Hashimoto’s thyroiditis presenting solely with psychotic symptoms: A case report
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This case report highlights the infrequent occurrences of myxedema psychosis and pituitary hyperplasia as secondary complications of Hashimoto’s thyroiditis. The subject of interest is a 16-year-old female patient who displayed persistent symptoms of delusions, auditory hallucinations, and depression without any discernible cause. The physical examination did not reveal any notable abnormalities. Despite a continuous 4-week treatment regimen involving antipsychotic and antidepressant medications, the patient experienced a deterioration of psychotic symptoms, which resulted in substantial impairment in social functioning. Cranial magnetic resonance imaging scan detected an enlarged pituitary gland and laboratory tests indicated abnormal thyroid function and the presence of specific thyroiditis autoantibodies. Combined with these results, thyroid ultrasound findings revealed features that were consistent with Hashimoto’s thyroiditis. Consequently, the patient was prescribed levothyroxine sodium replacement therapy, as well as low-dose antipsychotic and antidepressant medications, which led to a gradual amelioration of their psychotic symptoms. Following 6 months of treatment, the patient was ordered to stop taking the antipsychotic and antidepressant drugs but continue with levothyroxine sodium replacement therapy exclusively. The results of the 1-year follow-up demonstrated the restoration of thyroid function to normal levels, the normalization of pituitary size and structure, and the absence of any psychotic symptoms. These findings provide evidence for a diagnosis of myxedema psychosis and secondary pituitary hyperplasia caused by hypothyroidism associated with Hashimoto’s thyroiditis. This emphasizes the significance of supplementary tests in the diagnostic procedures carried out by psychiatrists.
- Selvaraj V, Padala PR. Thyroid myopathy with rhabdomyolysis presenting as agitation: A case report. Prim Care Companion J Clin Psychiatry. 2008;10(4):328. doi: 10.4088/pcc.v10n0411a
- Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry. 2003;5(6):260-266. doi: 10.4088/pcc.v05n0603
- Morosán Allo YJ, Rosmarin M, Urrutia A, Faingold MC, Musso C, Brenta G. Myxedema madness complicating postoperative follow-up of thyroid cancer. Arch Endocrinol Metab. 2015;59(4):359-363. doi: 10.1590/2359-3997000000090
- Parikh N, Sharma P, Parmar C. A case report on myxedema madness: Curable psychosis. Indian J Psychol Med. 2014;36:80-81. doi: 10.4103/0253-7176.127260
- Martinez Quintero B, Yazbeck C. Pituitary hyperplasia secondary to primary hypothyroidism. Clin Case Rep. 2020;8:1317-1318. doi: 10.1002/ccr3.2863
- Correia I, Marques IB, Ferreira R, Sousa L. Encephalopathy associated with autoimmune thyroid disease: A potentially reversible condition. Case Rep Med. 2016;2016:9183979. doi: 10.1155/2016/9183979
- Asher R. Myxoedematous madness. Br Med J. 1949;2:555-562. doi: 10.1136/bmj.2.4627.555
- Pak K, Kim M, Kim K, Kim BH, Kim, SJ, Kim IJ. Cerebral glucose metabolism and Cerebral blood flow in thyroid dysfunction: An activation likelihood estimation meta-analysis. Sci Rep. 2020;10:1335. doi: 10.1038/s41598-020-58255-5
- Samuels MH. Psychiatric and cognitive manifestations of hypothyroidism. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):377-383. doi: 10.1097/MED.0000000000000089
- Mohamed MF, Danjuma M, Mohammed M, et al. Myxedema psychosis: Systematic review and pooled analysis. Neuropsychiatr Dis Treat. 2021;17:2713-2728. doi: 10.2147/NDT.S318651
- Cao J, Lei T, Chen F, Zhang C, Ma C, Huang H. Primary hypothyroidism in a child leads to pituitary hyperplasia: A case report and literature review. Medicine. 2018;97(42):e12703. doi: 10.1097/MD.0000000000012703
- Hu YY, Li GM, Hu WW, Wang Y. Characteristics of girls with pituitary hyperplasia and sexual precocity secondary to primary hypothyroidism. Acta Paediatr. 1992;103:e43-e48. doi: 10.1111/apa.12444
- Krüger J, Kraschewski A, Jockers-Scherübl MC. Myxedema madness-systematic literature review of published case reports. Gen Hosp Psychiatry. 2021;72:102-116. doi: 10.1016/j.genhosppsych.2021.08.005
- Lehrmann JA, Jain S. Myxedema psychosis with grade II hypothyroidism. Gen Hosp Psychiatry. 2002;24(4):275-277. doi: 10.1016/s0163-8343(02)00190-1
- Azzopardi L, Murfin C, Sharda A, De Silva N. Myxoedema madness. BMJ Case Rep. 2010;2010:bcr0320102841. doi: 10.1136/bcr.03.2010.2841
- Ueno S, Tsuboi S, Fujimaki M, et al. Acute psychosis as an initial manifestation of hypothyroidism: A case report. J Med Case Rep. 2015;9:264. doi: 10.1186/s13256-015-0744-z
- Patel RS, Heer AS, Lesko A, Kim SW, Ishaq M. Risperidone and levothyroxine for managing “Myxedema Madness”. Cureus. 2020;12(8):e10152. doi: 10.7759/cureus.10152
- Ashley WW Jr., Ojemann JG, Park TS, Wippold FJ 2nd. Primary hypothyroidism in a 12-year-old girl with a suprasellar pituitary mass: Rapid regression after thyroid replacement therapy: Case report. J Neurosurg. 2005;102(4 Suppl):413-416. doi: 10.3171/ped.2005.102.4.0413