Case Report  |   January 2017
Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis
Author Notes
  • From the Department of Internal Medicine at Coney Island Hospital in Brooklyn, New York. 
  •  *Address correspondence to Matthew M. Mavroson, DO, Department of Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, NY 11235-7795. E-mail: mmavroson@gmail.com
     
Article Information
Endocrinology / Psychiatry
Case Report   |   January 2017
Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 50-54. doi:10.7556/jaoa.2017.007
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 50-54. doi:10.7556/jaoa.2017.007
Abstract

Myxedema psychosis is uncommon in patients with primary hypothyroidism. Most often, this disease state can be found in patients with Hashimoto thyroiditis or after total thyroidectomy. Chronic hypothyroidism can lead to an insidious onset of psychiatric symptoms in patients, such as dementia, delirium, psychosis, hallucinations, and coma. A 31-year-old man with an unremarkable medical history was brought to the psychiatric emergency department for new-onset aggression, paranoid behavior, and hallucinations for 4 days. Initial test results showed a thyroid-stimulating hormone level of 306.0 mIU/L and a free thyroxin level of 0.24 ng/dL. No other clinical or laboratory abnormalities were found. A diagnosis of myxedema psychosis was established, and the patient was treated with tapering doses of intravenous hydrocortisone and 0.1 mg of intravenous levothyroxine daily. On hospital day 3, his mental status began to improve, and he was discharged on day 4. Myxedema psychosis is rarely the initial presenting symptom of hypothyroidism, especially in the absence of other abnormal clinical or laboratory findings.

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