Page 83 - JCBP-2-3

Journal of Clinical and

Basic Psychosomatics

CASE REPORT
Hashimoto’s thyroiditis presenting solely with

psychotic symptoms: A case report

Xiaoxi Liu 1 , Wenhao Jiang 2 , Yingying Yue 2 , and Yonggui Yuan *
2
1 Department of Mental Health, Linyi Central Hospital, Linyi, Shandong, China
2 Department of Psychosomatic and Psychiatry, Zhongda Hospital, School of Medicine, Southeast
University, Nanjing, Jiangsu, China

Abstract

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
*Corresponding author:
Yonggui Yuan symptoms. Following 6 months of treatment, the patient was ordered to stop taking
(yygylh2000@sina.com) the antipsychotic and antidepressant drugs but continue with levothyroxine sodium
Citation: Liu X, Jiang W, Yue Y, replacement therapy exclusively. The results of the 1-year follow-up demonstrated
Yuan Y. Hashimoto’s thyroiditis the restoration of thyroid function to normal levels, the normalization of pituitary
presenting solely with psychotic size and structure, and the absence of any psychotic symptoms. These findings
symptoms: A case report. J Clin
Basic Psychosom. 2024;2(3):2317. provide evidence for a diagnosis of myxedema psychosis and secondary pituitary
doi: 10.36922/jcbp.2317 hyperplasia caused by hypothyroidism associated with Hashimoto’s thyroiditis. This
Received: November 27, 2023 emphasizes the significance of supplementary tests in the diagnostic procedures
carried out by psychiatrists.
Accepted: March 4, 2024
Published Online: June 19, 2024
Keywords: Hashimoto’s thyroiditis; Myxedema psychosis; Secondary pituitary
Copyright: © 2024 Author(s). hyperplasia; Hypothyroidism; Psychotic symptoms
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. Hashimoto’s thyroiditis is an autoimmune disease characterized by a gradual onset and
Publisher’s Note: AccScience slow progression, leading to hypothyroidism. While the mental health implications of
Publishing remains neutral with hypothyroidism, such as depression and cognitive impairments, are well documented,
regard to jurisdictional claims in
published maps and institutional the presence of positive symptoms is rarely reported. Myxedema psychosis (MP), a
affiliations. rare complication of Hashimoto’s thyroiditis associated with hypothyroidism, can

Volume 2 Issue 3 (2024) 1 doi: 10.36922/jcbp.2317