The emergence of psychosis in a patient with severe hypothyroidism: A case report and literature review

2017 ◽  
Vol 41 (S1) ◽  
pp. s842-s842
Author(s):  
M.L. Turk ◽  
J. Rosen
Keyword(s):  
Psychiatric Symptoms ◽  
Hormone Replacement ◽  
Psychotic Symptoms ◽  
Free T4 ◽  
Thyroid Hormone Replacement ◽  
History Of ◽  
Speed Up ◽  
Competing Interest ◽  
Shed Light ◽  
Basic Medical

Hypothyroidism is associated with changes in mental state that can range from mild cognitive impairment to depression to florid myxedema coma. A few cases have linked the occurence of psychotic symptoms in the context of severe hypothyroidism, an event referred in the literature as “myxedema madness”. We describe the case of a 48-year-old male with no past psychiatric history and a past medical history of hypertension and hypothyroidism who presented to the psychiatric unit for management of new-onset psychosis, particularly paranoid delusions. On basic medical screening, the patient was found to have severe hypothyroidism manifested by a TSH level of 51.85 and a free T4 level less than 0.4. The patient was treated with both an antipsychotic and thyroid hormone replacement, after which his hypothyroid symptoms and his psychosis improved. Liothyronine was also prescribed to speed up the recovery course, as his delusions were thought to be due to his hypothyroidism. The aim of this poster is to shed light on the possibility of development of psychosis concomitantly with severe hypothyroidism, given the rarity of such events, as well as to illustrate the importance of treating the underlying medical cause rather than only focusing on the treatment of the psychiatric symptoms. The use of Liothyronine proved to be beneficial in this case, as the patient's symptoms drastically improved after its administration. This could potentially illustrate the importance of using Liothyronine particularly in the treatment of delusional disorder in severe hypothyroidism.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Symptomatology as the Initial Presentation of Brain Cancer

2017 ◽  
Vol 41 (S1) ◽  
pp. S165-S165
Author(s):  
A. Fornelos ◽  
P. Macedo ◽  
A. Figueiredo ◽  
M. Roque
Keyword(s):  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Mass Effect ◽  
Adult Brain ◽  
Neurological Deficits ◽  
Psychotic Symptoms ◽  
Social Maladjustment ◽  
Organic Brain Disease ◽  
History Of ◽  
Competing Interest

Glioblastoma multiforme is the most common primary adult brain tumor. Clinically, non-specific psychiatric symptoms may arise as their first and only manifestation, prior to any neurological deficits. The most form of psychiatric presentation of neurological diseases are depressive complaints, although these may also be accompanied by behavioral and/or cognitive, anxious and psychotic symptoms. By explaining this case report we aim to emphasize the importance of considering the diagnosis of an organic brain disease, even when only primary psychiatric symptoms are evident. The bibliographic research was made using PubMed and Scielo, and analysis of the electronic patient process. Man of 68 years with a history of hypertension, nephrectomy, splenectomy and left brachial plegia after a car accident. He had been previously seen by a psychiatrist for a 6-month history of depressive symptoms, which had been successfully treated. He later developed new behavioral changes such as heteroaggressiveness, social maladjustment and disfasia, for which he was sent to the emergency room. Brain-CT scan displayed a left front temporal expansive injury. Admitted to the Neurology Department for further diagnostic investigation. Subsequent MRI, detected massive infiltrative lesion with significant mass effect and cystic/necrotic area. The anatomopathology disclosed a glioblastoma grade IV. This case reinforces the importance of carrying a imagiologic workup in cases like this, especially on patients with atypical presentation of psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric Symptoms Paraneoplastic and Legal Obligation to Combination Therapy

2016 ◽  
Vol 33 (S1) ◽  
pp. S463-S463
Author(s):  
M.D. Piqueras Acevedo ◽  
I. Martínez Pérez ◽  
M.R. Raposo Hernández: ◽  
A.L. González Galdámez ◽  
A. Belmar Simó ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Clinical Status ◽  
Combined Treatment ◽  
Breast Disease ◽  
Medical Decision ◽  
Psychotic Symptoms ◽  
Psychiatric Clinic ◽  
History Of ◽  
Oncology Treatment ◽  
Competing Interest

Women 49-year-old with a history of left mastectomy for breast Ca. The patient is brought to the emergency by his family for disorderly conduct compatible with manic phase and psychotic symptoms by delirious speech mystical-religious content refusal of the patient to be evaluated by any medical decision and abandoned chemotherapy. Initial screening is performed from the emergency department of organic pathology (TAC without findings and normalcy in other PC). At the beginning of involuntary admission income that is corroborated by the commission judicial, a request of the family and given the history of abandonment IC Oncology treatment is performed as a result of which it is found that the onset of the psychiatric clinic communicates matches the decision to abandon treatment; after reassessment of the clinical status of the patient and recommendation by her oncologist to resume treatment with RT to court new authorization for further diagnosis and initiation of treatment after assessment by forensic and judge is granted a week tests requested. After screening of limbic encephalitis but positive AC. SD income it is maintained and combined treatment is performed. At discharge, the patient is stable DP vs. psychopathology with good controls over concomitant breast disease.ResultsThe need for medical treatment in organic pathology is justified even against the will of the patient in the context of represenDisclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Pancytopenia in a Patient With Severe Hypothyroidism: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A946-A947
Author(s):  
Aysegul Bulut ◽  
Khaled AlSibai ◽  
Catalina Norman
Keyword(s):  
Thyroid Hormone ◽  
Reference Range ◽  
Hormone Replacement ◽  
Macrocytic Anemia ◽  
Normocytic Anemia ◽  
Free T4 ◽  
Left Femur ◽  
Thyroid Hormone Replacement ◽  
Myxedema Coma ◽  
History Of

Abstract Introduction: Hypothyroidism usually affects red blood cell line most commonly seen as normochromic normocytic anemia. We present a unique case of a patient with pancytopenia in the setting of severe hypothyroidism, which improved following IV thyroid hormone replacement. Case: An 85-year-old female with history of type II diabetes mellitus and hypothyroidism who was admitted for open reduction and internal fixation (ORIF) of a displaced left femur fracture following a mechanical fall. Patient has a long-standing history of hypothyroidism on replacement with levothyroxine 75 mcg, which was inadvertently discontinued at the nursing home 2 weeks prior to presentation. CBC on admission was notable for pancytopenia with macrocytic anemia with hemoglobin of 6.2 g/dl (baseline of 11), leukopenia with WBC of 4.2 x103/ul and thrombocytopenia with platelet of 77 X 103 /ul. TSH was 83 uIU/mL (reference range: 0.34 - 5.6) and Free T4 was < 0.11 ng/dl (reference range: 0.93 - 1.7). Patient was on the verge of developing myxedema coma as she presented with hypotension with blood pressure of 103/55 mmHg, hyponatremia 133 mmol/L and mild change in mental status. There was no evidence for hypothermia or bradycardia. Presence of a small thigh hematoma on examination partially explained the acute drop in hemoglobin. Iron panel, folic acid and vitamin B12 levels were found to be within normal range. Patient had no active of infection to suggest sepsis and she did not receive any myelosuppressive medication. Rapid replacement with IV levothyroxine was started before proceeding with surgery to prevent development of myxedema coma. Free T4 normalized at 1.05 ng/dl after receiving a total of 700 mcg of IV levothyroxine on day 5 of hospitalization. ORIF was done with no complications. Pancytopenia resolved upon thyroid replacement therapy and she was discharged on her regular dose of levothyroxine 75 mcg daily. Discussion: Most common hematologic abnormality associated with hypothyroidism is normochromic normocytic anemia. Currently, there are less than 10 reported cases of pancytopenia associated with hypothyroidism. The exact mechanism is unclear but proposed hypothesis is transient bone marrow hypoplasia. The most common clinical presentation, as seen in our patient, is profound hypothyroidism with ultimate outcome of myxedema coma. Most of these patients had resolution of pancytopenia following adequate thyroid hormone replacement. Interestingly, all cases have been reported in female patient population. Further research is needed to understand pathophysiology, risk factors, prognosis and the risk of pancytopenia recurrence in patients with severe hypothyroidism. More importantly, hypothyroidism must certainly be entertained as a differential diagnosis of pancytopenia.

Comorbid depression and ulcerative colitis – is there a connection?

2017 ◽  
Vol 41 (S1) ◽  
pp. S534-S534
Author(s):  
A. Melada ◽  
I. Krišto-Mađura ◽  
A. Vidović
Keyword(s):  
Ulcerative Colitis ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Specific Treatment ◽  
Unknown Etiology ◽  
Suicidal Thoughts ◽  
Symptoms Of Depression ◽  
Bidirectional Communication ◽  
History Of ◽  
Competing Interest

Ulcerative colitis (UC) is a subset disorder of inflammatory bowel disease (IBD) with chronic course and symptoms such as fatigue, gastrointestinal pain, fever, etc. IBD is associated with psychological manifestations including depression and anxiety. There is an increased number of studies trying to link these comorbidities. The gut-brain axis is regulated by intestinal microbiota and this bidirectional communication including immune, neural, endocrine and metabolic mechanisms may bring us closer to the answer. The following case concerns a 56-year-old patient with history of major depressive disorder who was in continuous psychiatric care and treated with antidepressants. Several years after the beginning of psychiatric treatment, he was hospitalized for diagnostic examination due to subfebrility of unknown etiology, but with no final somatic diagnosis. After two years he was referred to our department and at administration the patient showed symptoms of depression, anxiety, lack of motivation and suicidal thoughts and tendencies. Subfebrility was still present at that time. His psychopharmacotherapy was revised and there was a slight improvement in mood and behaviour. During outpatient follow-ups the symptoms of depression were still prominent and remission was not achieved even with modulation of antidepressant pharmacotherapy. The following year the patient was diagnosed with UC and started specific treatment after he presented with diarrhea in addition to subfebrility. Subsequently his mood improved, suicidal thoughts were diminished and ultimately remission was achieved. This case suggests that only after UC was being treated the psychiatric symptoms also withdrew which implicates that inflammatory mediators were involved in pathogenesis of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Lithium treatment and thyroid dysfunction – data from an inpatient psychiatric department

2016 ◽  
Vol 33 (S1) ◽  
pp. S545-S545
Author(s):  
M. Lázaro ◽  
A. Mota ◽  
A. Moreira ◽  
R. Alves ◽  
M.A. Nobre
Keyword(s):  
Thyroid Dysfunction ◽  
Lithium Treatment ◽  
Hormone Replacement ◽  
Thyroid Hormone Replacement ◽  
High Prevalence ◽  
Thyroid Hormone Replacement Therapy ◽  
Competing Interest ◽  
Psychiatric Department ◽  
Term Monitoring

IntroductionLithium is among the most effective therapies for bipolar disorder. Lithium treatment may cause hypothyroidism, goiter or to a lesser extent hyperthyroidism, since it can affect several aspects of thyroid functioning. The prevalence of lithium-associated hypothyroidism varies extensively between studies, reaching up to 47%, and affecting more females than males (5:1).ObjectiveDetermine the prevalence of thyroid dysfunction in an acute inpatient psychiatric department dedicated to affective disorders and its association with lithium therapy.AimsTo review the relation between lithium treatment and thyroid dysfunction.MethodsObservational, descriptive and retrospective study with clinical and laboratorial data concerning all inpatient episodes of 2015 in our Psychiatric Department. A non-systematic literature search was performed in PubMed.ResultsThe present study documented a high prevalence of thyroid dysfunction, particularly in women. Most cases were due to either hypothyroidism or subclinical hypothyroidism. Patients treated with lithium were more often under thyroid hormone replacement therapy (levothyroxine).ConclusionsThe evidence that lithium treatment is associated with hypothyroidism is well established and this condition is easily treatable with levothyroxine. This study highlights the importance of baseline screening of thyroid function and regular long-term monitoring in patients treated with lithium.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Mercedes Pineyro ◽  
Patrica Agüero ◽  
Florencia Irazusta ◽  
Claudia Brun ◽  
Paula Duarte ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Pituitary Tumor ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Sellar Mass ◽  
History Of ◽  
Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

scholarly journals Free Triiodothyronine Has a Distinct Circadian Rhythm That Is Delayed but Parallels Thyrotropin Levels

2008 ◽  
Vol 93 (6) ◽  
pp. 2300-2306 ◽  
Author(s):  
W. Russell ◽  
R. F. Harrison ◽  
N. Smith ◽  
K. Darzy ◽  
S. Shalet ◽  
...  
Keyword(s):  
Circadian Rhythm ◽  
Thyroid Hormone ◽  
Cross Correlation ◽  
Hormone Replacement ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Free Triiodothyronine ◽  
Free T4 ◽  
Cross Sectional ◽  
Thyroid Hormone Replacement

Abstract Context: TSH is known to have a circadian rhythm, but the relationship between this and any rhythm in T4 and T3 has not been clearly demonstrated. Objective: With a view to optimizing thyroid hormone replacement therapy, we have used modern assays for free T4 (FT4) and free T3 (FT3) to investigate circadian rhythmicity. Setting: The study was performed at a university hospital. Design and Subjects: This was a cross-sectional study in 33 healthy individuals with 24-h blood sampling (TSH in 33 and FT4 and FT3 in 29 individuals) and cosinor analysis. Results: Of the individuals, 100% showed a sinusoidal signal in TSH, for FT4 76%, and for FT3 86% (P < 0.05). For FT4 and FT3, the amplitude was low. For TSH the acrophase occurred at a clock time of 0240 h, and for FT3 approximately 90 minutes later at 0404 h. The group cosinor model predicts that TSH hormone levels remain above the mesor between 2020 and 0820 h, and for FT3 from 2200–1000 h. Cross correlation of FT3 with TSH showed that the peak correlation occurred with a delay of 0.5–2.5 h. When time-adjusted profiles of TSH and FT3 were compared, there was a strong correlation between FT3 and TSH levels (ρ = 0.80; P < 0.0001). In contrast, cross correlation revealed no temporal relationship between FT4 and TSH. Conclusions: FT3 shows a circadian rhythm with a periodicity that lags behind TSH, suggesting that the periodic rhythm of FT3 is due to the proportion of T3 derived from the thyroid. Optimizing thyroid hormone replacement may need to take these rhythms into account.

A broken heart

2017 ◽  
Vol 41 (S1) ◽  
pp. S422-S423
Author(s):  
M.J. Gordillo Montaño ◽  
S. Ramos Perdigues ◽  
S. Latorre ◽  
M. de Amuedo Rincon ◽  
P. Torres Llorens ◽  
...  
Keyword(s):  
Heart Function ◽  
Mood Stabilizer ◽  
Psychotic Symptoms ◽  
Emotional States ◽  
Cardiac Syndrome ◽  
History Of ◽  
Competing Interest ◽  
High Doses ◽  
Depressive Episodes ◽  
The Impact

IntroductionWithin the various cultures and throughout the centuries has observed the relationship between emotional states and heart function, colloquially calling him “heartbroken”. Also in the medical literature are references to cardiac alterations induced by stress.ObjectiveTakotsubo is a rare cardiac syndrome that occurs most frequently in postmenopausal women after an acute episode of severe physical or emotional stress. In the text that concerns us, we describe a case related to an exacerbation of psychiatric illness, an episode maniform.MethodWoman 71 years old with a history of bipolar I disorder diagnosed at age 20. Throughout her life, she suffered several depressive episodes as both manic episodes with psychotic symptoms. Carbamazepine treatment performed and venlafaxine. He previously performed treatment with lithium, which had to be suspended due to the impact on thyroid hormones and renal function, and is currently in pre-dialysis situation.She requires significant adjustment treatment, not only removal of antidepressants, but introduction of high doses of antipsychotic and mood stabilizer change of partial responders. In the transcurso income, abrupt change in the physical condition of the patient suffers loss of consciousness, respiratory distress, drop in blood pressure, confusion, making involving several specialists. EEG was performed with abnormal activity, cranial CT, where no changes were observed, and after finally being Echocardiography and coronary angiography performed when diagnosed Takotsubo.Results/conclusionsIn this case and with the available literature, we can conclude that the state of acute mania should be added to the list of psychosocial/stressors that can trigger this condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ADHD and bipolar disorder challenge in diagnosis in children and adolescents

2016 ◽  
Vol 33 (S1) ◽  
pp. S347-S347
Author(s):  
P. Cano Ruiz ◽  
A. Gómez Peinado ◽  
S. Cañas Fraile ◽  
P. Sanmartin Salinas
Keyword(s):  
Bipolar Disorder ◽  
Children And Adolescents ◽  
Attention Deficit Disorder ◽  
Psychiatric Symptoms ◽  
Family Factors ◽  
Bipolar Spectrum ◽  
Hyperactivity Disorder ◽  
Bipolar Disease ◽  
History Of ◽  
Competing Interest

IntroductionThe professionals in charge of children and adolescents with attention deficit disorder and hyperactivity disorder (ADHD) should be prepared to treat a wide variety of psychiatric symptoms, as most have at least one comorbid psychiatric disorder.Sometimes the differential diagnosis between ADHD and bipolar disease is difficult because of overlapping symptoms between the two disorders (Geller et al., 1997; Biederman et al., 2000; Singh et al., 2006).MethodologyA literature review about the comorbidity between ADHD and bipolar disorder in children and adolescents was performed.ResultsAccording to different studies, between 60 and 90% of children and adolescents with ADHD have comorbid bipolar disorder. However, the percentage of children and adolescents with ADHD that has comorbid bipolar disorder varied from 10 to 22% (puedes poner from 60 to 90% si no quieres repetir el and).ConclusionsThe prevalence of bipolar disease, particularly among adolescents, is between 1 and 7%. This percentage is higher if all forms of bipolar spectrum are included. Some personal and family factors increase the probability of a patient having ADHD present bipolar disease: decreased IQ, delayed development, family history of ADHD or bipolar disease, and the combined subtype.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A case of neurosarcoidosis presenting with isolated psychotic symptoms

2016 ◽  
Vol 33 (S1) ◽  
pp. S637-S637
Author(s):  
O. Onur ◽  
E. Carpar ◽  
Y. Altunkaynak
Keyword(s):  
Psychiatric Symptoms ◽  
Family Background ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
Vital Signs ◽  
Intensity Change ◽  
Psychotic Symptoms ◽  
Neurologic Manifestation ◽  
Competing Interest ◽  
Granulomatous Diseases

Neurosarcoidosis (NS) is a neurologic manifestation of sarcoidosis, a rare multisystemic granulomatous disease. Although psychiatric symptoms have been reported to occur in 20% of patients with NS, isolated NS without any signs of systemic disease is a rarity.CaseA 56-year-old female admitted to psychiatry clinic due to complaints of forgetfulness, visual and auditory hallucinations, inability to go outside alone, washing hands in closet cabin, difficulty finding words for the last one year, progressing in last four months. Personal and family background was unremarkable. Vital signs and physical examination revealed no abnormalities. In neuropsychiatric examination, Glasgow Coma Scale score was 15 without any meningeal irritation signs or gait abnormalities. Cranial nerves, extrapyramidal, motor, cerebellar, and sensory systems were intact. All aspects of orientation (time, place and person) were impaired. She scored 12 points out of 30 in Mini Mental Test. Speech was non-fluent with looseness of associations. Impaired recall, abstract thinking, judgment, behaviour planning and attention were noted. Visiospatial disorientation and contructional dressing apraxia were revealed. MR Imaging reported a T2-weighted signal intensity change in nodular fashion suggesting a granulamatous lesion. Differential diagnoses included granulomatous diseases, neoplasms, infections and Behcet's disease. After necessary excluding evaluations were undergone, a diagnosis of NS was made due to increased angiotensin converting enzyme levels in cerebrospinal fluid. The clinical picture responded well to prednisone treatment and symptoms resolved within one month.ConclusionIncreased awareness is essential to identify rare granulamotous diseases as a differential diagnosis in encountering psychotic symptoms accompanying demantial clinic presentation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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