Myxedema madness

Q: What is myxedema madness?

Answer: When myxedema presents with psychotic features, it is called myxedema madness. 

The actual cause of psychosis in these patients is not clear, but concomitant hyponatremia is suspected to be the cause. Seizure is also not uncommon. Progressively, these patients progress to altered consciousness, confusion, lethargy, and obtundation. Focal or generalized seizures may progress to status epilepticus. Lumbar puncture (LP) may reveal elevated protein levels (typically <100 mg/dL).

#endocrinology

#neurology

#psychiatry

References:

1. Westphal SA. Unusual presentations of hypothyroidism. Am J Med Sci 1997; 314:333.

2. Mavroson MM, Patel N, Akker E. Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis. J Am Osteopath Assoc 2017; 117:50.

3. Jansen HJ, Doebé SR, Louwerse ES, et al. Status epilepticus caused by a myxoedema coma. Neth J Med 2006; 64:202.

4. Haupt M, Kurz A. Reversibility of dementia in hypothyroidism. J Neurol 1993; 240:333.