Myxedema madness complicating postoperative follow-up of thyroid cancer
Arch. endocrinol. metab. (Online)
;
59(4): 359-364, Aug. 2015. tab, ilus
Artículo
en Inglés
| LILACS
| ID: lil-757368
ABSTRACT
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.
Texto completo:
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Índice:
LILACS (Américas)
Asunto principal:
Agitación Psicomotora
/
Tiroxina
/
Neoplasias de la Tiroides
/
Mixedema
Tipo de estudio:
Factores de riesgo
Límite:
Femenino
/
Humanos
Idioma:
Inglés
Revista:
Arch. endocrinol. metab. (Online)
Asunto de la revista:
Endocrinologia
/
Metabolismo
Año:
2015
Tipo del documento:
Artículo
País de afiliación:
Argentina
Institución/País de afiliación:
Unidad Asistencial Dr. Cesar Milstein/AR
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