Psychosis with untreated hypothyroidism: How a generalist made a difference

Myxoedema psychosis is a rare but treatable condition resulting from severe hypothyroidism. We report the case of a man who presented to a primary healthcare facility seeking a medical report for financial assistance, having lost his job after being treated for schizophrenia. A comprehensive re-evaluation raised the possibility of endocrinopathy-induced psychosis as one of the differentials. The diagnostic process was challenging due to the rarity of the condition and the absence of classic hypothyroid features. Laboratory investigations revealed markedly low free thyroxine levels and elevated thyroid-stimulating hormone and anti-thyroid peroxidase antibody levels, confirming the diagnosis. Treatment with levothyroxine led to significant clinical improvement. This case underscores the vital role of primary care providers in recognising organic causes of psychosis through patient-centred assessment, application of primary care principles and interdisciplinary collaboration. It also highlights the potential consequences of misdiagnosis in atypical psychiatric presentations, including functional decline and job loss, and reinforces that appropriate management can lead to optimal outcomes.