Ramifications of untreated hypothyroidism: case report of cognitive impairment and acute psychosis in an elderly female
- PDF / 667,670 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 115 Downloads / 192 Views
nnals of General Psychiatry Open Access
CASE REPORT
Ramifications of untreated hypothyroidism: case report of cognitive impairment and acute psychosis in an elderly female Janette C. Leal* and Allison H. Beito
Abstract Hypothyroidism is a common condition in the general population. While myxedema is a known complication, we present a case highlighting a late-onset presentation of psychosis with confounding cognitive impairment in a patient who believed she no longer needed thyroid replacement medication because of her advanced age. Introduction Hypothyroidism is a common condition in the older population, estimated to afflict 5–20% of elderly women [1]. With an aging population, cases are expected to become more widespread in the near future. While psychiatric presentations of hypothyroidism were initially described in the late 1880s, and the term “myxedema madness” was added to the literature in 1949 [2, 3], ensuing cases over the years have highlighted the true diversity of potential psychotic presentations. Elderly patients in particular may demonstrate affective disturbance, cognitive dysfunction, and a wide range of psychotic symptoms, without a predictable progression of medical or psychiatric symptoms [2, 3]. Psychiatric presentations of hypothyroidism require a vigilant approach to investigation for thyroid disturbance, as left untreated, hypothyroidism may lead to excess morbidity. Here, we present one case of hypothyroidism-related psychosis and cognitive impairment treated in our hospital, with the purpose of further illustrating the range of potential presentations of which providers should be aware.
*Correspondence: [email protected] Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
Case presentation A 79-year-old, married, Caucasian female was brought to medical attention by her husband. She had suffered 2 weeks of escalating delusions of pregnancy, hallucinations with observed response to internal stimuli at home, and agitation with increasing suspiciousness toward family members. Her previous medical history was pertinent for treated hypothyroidism of 50 years duration, hyperlipidemia, diverticulosis, Vitamin D deficiency, and mild osteoarthritis. She had no family or personal history of formally diagnosed psychiatric disorders. She was high school graduate, retired housecleaner and teacher’s aide, who lived independently in a house with her husband. She had no lifetime history of any substance use. Interestingly, she had been hospitalized 1 year prior to this presentation, for uncontrolled hypothyroidism and paranoid thoughts associated with medication non-adherence. At that time, thyroid replacement had been re-initiated with improvement in paranoia. Prior to this admission, the patient insisted that she had been impregnated by an intruder into her home, and possessed delusional thoughts that her abdomen was filled with embryos, necessitating caesarian section. She was willing to seek medical attention only for the purpose of scheduling a ca
Data Loading...
