OJPsych  Vol.3 No.3 , July 2013
Iatrogenic hypothyroidism and acute psychosis
Abstract: We present the case of a 39 years old woman who was referred to our day hospital unit because of anxiety. The patient didn’t endorse any past psychiatric symptoms except for an acute psychotic episode in August 2010. In June 2010 she was diagnosed with hypothyroidism (likely due to Hashimoto’s thyroiditis) and was started on Methilmazole 30 mg. Shortly after that she reported persecutory ideation and hallucinations which quickly progressed, until she was hospitalized in a psychiatric facility. Upon admittance her lab work revealed severe hypothyroidism. Methilmazole was suspended, she was started on Haloperidol, and the symptoms went into remission after four days. Despite the fact that she self discontinued Haloperidol shortly after discharge, she showed no sign of psychotic symptoms. While it is widely accepted that hypothyroidism can cause depressive symptoms, to the best of our knowledge very few cases of psychotic symptoms associated with this condition have been described. Based on the patient’s clinical history, on the rapid onset and remission of symptoms, on the lab values and on the doses of medication that were prescribed, we hypothesize that our patient’s psychotic episode was caused by iatrogenic hypothyroidism.
Cite this paper: Islam, L. , Masu, A. , Scarone, S. and Gambini, O. (2013) Iatrogenic hypothyroidism and acute psychosis. Open Journal of Psychiatry, 3, 290-292. doi: 10.4236/ojpsych.2013.33028.

[1]   Benvenga, S. Lapa, D. and Trimarchi, F. (2003) Don’t forget the thyroid in the etiology of psychoses. The American Journal of Medicine, 1, 159-160.

[2]   Roberts, C.G.P. and Ladenson, P.W. (2004) Hypothyroidism. Lancet, 363, 797-803. doi:10.1016/ S0140-6736(04)15696-1

[3]   Heinrich, T.W. and Grahm, G. (2003) Hypothyroidism presenting as Psyhcosis: Myxedema madness revisited. Journal of Clinical Psychiatry, 5, 260-266.

[4]   Hall, R.C. (1983) Psychiatric effects of thyroid hormone disturbance. Psychosomatics, 24, 7-18. doi:10.1016/S0033-3182(83)73255-X

[5]   Azzopardi, L., Murfin, C., Sharda, A. and De Silva, N. (2010) Myxedema madness. British Medical Journal Case Reports.

[6]   Brewer, C. (1969) Psyhcosis due to acute hypothyroidism during the administration of charbimazole. The British Journal of Psychiatry, 115, 1181-1183. doi:10.1192/bjp.115.527.1181

[7]   Herridge, C.F. and Abey-Wickrama, I. (1969) Acute iatrogenic hypothyroid psychosis. British Medical Journal, 3, 154. doi:10.1136/bmj.3.5663.154

[8]   Lehrmann, J.A. and Jain, S. (2002) Myxedema psychosis with grade II hypothyroidism. General Hospital Psychiatry, 24, 275-277. doi:10.1016/S0163-8343(02)00190-1

[9]   Logothetis, J. (1963) Psychotic behaviour as the indicator of adult myxoedema. The Journal of Nervous and Mental Disease, 136, 561-568.

[10]   Madakasira, S. and Hall, T.B. (1981) Capgras syndrome in a patient with myxedema. American Journal of Psychiatry, 138, 1506-1508. doi:10.1097/00005053-196306000-00008