Indian Journal of PsychiatryIndian Journal of Psychiatry
Home | About us | Current Issue | Archives | Ahead of Print | Submission | Instructions | Subscribe | Advertise | Contact | Login 
    Users online: 2087 Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Tables

 Article Access Statistics
    Viewed1917    
    Printed6    
    Emailed0    
    PDF Downloaded76    
    Comments [Add]    

Recommend this journal

 


 
 Table of Contents    
LETTERS TO EDITOR  
Year : 2021  |  Volume : 63  |  Issue : 3  |  Page : 302-304
Psychosis as acute presentation in Hashimoto's thyroiditis


1 Department of Psychiatry, Himalayan Institute of Medical Science, Dehradun, Uttarakhand, India
2 Department of Medicine, Division of Endocrinology, Himalayan Institute of Medical Science, Dehradun, Uttarakhand, India

Click here for correspondence address and email

Date of Submission23-Mar-2020
Date of Decision04-May-2020
Date of Acceptance27-Feb-2021
Date of Web Publication17-Jun-2021
 

How to cite this article:
Gondwal R, Avinash PR, Pal A, Modi S. Psychosis as acute presentation in Hashimoto's thyroiditis. Indian J Psychiatry 2021;63:302-4

How to cite this URL:
Gondwal R, Avinash PR, Pal A, Modi S. Psychosis as acute presentation in Hashimoto's thyroiditis. Indian J Psychiatry [serial online] 2021 [cited 2021 Sep 25];63:302-4. Available from: https://www.indianjpsychiatry.org/text.asp?2021/63/3/302/318713




Sir,

Hashimoto's thyroiditis (HT) is an auto-immune mediated disorder that results in destruction of the thyroid tissues by cell-mediated and antibody-mediated immune processes.[1] Neuropsychiatric symptoms are commonly associated with HT.[2] However, psychotic symptoms in relation to HT have been rarely reported.[3] We introduce this case of a patient presenting with acute onset psychotic symptoms, without any previous history of psychiatric disease or thyroid dysfunction.

A 45-year-old female was brought to the emergency room with an illness of subacute onset and gradual progression, characterized by suspiciousness, hearing voices not heard by others for 6 months and decreased sleep for 1 month. The symptoms initially had started after an argument involving her elder son and his wife, when she started suspecting that her son was planning to harm his wife and her. Within a few days, she also reported of 3rd person auditory hallucination conveying her about the ill-motives of her son. Over the next few months, the suspicion grew stronger in conviction and the patient withdrew herself from interacting with other family members and her duration of sleep decreased. There was no past history of any medical or psychiatric illness. On examination, she presented with a perplexed affect, psychomotor retardation, third-person auditory hallucination and delusion of persecution.

Blood investigations were mostly normal except the thyroid profile was suggestive of overt primary hypothyroidism. She had low serum T3 (0.40 ng/dl), low T4 (16.62 ng/dl), and raised thyroid stimulating hormone (247.70 μIU/ml). On further evaluation, she was found to have elevated titers of anti-thyroid peroxidase antibody (292 IU/mL; normal <50 IU/mL) and anti-thyroglobulin antibody (866.32 IU/ml; normal <100 IU/ml). She was started on Thyroxine 100 μg and 75 μg on alternate days, along with Risperidone 2 mg. Her psychotic symptoms started improving drastically within 2 days. Owing to the remarkable clinical response, the final diagnosis of the patient was ascertained as “Psychotic disorder due to HT.” Risperidone was stopped after a week of initiation, and thyroxine was continued. The patient followed up after 1 week and 1 month without any symptoms of psychosis.

Psychotic symptoms in relation to HT are relatively less common. HT usually presents with well-known symptoms of hypothyroidism such as weakness, tiredness, lethargy, peri-orbital edema, cold intolerance, and constipation. HT primarily presenting with a psychotic symptom is rare [Table 1].[4],[5],[6] This case report thus goes on to re-iterate the well taught point of looking for other treatable medical comorbidities in patients presenting with apparently primary psychiatric conditions. Another important issue that should be discussed here is the proximity of this entity to the previously well-known condition of “Myxedema Psychosis.”[7] It is also a relatively rare entity, but mostly seen in patients with HT or in patients who had undergone total thyroidectomy. The important distinguishing feature is that Myxedema Psychosis usually is suspected in patients with long-standing thyroid dysfunction and it requires more intensive emergency attention. To conclude, we present a case of HT presenting with acute psychosis as the presenting feature. Furthermore, patients with HT should be monitored for any evolving psychotic symptoms.
Table 1: Review of clinical details of our case in context to previously published literature

Click here to view


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ahmed R, Al-Shaikh S, Akhtar M. Hashimoto thyroiditis: A century later. Adv Anat Pathol 2012;19:181-6.  Back to cited text no. 1
    
2.
Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry 2003;5:260-6.  Back to cited text no. 2
    
3.
Arrojo M, Perez-Rodriguez MM, Mota M, Moreira R, Azevedo A, Oliveira A, et al. Psychiatric presentation of Hashimoto's encephalopathy. Psychosom Med 2007;69:200-1.  Back to cited text no. 3
    
4.
DAS S, Doval N, Moun V. Autoimmune thyroiditis presenting as psychosis. Shanghai Arch Psychiatry 2017;29:174-6.  Back to cited text no. 4
    
5.
Robles-Martínez M, Candil-Cano AM, Valmisa-Gómez de Lara E, Rodríguez-Fernández N, López B, Sánchez-Araña T. Psychosis, an unusual presentation of Hashimoto's thyroiditis. Rev Psiquiatr Salud Ment 2015;8:243-4.  Back to cited text no. 5
    
6.
Psychosis Related with Hashimoto Thyroiditis: A Case Report. Available from: http://www.dusunenadamdergisi.org/ing/fArticledetails.aspx?MkID=1122. [Last accessed on 2020 Feb 29].  Back to cited text no. 6
    
7.
Mavroson MM, Patel N, Akker E. Myxedema psychosis in a patient with undiagnosed hashimoto thyroiditis. J Am Osteopath Assoc 2017;117:50-4.  Back to cited text no. 7
    

Top
Correspondence Address:
Priya Ranjan Avinash
Department of Psychiatry, Himalayan Institute of Medical Science, Dehradun, Uttarakhand
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_232_20

Rights and Permissions



 
 
    Tables

  [Table 1]



 

Top