychosis, and coma and can reduce the effectiveness of potentially life-saving cancer therapies, whereas iatrogenic causes can provoke atrial fibrillation and osteoporosis. Consequently, the diagnosis and treatment of hypothyroidism in cancer patients are pertinent. We summarize the history, epidemiology, pathophysiology, clinical diagnosis, and management of hypothyroidism in cancer patients.
Collapse
Affiliation(s)
- Yvette Carter
- Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | | |
Collapse
|
39
|
Abstract
Thyroid disorders are common in the general population and in hospitalized patients. Thyroid disease may present first with neurological complications or else may occur concurrently in patients suffering other neurological disorders, particularly those with an autoimmune etiology. For this reason neurologists will commonly encounter patients with thyroid disease. This chapter provides an overview of the neurological complications and associations of disorders of the thyroid gland. Particular emphasis is placed on conditions such as thyrotoxic periodic paralysis and myxedema coma in which the underlying thyroid disorder may be occult leading to a first, often emergency, presentation to a neurologist. Information about clinical features, diagnosis, pathogenesis, therapy, and prognosis is provided. Emphasis is placed on those aspects most likely to be relevant to the practicing neurologist and the interested reader is directed to references to good, recent review articles for further information.
Collapse
Affiliation(s)
- Clare A Wood-Allum
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield and Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK.
| |
Collapse
|
40
|
Abstract
Myxedema madness is a very rare but established entity. A psychotic patient having hypothyroid features should always be evaluated regarding same. A 30-year-old female without known significant past medical history had, for the past one and half year, continuous persecutory and referential delusions; second and third person auditory hallucinations, facial puffiness and Brief Psychiatric Rating Scale (BPRS) score of 41 on admission. Her thyroid profile was: Thyroid stimulating hormone - 63.71 mIU/L, Free tri iodo threonine (FT3) - 2.1 pg/ml, free tetra iodo thyronine (FT4) - 0.6 ng/ml with normal ultrasound-thyroid. Patient was started on thyroxin 100 μg with a low dose risperidone 2 mg. Risperidone was withdrawn over a week and the patient was discharged on thyroxin alone with BPRS score of 8 and absence of delusions and hallucinations.
Collapse
Affiliation(s)
- Nimesh Parikh
- Department of psychiatry, V S Hospital, Ahmedabad, Gujarat, India
| | - Prateek Sharma
- Department of psychiatry, V S Hospital, Ahmedabad, Gujarat, India
| | - Chirag Parmar
- Department of psychiatry, V S Hospital, Ahmedabad, Gujarat, India
| |
Collapse
|
41
|
Feldman AZ, Shrestha RT, Hennessey JV. Neuropsychiatric manifestations of thyroid disease. Endocrinol Metab Clin North Am 2013; 42:453-76. [PMID: 24011880 DOI: 10.1016/j.ecl.2013.05.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The interface between thyroid hormone action and neuropsychiatric function is intricate, and several mechanisms of thyroid hormone uptake into brain tissues, hormone activation, and influences on neurotransmitter generation have been identified. Symptoms of hypothyroidism are nonspecific, whereas those attributed to thyrotoxicosis may be more characteristic. Neuropsychiatric manifestations triggered by thyroid dysfunction likely respond well to reestablishment of the euthyroid state, although some patients have persistent complaints. The addition of LT3 to ongoing LT4 replacement has yet to be definitively shown to be advantageous. Treatment of euthyroid depression with LT3 in addition to antidepressant therapy lacks convincing evidence of superior outcomes.
Collapse
Affiliation(s)
- Anna Z Feldman
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Gryzmish 6, Boston, MA 02215, USA
| | | | | |
Collapse
|
42
|
Hyams C, Joshi P, Foster P, Katz J. Acute psychosis caused by hypothyroidism following radioactive iodine treatment of Graves' disease. JRSM SHORT REPORTS 2013; 4:26. [PMID: 23560226 PMCID: PMC3616310 DOI: 10.1177/2042533313476858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Catherine Hyams
- Department of Endocrinology, Barnet Hospital, Barnet & Chase Farm NHS Trust, Wellhouse Lane , Herts EN5 3DJ , UK
| | | | | | | |
Collapse
|
43
|
Association between bipolar affective disorder and thyroid dysfunction. Asian J Psychiatr 2013; 6:42-5. [PMID: 23380316 DOI: 10.1016/j.ajp.2012.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 07/05/2012] [Accepted: 08/06/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bipolar affective disorder may be associated with alterations in thyroid function. A comprehensive thyroid assessment is important for assessing clinical and sub-clinical imbalances linked to a variety of mood disorders like bipolar affective disorder. AIM To find out the association between bipolar affective disorder and thyroid dysfunction. MATERIALS AND METHOD The present cross-sectional study was conducted at Government District Wenlock Hospital, Mangalore (GDWH), India. A total of 50 newly diagnosed bipolar affective disorder patients and 50 age and sex matched controls without bipolar affective disorder as confirmed by the application of Bipolar Spectrum Diagnostic Scale were included in the study. Thyroid function was assessed among the patients and control group to study the association between bipolar affective disorder and thyroid dysfunction. Odds ratio was calculated to find out the strength of association between thyroid gland dysfunction and bipolar affective disorder. RESULTS The mean Bipolar Spectrum Diagnostic Scale score among patients diagnosed with bipolar affective disorder was 20.84 and that of the control group was 1.98. The proportion of thyroid dysfunction among bipolar affective disorder patients and among control group was 14% and 6% respectively. The odds ratio was calculated to be 2.55. Mean T3 values were higher in the bipolar affective disorder patients than the control group and this association was found to be statistically significant (p=0.031). Mean T4 and TSH values were higher among the bipolar affective disorder patients but did not show any significant differences when compared with the control group. CONCLUSION The present study concludes that a statistically significant association exists between elevated T3 hormone and bipolar affective disorder and observes that the patients with bipolar affective disorder are 2.55 times more commonly associated with thyroid dysfunction.
Collapse
|
44
|
Olry R, Haines DE. Historical and Literary Roots of Münchhausen Syndromes. PROGRESS IN BRAIN RESEARCH 2013; 206:123-41. [PMID: 24290479 DOI: 10.1016/b978-0-444-63364-4.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Régis Olry
- Département d'Anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | | |
Collapse
|
45
|
Neal JM, Yuhico RJO. "Myxedema madness" associated with newly diagnosed hypothyroidism and obstructive sleep apnea. J Clin Sleep Med 2012; 8:717-8. [PMID: 23243407 DOI: 10.5664/jcsm.2274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This is the case report of a 32-year-old obese male with a history of agitation, hallucinations, and delirium, recently diagnosed with primary hypothyroidism; he gave a several month history of fatigue with nocturnal snoring and frequent awakening. Polysomnogram revealed severe OSA; initiation of CPAP and levothyroxine resulted in immediate improvement. The lack of a previous psychiatric history and acuteness of presentation was consistent with hypothyroid psychosis complicated by sleep deprivation cause by untreated OSA. Primary hypothyroidism is a common disorder often associated with depression. It is rarely associated with psychosis and was first described as "myxoedematous madness" in 1949. It has not been previously reported to cause psychosis when associated with obstructive sleep apnea. This case illustrates the need for examination of potential multiple organic causes in a patient who presents with psychosis in the critical care setting.
Collapse
Affiliation(s)
- J Matthew Neal
- Department of Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN 47303, USA.
| | | |
Collapse
|
46
|
Revisiting thyroid hormones in schizophrenia. J Thyroid Res 2012; 2012:569147. [PMID: 22545225 PMCID: PMC3321576 DOI: 10.1155/2012/569147] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 02/07/2023] Open
Abstract
Thyroid hormones are crucial during development and in the adult brain. Of interest, fluctuations in the levels of thyroid hormones at various times during development and throughout life can impact on psychiatric disease manifestation and response to treatment. Here we review research on thyroid function assessment in schizophrenia, relating interrelations between the pituitary-thyroid axis and major neurosignaling systems involved in schizophrenia's pathophysiology. These include the serotonergic, dopaminergic, glutamatergic, and GABAergic networks, as well as myelination and inflammatory processes. The available evidence supports that thyroid hormones deregulation is a common feature in schizophrenia and that the implications of thyroid hormones homeostasis in the fine-tuning of crucial brain networks warrants further research.
Collapse
|
47
|
Payer J, Petrovic T, Lisy L, Langer P. Hashimoto encephalopathy: a rare intricate syndrome. Int J Endocrinol Metab 2012; 10:506-14. [PMID: 23843812 PMCID: PMC3693614 DOI: 10.5812/ijem.4174] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/06/2012] [Accepted: 02/29/2012] [Indexed: 01/18/2023] Open
Abstract
Recently, several patients have been reported with various signs of encephalopathy and high thyroid antibody levels together with good responsiveness to glucocorticoid therapy. Despite the various clinical presentations, these cases have been termed "Hashimoto encephalopathy" (HE). Although all of the pathogenic components have not yet been clearly elucidated, it is believed that brain vasculitis and autoimmunity directed against common brain-thyroid antigens represent the most likely etiologic pathway. The most common clinical signs include unexplained or epilepsy-like seizures resistant to anti-convulsive treatment, confusion, headaches, hallucinations, stroke-like episodes, coma, impairment of cognitive function, behavioral and mood disturbance, focal neurological deficits, disturbance of consciousness, ataxia, and presenile dementia, together with the presence of high thyroid antibody levels, especially against thyroperoxidase (TPOab). In most cases, the thyroid function is normal or decreased; the thyroid function is rarely increased. The examination of the cerebrospinal fluid, EEG, MRI, SPECT, and neuropsychological examinations are primarily used as diagnostic tools. Most cases showed neural symptoms for months before the acute onset; in some cases, a dramatic acute onset was described. Once the diagnosis is made, corticosteroid treatment usually provides a dramatic recovery. The authors also present a short review of literary cases reported in last decade.
Collapse
Affiliation(s)
- Juraj Payer
- Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Faculty Hospital Ruzinov, Bratislava, Slovakia
- Corresponding author: Juraj Payer, Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Faculty Hospital Ruzinov, Bratislava, Slovakia. Tel.: +421-248234108, Fax: +421-248234110, E-mail:
| | - Tomas Petrovic
- Clinic of Internal Medicine, Faculty of Medicine, Comenius University, Faculty Hospital Ruzinov, Bratislava, Slovakia
| | - Lubomir Lisy
- Clinic of Neurology, Slovak Medical University, Bratislava, Slovakia
| | - Pavel Langer
- Institute of Experimental Endocrinology, Slovak Acadeamy of Sciences, Bratislava, Slovakia
| |
Collapse
|
48
|
Abstract
This guest editorial seeks to address the promise and the reality of biomarkers in geriatric psychiatry by tying together the three articles on biomarkers of depression included in this issue of the Journal. They represent different streams of biological research, which have developed over the last 40 years. We will try to put each area of research into context.
Collapse
|
49
|
Oppo A, Franceschi E, Atzeni F, Taberlet A, Mariotti S. Effects of hyperthyroidism, hypothyroidism, and thyroid autoimmunity on female sexual function. J Endocrinol Invest 2011; 34:449-53. [PMID: 21532331 DOI: 10.1007/bf03346712] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Thyroid hormones affect male and female sexual functions, but data in hypo- and hyperthyroid women are scanty. AIM To investigate sexual function in hypo- and hyperthyroid women before and immediately after restoration of euthyroidism and in women with euthyroid Hashimoto's thyroiditis (HT). PATIENTS AND CONTROLS Fifty-six women with thyroid diseases (age 19-50 yr; 22 with hyperthyroidism, 17 with hypothyroidism, and 17 with euthyroid HT) and 30 age-matched healthy women. MAIN OUTCOME MEASURES Hypoactive sexual desire, disorders of sexual arousal, vaginal lubrication, orgasm, satisfaction, and sexual pain (SPD) were assessed by Female Sexual Function Index. Serum TSH, free T4 (FT4) and thyroid autoantibodies (anti-thyroglobulin, anti-thyroperoxidase, and TSH-receptor antibodies) were assessed at the diagnosis; FT4 and TSH were repeated after treatment to confirm normalization of thyroid function. RESULTS All sexual domains scores were significantly reduced (p ranging <0.0001-<0.05) in both hypo- and hyperthyroid women. Correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged. In hyperthyroid women therapy normalized sexual desire, arousal/lubrication, satisfaction, and pain, while orgasm remained significantly impaired. Interestingly, euthyroid HT women displayed a significant decrease in sexual desire (p<0.0005), with no changes in the other sexual domains. CONCLUSIONS Both hypo- and hyperthyroidism markedly impair female sexual function. A rapid improvement is observed with the restoration of euthyroidism, although a longer period of time may be needed for full normalization. Preliminary data suggest that thyroid autoimmunity may selectively impair sexual desire, independently from thyroid function.
Collapse
Affiliation(s)
- A Oppo
- Department of Medical Sciences M. Aresu, University of Cagliari and Endocrinology Unit, A.O.U. Cagliari, Cagliari, Italy
| | | | | | | | | |
Collapse
|
50
|
Dali-Gottfried O, Luder AS. Psychiatric presentation of thyroid disease in adolescence. Int J Adolesc Med Health 2011; 12:323-330. [PMID: 22912302 DOI: 10.1515/ijamh.2000.12.4.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|