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First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report

This case report describes a woman with no psychiatric history and previously diagnosed Hashimoto’s thyroiditis who presented to the psychiatric emergency department with a first episode of psychosis. The initial workup for organic causes of psychosis revealed an astronomically high thyroid stimulat...

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Autores principales: Lipkes, Celeste, Haider, Shanzay, Rashid, Ali, Angarita, Gustavo A., Riley, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987109/
https://www.ncbi.nlm.nih.gov/pubmed/35401262
http://dx.doi.org/10.3389/fpsyt.2022.863898
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author Lipkes, Celeste
Haider, Shanzay
Rashid, Ali
Angarita, Gustavo A.
Riley, Sarah
author_facet Lipkes, Celeste
Haider, Shanzay
Rashid, Ali
Angarita, Gustavo A.
Riley, Sarah
author_sort Lipkes, Celeste
collection PubMed
description This case report describes a woman with no psychiatric history and previously diagnosed Hashimoto’s thyroiditis who presented to the psychiatric emergency department with a first episode of psychosis. The initial workup for organic causes of psychosis revealed an astronomically high thyroid stimulating hormone (TSH) (> 1,000 μIU/mL) out of proportion to the patient’s minimal physical symptoms of hypothyroidism. Additionally the patient’s head imaging showed an enlarged pituitary, a rare, but reversible, presentation of chronically untreated primary hypothyroidism. The patient was transferred to a medical unit to receive IV thyroid hormone replacement as well as an adjunctive antipsychotic to assist with remission of her distressing auditory hallucinations and persecutory delusions. This case highlights the importance of a thorough medical workup for causes of new onset psychosis and the need for further consensus in the literature regarding choice of antipsychotic and duration of treatment for psychosis secondary to hypothyroidism.
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spelling pubmed-89871092022-04-08 First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report Lipkes, Celeste Haider, Shanzay Rashid, Ali Angarita, Gustavo A. Riley, Sarah Front Psychiatry Psychiatry This case report describes a woman with no psychiatric history and previously diagnosed Hashimoto’s thyroiditis who presented to the psychiatric emergency department with a first episode of psychosis. The initial workup for organic causes of psychosis revealed an astronomically high thyroid stimulating hormone (TSH) (> 1,000 μIU/mL) out of proportion to the patient’s minimal physical symptoms of hypothyroidism. Additionally the patient’s head imaging showed an enlarged pituitary, a rare, but reversible, presentation of chronically untreated primary hypothyroidism. The patient was transferred to a medical unit to receive IV thyroid hormone replacement as well as an adjunctive antipsychotic to assist with remission of her distressing auditory hallucinations and persecutory delusions. This case highlights the importance of a thorough medical workup for causes of new onset psychosis and the need for further consensus in the literature regarding choice of antipsychotic and duration of treatment for psychosis secondary to hypothyroidism. Frontiers Media S.A. 2022-03-24 /pmc/articles/PMC8987109/ /pubmed/35401262 http://dx.doi.org/10.3389/fpsyt.2022.863898 Text en Copyright © 2022 Lipkes, Haider, Rashid, Angarita and Riley. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Lipkes, Celeste
Haider, Shanzay
Rashid, Ali
Angarita, Gustavo A.
Riley, Sarah
First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title_full First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title_fullStr First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title_full_unstemmed First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title_short First Episode Psychosis and Pituitary Hyperplasia in a Patient With Untreated Hashimoto’s Thyroiditis: A Case Report
title_sort first episode psychosis and pituitary hyperplasia in a patient with untreated hashimoto’s thyroiditis: a case report
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8987109/
https://www.ncbi.nlm.nih.gov/pubmed/35401262
http://dx.doi.org/10.3389/fpsyt.2022.863898
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