Bhattarai Himal Bikram, Kunwar Gehendra Jung, Rijal Ashes, Shah Sangam, Uprety Manish, Subedi Ayusha, Singh Prabesh Bikram, Khanal Santosh, Shah Bidhan Bikram, Rupakheti Ashim
Gandaki Medical College, Teaching Hospital and Research Center, Pokhara, Nepal.
Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal.
Ann Med Surg (Lond). 2022 Sep 7;82:104565. doi: 10.1016/j.amsu.2022.104565. eCollection 2022 Oct.
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.
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).
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.
Acute myxedema madness should be considered in the differential diagnosis of acute psychosis in patients with hypothyroidism.
甲状腺功能减退症在普通人群中很常见，会出现一系列医学、神经和精神症状。然而，甲状腺功能减退症很少导致急性精神病，即黏液水肿性精神病（MP），许多医生常常会漏诊。
我们在此报告一例36岁女性病例，该患者有一周异常行为、妄想和幻觉病史。检查发现促甲状腺激素（TSH）高达78.60 mIU/mL，游离甲状腺素（FT4）低至0.64 pmol/L。诊断为甲状腺功能减退症后，她接受了口服甲状腺激素替代治疗（左甲状腺素75μg/天）并加用抗精神病药物，症状在数天内得到缓解。她停用了抗精神病药物并出院，建议坚持甲状腺素替代治疗并定期复查甲状腺功能检查（TFT）。
黏液水肿性精神病是常见内分泌疾病甲状腺功能减退症的一种不常见表现形式。其表现的非典型性偶尔会使诊断复杂化。在诊断“首发精神病”时，始终进行全面的器质性筛查至关重要。
在甲状腺功能减退症患者急性精神病的鉴别诊断中应考虑急性黏液水肿性疯狂。
