Psychosis Due to Hypothyroidism: Are Antipsychotics Indicated?

Psychosis Due to Hypothyroidism: Are Antipsychotics Indicated?

Deborah L. Sanchez, M.D. 1,2, Adam J. Fusick, M.D2, William B. Hudson, M.D.2, Theresa A. Schwitalla,M.D.2, Maria C. Catalano,D.O.2,3, Susan K. Schultz, M.D.1,2,4, Glenn Catalano, M.D. 1,2

1Mental Health and Behavioral Sciences Service, James A. Haley Veterans Hospital, Tampa, Florida; 2Department of Psychiatry and Behavioral Neurosciences, University of South Florida Morsani College of Medicine, Tampa, Florida; 3Ambulatory Care Service, James A. Haley Veterans Hospital, Tampa, Florida; 4Department of Psychiatry, University of Iowa Carver College of Medicine

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Objective: To present a case of thyroid-related psychosis and review the literature to assess evidence regarding the use of antipsychotic medications in patients who develop this condition.

Data Sources: The OVID database was utilized to search for the terms “myxedema madness” and the combination of the terms “psychosis” and “thyroid.” The database was searched from 1946 until July 2018 and was limited to English language articles.

Study Selection: A total of 25 articles were included in this study. These included 27 distinct case reports.

Data Extraction: The abstracts of identified articles were reviewed. If an abstract was unavailable or inconclusive, the full article was reviewed. If there was no case report, or if the case was not clearly related to hypothyroidism, it was excluded. Authors assessed and identified cases included. Studies were excluded if recovery time was unreported; if cases included patients with pre-existing, chronic mental illness or intellectual disability, or if thyroid replacement medication was not initially administered.

Results: Data suggested that there may be no benefit to treating thyroid-related psychosis with scheduled dosing of antipsychotics in addition to thyroid replacement. The review also suggested that male patients with thyroid-related psychosis seemed to respond more rapidly to thyroid replacement than female patients.

Conclusions: Scheduled dose antipsychotic therapy was not observed to hasten recovery. Males with thyroid-related psychosis were observed to respond more quickly to thyroid replacement than females among the identified cases identified. Consideration should be given to initial trials of thyroid replacement alone in cases of thyroid-related psychosis.

Keywords: Hypothyroidism, Myxedema, Psychosis,Hallucinations, Levothyroxine, Endocrine

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How to cite this article:

Deborah L. Sanchez, Adam J. Fusick, William B. Hudson, Theresa A. Schwitalla, Maria C. Catalano, Susan K. Schultz, Glenn Catalano. Psychosis Due to Hypothyroidism: Are Antipsychotics Indicated?. International Journal of Case Reports, 2019 4:103. DOI: 10.28933/ijcr-2019-10-0506


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