Page 87 - JCBP-2-3

Journal of Clinical and
Basic Psychosomatics Hashimoto’s thyroiditis presenting psychotic symptoms

by elevated PRL levels. However, these specific clinical Acknowledgments
signs were not observed in this patient’s case, increasing
the possibility of misdiagnosis. Misidentifying PHPH as We would like to express our sincere gratitude to the
a pituitary tumor followed by surgical intervention can Department of Psychosomatic and Psychiatry, Zhongda
have significant adverse consequences including lifelong Hospital, School of Medicine, Southeast University for
hormone replacement therapy requirement and substantial their assistance in treating the patient. We are also thankful
deterioration in the patient’s quality of life. Therefore, to the patient for agreeing to participate in this case study.
it is crucial to conduct a comprehensive assessment Funding
that incorporates clinical presentation evaluation
alongside neuroendocrine and imaging examinations None.
while monitoring the patient’s response to treatment for
achieving an accurate differential diagnosis. Conflict of interest
In a systematic review of 52 patients with myxedema The authors declare that they have no conflicts of interest.
psychosis, it was found that brain imaging was conducted Author contributions
13
for a mere 16 individuals, uncovering pathological
findings in only five instances. This review also identified Conceptualization: Xiaoxi Liu, Yonggui Yuan
several neurological conditions in the patient population, Investigation: Xiaoxi Liu, Wenhao Jiang, Yingying Yue
14
including white matter lesions (3.85%), cerebral atrophy Writing – original draft: Xiaoxi Liu
16
15,
(1.9%), and a combination of both conditions (3.85%). Writing – review & editing: Xiaoxi Liu, Wenhao Jiang,
At present, there is a scarcity of case reports documenting Yonggui Yuan
the co-occurrence of myxedema psychosis and PHPH. In
addition, it should be noted that the initiation of thyroxine Ethics approval and consent to participate
replacement therapy in the 1 week may worsen psychotic Verbal consent was obtained from the patient. This study
st
symptoms, thus underlining the potential use of short- was approved by the Research Ethics Review Board
term adjunctive antipsychotic medication. Furthermore, (Approval ID: LCH-LW-2023013) of the Linyi Central
the majority of myxedema psychosis patients (more Hospital.
than 90%) experienced complete resolution of psychotic
symptoms through oral thyroxine replacement therapy Consent for publication
and temporary use of antipsychotics during the follow-up
period. 13,17 Similarly, it has been observed that PHPH Verbal consent was obtained from the patient for publishing
typically reverts to its normal state within a span of one to her data in this paper.
months after initiating thyroxine replacement therapy. In Availability of data
18
our case study, the patient exhibited a positive prognosis
after receiving a combination therapy comprising low-dose The data used in this work are presented in the text and
lurasidone, sertraline, and sodium thyroxine replacement original data can be obtained from the corresponding
therapy for a short duration. author following a formal request.
4. Conclusion References

The co-occurrence of myxedema psychosis and PHPH 1. Selvaraj V, Padala PR. Thyroid myopathy with
is a rare clinical phenomenon. In the context of thyroid rhabdomyolysis presenting as agitation: A case report. Prim
disorders presenting with diverse symptoms, there is a Care Companion J Clin Psychiatry. 2008;10(4):328.
high chance of misdiagnosis and inadequate treatment doi: 10.4088/pcc.v10n0411a
if the diagnostic process is solely symptomatology-based 2. Heinrich TW, Grahm G. Hypothyroidism presenting
without involving additional testing. The majority of as psychosis: Myxedema madness revisited. Prim Care
patients diagnosed with myxedema psychosis or PHPH Companion J Clin Psychiatry. 2003;5(6):260-266.
exhibit a favorable prognosis after receiving thyroxine doi: 10.4088/pcc.v05n0603
replacement therapy. Therefore, it is imperative to
consistently prioritize organic etiology as the principal 3. Morosán Allo YJ, Rosmarin M, Urrutia A, Faingold MC,
differential diagnosis when assessing psychotic symptoms Musso C, Brenta G. Myxedema madness complicating
to prevent adverse outcomes. Precise diagnosis and postoperative follow-up of thyroid cancer. Arch Endocrinol
treatment are pivotal for effective management, as Metab. 2015;59(4):359-363.
emphasized in this case report. doi: 10.1590/2359-3997000000090

Volume 2 Issue 3 (2024) 5 doi: 10.36922/jcbp.2317