title: Case of prolonged alcohol withdrawal syndrome accompanied with hyperthyroidsim.
abstract: Hyperthyroidism is associated with increased psychiatric morbidity. It may alter the clinical course of alcohol withdrawal syndrome. We report a 69 year old man who presented prolonged alcohol withdrawal syndrome associated with hyperthyroidism. Initially, he developed typical alcohol withdrawal syndrome including tremor, disorientation, delirium and visual hallucination of small animals. Thyroid function tests revealed a free triiodothyronine (T3) of 6.1 pg/dl (range, 3.0 to 5.8), a free thyroxine (T4) of 2.3 ng/dl (range, 0.85 to 2.15) and a thyroid stimulating hormone (TSH) of 0.003 microU/ml (range, 0.3 to 4.0), and thiamazole was administered. Even after a month, he continuously presented persecutory delusion, auditory hallucination and cognitive dysfunction. Although these symptoms did not respond to the medication including antipsychotics, they totally passed away after the thyroid function reached down to the normal level (free T3 3.0 pg/ml, free T4 1.1 ng/dl, TSH 0.004 microU/ml). In addition, cognitive function was recovered to the normal level as he scored 28/30 on the Mini Mental State Examination. We propose that hyperthyroidism contributed to the occurrence of psychotic symptoms and cognitive dysfunction.
authors.affiliation: Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Narumoto
authors.forename: Syogo
authors.initials: S
authors.lastname: Oka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimizu
authors.forename: Michihisa
authors.initials: M
authors.lastname: Sumi
authors.forename: Yurinosuke
authors.initials: Y
authors.lastname: Kitabayashi
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueda
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukui
mesh_terms: D000368:Aged; D000430:Alcohol Withdrawal Delirium / Q000209:etiology*; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008713:Methimazole / Q000008:administration & dosage; D013375:Substance Withdrawal Syndrome / Q000150:complications*; D013960:Thyroid Function Tests; D016896:Treatment Outcome
chemical_list: D000431:Ethanol; D008713:Methimazole