[Myxedema psychosis, a rare complication of untreated hypothyroidism]

Myxedema psychosis, also known as myxedema madness, is a rare neuropsychiatric manifestation of untreated or inadequately treated hypothyroidism. We report the case of a 46-year-old woman presenting to the emergency department with acute psychiatric symptoms, including confusion, hallucinations, and delusions. Physical examination revealed classic signs of hypothyroidism, such as periorbital edema, dry skin, and diffuse hair loss. Laboratory results showed a markedly elevated thyroid-stimulating hormone (TSH) level of 45.76 mU/L and a severely reduced free thyroxine (T4) level (< 1.0 pmol/L), confirming the diagnosis of myxedema psychosis. Intravenous administration of levothyroxine and liothyronine (T3) led to rapid resolution of psychotic symptoms. This case report underscores the critical need to evaluate somatic causes, including hypothyroidism in patients presenting with acute psychiatric symptoms. Timely diagnosis and appropriate thyroid hormone replacement therapy can result in full recovery.