Endocrine Abstracts

JOINT3628

Introduction: Clinical manifestations of hypothyroidism includeS fatigue, weight gain, constipation, and myoxodema. Psychiatric symptoms can also be prominent and they were described as myxoedematous madness(1). They include depression, cognitive impairment and, in rare cases, psychotic features. We report here the case of a 49-year-old man presenting with delusional ideas of persecution, a manifestation of hypothyroidism, highlighting the challenges of diagnosing psychiatric symptoms as part of an endocrine disorder.

Case Presentation: He was a 48-year-old male without family history of psychiatric disorders. He was admitted for patent hypothyroidism complicated by rhabdomyolysis and acute renal failure, 8 months after receiving radioactive iodine therapy (RAI) for Graves’ disease. He presented with generalized fatigue, myalgias, weight gain, and somnolence. On examination, he exhibited generalized myxedema, psychomotor slowing. He also described persecutory delusions, in which he believed that medical team and patients hospitalized next to him, were conspiring against him. Biochemical results confirmed severe hypothyroidism with a TSH of 87 and FT4 of 0.7. With the improvement of thyroid function, the persecutory delusion is resolving and further psychiatric evaluation is planned.

Discussion: Hypothyroidism is often accompanied by psychiatric symptoms, but the onset of delusions—particularly persecutory delusions—is rare (2) and may be confused with primary psychiatric disorders. In this case, the origin of the delusions were quite easy due to the contexte of severe hypothyroidism but it might be challenging in further situations (3). This case underscores the importance of considering endocrine disorders, such as hypothyroidism, when evaluating psychiatric symptoms, especially in patients with known thyroid dysfunction. Specific hormone replacement therapy is essential in managing both the physical and psychiatric components of the disease.

Conclusion: This case highlights the need for clinicians to be aware of the varity of psychiatric manifestations of hypothyroidism, including rare symptoms such as delusional ideas of persecution. Delusions in hypothyroid patients may resolve with appropriate thyroid hormone replacement, and recognizing this association can prevent unnecessary psychiatric interventions and improve patient outcomes.

Citations: 1. Dastjerdi G. Delusional Type Psychosis Associated with Hypothyroidism: A Case Report. Procedia - Soc Behav Sci. juill 2013;84:1050-2.

2. Heinrich TW, Grahm G. Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited. Prim Care Companion CNS Disord [Internet]. 1 déc 2003 [cité 2 févr 2025];5(6).

3. Ueno S, Tsuboi S, Fujimaki M, Eguchi H, Machida Y, Hattori N, et al. Acute psychosis as an initial manifestation of hypothyroidism: a case report. J Med Case Reports. déc 2015;9(1):264.