Myxedema psychosis

Myxedema psychosis is a relatively uncommon consequence of hypothyroidism, such as in Hashimoto's thyroiditis or in patients who have had the thyroid surgically removed and are not taking thyroxine. A chronically under-active thyroid can lead to slowly progressive dementia, delirium, and in extreme cases to hallucinations, coma, or psychosis, particularly in the elderly. It was first recognized by Dr Richard Asher of London in 1949.

Treatment is via the standard treatment for hypothyroidism with thyroxine replacement. Oral T₄, or in especially acute cases liothyronine, a sodium salt of T₃. Hormone replacement in these patients usually reverses the psychotic symptoms, but may not help with cognitive deficits caused by changes in metabolic activity in the CNS.

The "myxedema" part of the name simply refers to the non-pitting edema common to hypothyroidism.

Myxedematous psychosis, more commonly referred to as the myxedema madness is manifested through hypothyroidism which is a condition in where the thyroid gland does not produce enough thyroid hormones, some of the most common symptoms linked with both of these conditions include: Fatigue, Cold intolerance, Menstrual abnormalities, Decreased appetite, Constipation, Hoarse voice, Bradycardia, Non-pitting edema, Facial puffiness, Slow speech, and Delayed relaxation of deep tendon reflex and fatigue.[1]

A case report titled “Myxedema psychosis after levothyroxine withdrawal in radioactive iodine treatment of differentiated thyroid cancer: A case report” conducted by Pattravimonporn N, Chaikijurajai T, Chamroonrat W and Sriphrapradang C[2] focuses on a 42 year-old women who had suffered from papillary thyroid carcinoma and had a thyroidectomy which ultimately resulted in her developing paranoid delusions and visual/auditory hallucinations whilst undergoing treatment for elective radioactive iodine treatment, according to the report it states that “she had no history of mental illness” and that “the patient was immediately treated with thyroid hormone replacement therapy” this behaviour conducted by medical professionals supports kleinman’s statement where “The modern medical bureaucracy and the helping professions that work within it, as we have seen, are oriented to treat suffering as a problem of mechanical breakdown requiring a technical fix.” shown through the analysis conducted by the patients' doctors/nurses declaring that her medical history did not reveal any symptoms and she was immediately treated. This leads into the ideology of illness narratives which “edify us about how life problems are created, controlled, made meaningful. They also tell us about the way cultural values and social relations shape how we perceive and monitor our bodies, labels and categorize bodily symptoms and interpret complaints.” Kleinman believes and suggests that “illness has meaning; and to understand how it obtains meaning is to understand something fundamental about illness, about care and perhaps about life”, however through ‘Myxedema psychosis after levothyroxine withdrawal in radioactive iodine treatment of differentiated thyroid cancer: A case report’ it can be seen that the statement by Kleinman about the modern medical bureaucracy’s oriented behaviours is put into modern practise and medical practitioners only view illnesses, conditions and sickness as something requiring immediate fix or attentional rather than viewing the patients as another human being needing care.[3]