Hypothyroidism Induced Myxedema Madness and Hyponatremia: A Case Report

Hypothyroidism is a frequently encountered medical condition in general population. Several disorders can arise when the thyroid hormone production is either too high or not enough. We report here about a hypothyroid patient who was presented to a tertiary hospital with psychotic manifestations. A 55 year old male with family history of psychosis in first degree relative had for the past 2 months reduced sleep at night, reduced appetite and less interaction with family members and gradually developed trouble in speaking. Registration of memory was impaired, features of delusions of persecution and reference and third person auditory hallucinations were present. Patient was started on antipsychotics for one week but without any improvement. Laboratory investigations demonstrated hyponatraemia and an abnormal thyroid profile: thyroid stimulating hormone: 10.89 uIU/ml, free triiodo threonine (FT3): 1.96 pg/ml and a normal thyroid on ultrasound. Tab levothyroxine 125 mcg was added along with the antipsychotics. The patient showed marked improvement in symptoms and the antipsychotics were withdrawn over a week. Thereafter there were no signs or symptoms of delusions or hallucinations and the patient was discharged on tab levothyroxine alone. Thyroxine supplementation also resolved the hyponataremia in this patient.