Myxedema madness complicating postoperative follow-up of thyroid cancer

Archives of Endocrinology and Metabolism
Yanina J Morosán AlloGabriela Brenta

Abstract

Although hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen®) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine ...Continue Reading

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Citations

Oct 7, 2019·BMJ Case Reports·Mouhand Fh MohamedAbdel-Naser Elzouki
Jul 14, 2020·Case Reports in Psychiatry·Sundus SardarMouhand F H Mohamed
Nov 3, 2016·The Mental Health Clinician·Jerry McKee, Nancy Brahm
Jan 6, 2017·The Journal of the American Osteopathic Association·Matthew M MavrosonEleonora Akker
Aug 23, 2021·General Hospital Psychiatry·Jana KrügerMaria C Jockers-Scherübl

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