Patel Rikinkumar S, Heer Arpit S, Lesko Aquila, Kim Sung W, Ishaq Muhammad
Psychiatry, Griffin Memorial Hospital, Norman, USA.
Psychiatry and Behavioral Sciences, Jawaharlal Nehru Medical College, Belgaum, IND.
Cureus. 2020 Aug 31;12(8):e10152. doi: 10.7759/cureus.10152.
Hypothyroidism is one of the common comorbidities seen in patients with psychiatric conditions. Sometimes few patients may present with neuropsychiatric symptoms such as cognitive slowing, depression, or psychosis ("myxedema madness"). These patients are managed with antipsychotic medications while admitting laboratory works are processed. It has been found that antipsychotic use is associated with lower free thyroxine levels, so untreated hypothyroid patients may experience worsening of symptoms with antipsychotic use. It is recommended that hypothyroid patients with psychosis be treated for the underlying hypothyroidism with thyroid hormone replacement. In this article, we are presenting a case of a hypothyroid patient presenting to a psychiatric facility for worsening psychosis and persecutory delusions, and medication non-compliance to levothyroxine. We also discuss the management of psychosis in a patient with worsening hypothyroidism with a combination regimen: levothyroxine and risperidone.
甲状腺功能减退症是精神疾病患者中常见的合并症之一。有时，少数患者可能会出现认知迟缓、抑郁或精神病（“黏液性水肿狂”）等神经精神症状。在进行实验室检查时，这些患者使用抗精神病药物进行治疗。研究发现，使用抗精神病药物与游离甲状腺素水平降低有关，因此未经治疗的甲状腺功能减退患者使用抗精神病药物可能会使症状恶化。建议患有精神病的甲状腺功能减退患者采用甲状腺激素替代疗法治疗潜在的甲状腺功能减退症。在本文中，我们介绍了一例甲状腺功能减退患者因精神病恶化、被害妄想以及不依从左甲状腺素治疗而就诊于精神科机构的病例。我们还讨论了采用左甲状腺素和利培酮联合治疗方案对甲状腺功能减退症恶化患者的精神病管理。
