Myxedema madness complicating postoperative follow-up of thyroid cancer.
Although hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen®) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine withdrawal for the follow-up of thyroid cancer.
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Yanina J
YJ
Morosán Allo
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Melanie
M
Rosmarin
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Agustina
A
Urrutia
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Maria Cristina
MC
Faingold
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Carla
C
Musso
Unidad Asistencial Dr. Cesar Milstein, Buenos Aires, AR.
Gabriela
G
Brenta
D014150:Antipsychotic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D009230:Myxedema / Q000150:complications* / Q000188:drug therapy; D011184:Postoperative Period; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000209:etiology*; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D013974:Thyroxine / Q000627:therapeutic use*
D014150:Antipsychotic Agents; D013974:Thyroxine