title: Acute delirium in the setting of primary hypothyroidism: the role of thyroid hormone replacement therapy.
abstract: Psychiatric illness, mostly mania and psychosis, are reported to occur after rapid normalization of thyroid function in patients with primary hypothyroidism. It is generally believed that the gradual restoration of thyroid function may reduce the risk of psychiatric complications. This case report describes the occurrence of acute delirium in a 67-year-old man with primary hypothyroidism shortly after the initiation of thyroid hormone replacement. The use of low-dose thyroxine initially and persistent severe biochemical hypothyroidism on presentation with psychiatric symptoms illustrate that psychiatric illness can still occur despite unaggressive thyroid hormone replacement. A temporal relationship with the initiation of thyroxine and rapid recovery of mental state over 1 to 2 weeks differentiate this condition from hypothyroidism-related psychopathology, which tends to have a more prolonged course.
authors.affiliation: Department of Clinical & Biomedical Sciences, Barwon Health, The University of Melbourne, Geelong, Victoria, Australia. samere@barwonhealth.org.au
authors.forename: Samer
authors.initials: S
authors.lastname: El-Kaissi
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowicz
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.forename: Jack R
authors.initials: JR
authors.lastname: Wall
mesh_terms: D000368:Aged; D003693:Delirium / Q000139:chemically induced* / Q000209:etiology* / Q000523:psychology; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D013974:Thyroxine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D013974:Thyroxine