ABSTRACT
Primary hypothyroidism may present with myriad of unusual presentation apart from typically described signs and symptoms. We report an unusual case of primary hypothyroidism clinically presenting as acute psychosis and radiologically mimicking as pituitary macroadenoma. A 19-year-old female presented with h/o abnormal behaviour in the form of auditory hallucination, fearfulness, loss of memory and inability to recognise family members six months back. She also gave h/o multiple joint pain, easy fatigability, facial puffiness, somnolence, progressive weight gain, constipation and cold intolerance for similar duration. MRI brain revealed enlarged pituitary, while the thyroid function analysis pointed towards primary hypothyroidism. Patient improved with LT4.
ABSTRACT
Acute psychosis in patients receiving physiological corticosteroid replacement is rare. The exact mechanism of this disorder is not clear. We report a case of a 50 year old female with recurrent post operative pituitary macroadenoma who had presented to us with features of adrenocortical insufficiency. The patient was started on intravenous (iv) hydrocortisone and after receiving six doses, she developed features of acute psychosis. She was put on anti-psychotics and hydrocortisone was withheld for 24 hrs. The patient recovered in a couple of days and oral hydrocortisone was re-started at 5 mg per/day and increased to 15 mg/day without recurrence of symptoms of psychosis.
ABSTRACT
Aims: Thyroid dysfunction is commonly encountered in pregnancy and can affect maternal and Fetal outcomes. Limited data are available from north east India on the prevalence of various thyroid disorders in pregnancy. The present study was hence conducted to evaluate the prevalence of thyroid disorders in a large government hospital in Assam. Study Design: Prospective cohort study. Place and Duration of Study: Sample: Department of endocrinology and department of obstetrics, Gauhati medical college, Guwahati between may 2011 to April 2013. Methodology: Pregnant women irrespective of gestational age attending the antenatal clinic of Gauhati medical college were screened for thyroid dysfunction by estimation of serum free t34 (FT4), TSH and thyroid peroxidase antibodies (TPOAB). Subjects with known thyroid disorders, chronic illness or on medications known to affect thyroid status were excluded from the study. Results were interpreted as per the American thyroid association (ATA) 2011 guidelines. Results: A total of 542 pregnant women were enrolled for this prospective cohort study. The mean age was 23.85±4.04 yrs. Of the 542 women screened, 69.18% were Euthyroid, 21.58% had subclinical hypothyroidism (SCH), 5.35% had overt hypothyroidism (OH), hyperthyroidism was observed in 2.39% and 1.47% had gestational Thyrotoxicosis. TPOAB were positive in 18.08% of women. Conclusion: A high prevalence of thyroid disorders specially hypothyroidism were seen in this study using the newer ATA diagnostic criteria emphasizing the need for screening of all women during pregnancy.
ABSTRACT
Disorders of thyroid hormone metabolism are commonly encountered in clinical practice. Apart from conditions affecting the thyroid gland, thyroid hormone homeostasis may be altered by medications used in varied clinical settings. Drugs may interfere at different steps in thyroid hormone synthesis or secretion leading to hypothyroidism or thyrotoxicosis or may cause changes in hormone binding leading to difficulties in the interpretation of thyroid function tests. These difficulties have been largely overcome by the development of improved diagnostic tools including radio-active uptake studies, estimation of thyroid auto-antibodies and highly sensitive hormone assays.