Lipkes Celeste, Haider Shanzay, Rashid Ali, Angarita Gustavo A, Riley Sarah
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.
Front Psychiatry. 2022 Mar 24;13:863898. doi: 10.3389/fpsyt.2022.863898. eCollection 2022.
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.
本病例报告描述了一名无精神病史且先前被诊断为桥本甲状腺炎的女性，她因首次出现精神病症状而前往精神科急诊科就诊。对精神病的器质性病因进行的初步检查发现，促甲状腺激素（TSH）水平极高（>1000μIU/mL），与患者轻微的甲状腺功能减退身体症状不成比例。此外，患者的头部影像学检查显示垂体增大，这是长期未治疗的原发性甲状腺功能减退症罕见但可逆的表现。患者被转至内科病房接受静脉注射甲状腺激素替代治疗以及辅助性抗精神病药物治疗，以帮助缓解其令人痛苦的幻听和被害妄想。本病例强调了对新发精神病病因进行全面医学检查的重要性，以及在文献中就抗精神病药物的选择和甲状腺功能减退继发精神病的治疗持续时间达成进一步共识的必要性。
