Myxedema Madness - Systematic literature review of published case reports

[helvella]

Makes you cry.

The original Richard Asher paper was titled "Myxoedematous madness" - not "Myxedema Madness".

Full paper freely accessible here: pubmed.ncbi.nlm.nih.gov/181... - and there are links to further papers referring to the subject over many years.

The phrase "easily treatable" implies that the appropriate treatment regime is easy to provide and is readily available. Clearly, if liothyronine is required, that is not the case.

"It is diagnosed through the measurement of thyroid stimulating hormone" is an appallingly ignorant, trite, statement. It denies the possibility of hypothyroidism without sufficiently elevated TSH.

"Treated by application of L-thyroxine" may describe the reality but it simply isn't enough.

"Due to its excellent prognosis, myxedema madness should always be considered a differential diagnosis in new onset psychosis." However, if the patient didn't have myxoedema considered, they could have been suffering for years, and not treated. Including the words "new onset" condemns them to eternally being ignored and suffering.

Of course, not having access to the full paper could mean I am being unfair. If so, they need to re-write the abstract because that is how it reads.

Myxedema Madness - Systematic literature review of published case reports

Jana Krüger 1 , Adrian Kraschewski 2 , Maria C Jockers-Scherübl 2

Affiliations

• PMID: 34419786

• DOI: 10.1016/j.genhosppsych.2021.08.005

Abstract

Myxedema Madness is a rare but easily treatable cause of psychosis. Since Myxedema Madness was first described the question of a specific psychopathological symptom complex caused by severe hypothyroidism was raised in the literature. The present review of 52 published cases indicates that there are no specific somatic and psychopathological findings to diagnose a myxedema psychosis. It is diagnosed through the measurement of thyroid stimulating hormone and treated by application of L-thyroxine. Due to its excellent prognosis, myxedema madness should always be considered a differential diagnosis in new onset psychosis.

Keywords: Hypothyroidism; Madness; Myxedema; Psychosis.

Full paper is behind a paywall:

pubmed.ncbi.nlm.nih.gov/344...

[DawnieA]

Currently have a TSH of 211, 2 years ago it was 427 and I ended up in A n E, I just get accused of not taking my meds.

[Tythrop in reply to DawnieA]

Carbimozol?

[DawnieA in reply to Tythrop]

What is that?

[helvella in reply to DawnieA]

It is one of the two standard antithyroid medicines.

Carbimazole and Propylthiouracil.

[DawnieA in reply to helvella]

Is it not used for over active thyroids?

[helvella in reply to DawnieA]

Yes - I can't think of any other use for it.

I simply answered your question - but did not understand why the response you were asking about was added.

[DawnieA in reply to helvella]

Confused me too 🤣

[LindaC]

Thank you, helvella! My G-Grandmother died in 1950 [before my time] said to be of 'dementia' but, through all of those war years and rationing, she filled with fluid and took up a two seater sofa. This is the strand of family where obesity has had far-reaching effects in all members: all normal weight until well into adulthood. [I escaped until I didn't - but now have rid myself of it!]. The only 7 stone in dripping wet clothes, escaping obesity, WAS hypothyroid and took Levo but no one else was tested or believed in favour of their #'s game!

[tattybogle]

Do people get paid to rewrite interesting old thyroid knowledge ,mangle it / dumb it down so that it then informs no one of anything much.

Perhaps in a little while someone will rewrite this rewrite and make it say, "anyone with a normal TSH is normal , and anyone without a normal TSH is mad, so we don't need to treat any one at all for hypothyroidism" . ....... Simples !

[Jazzw]

I see that both authors work in the “Department of Psychiatry and Psychotherapy” so I guess they’re coming at this purely from that angle—that hypothyroidism is only rarely (in their view) a cause of “madness”.

But I bet it isn’t as rare as all that. I wouldn’t mind betting, for example, that quite a few cases of Hashimoto’s have been misdiagnosed as bipolar disorder (or at least, should have had hypothyroidism recognised as a contributory factor).

Eek. This sort of literature review thing always smacks of someone wanting something “published” so that they can claim to be professionals in their field without actually having to put in a lot of original effort. To me, anyway.

[RedApple in reply to Jazzw]

My thoughts exactly Jazzw.

[humanbean]

The phrase "easily treatable" implies that the appropriate treatment regime is easy to provide and is readily available. Clearly, if liothyronine is required, that is not the case.

Whether or not something is easily treatable is of interest but it is not the most important feature of myxoedema madness. What is important is the condition is recognised in the first place, because without recognition it won't get treated - and deaths could occur.

I'm sure I've read about people with central hypothyroidism who developed myxoedema madness. I can't find a link though - just this case report which doesn't mention myxoedema at all, but frankly I'm amazed that the woman didn't die given how low her Free T4 and Free T3 were.

edm.bioscientifica.com/view...

[helvella in reply to humanbean]

The clinical biochemist reviewed this lady’s blood results and elected to add on a free T4 (fT4) and free T3 (fT3), which were found to be <0.4 pmol/L (normal range (NR): 12–22 pmol/L) and 0.3 pmol/L (NR: 3.1–6.8 pmol/L), respectively.

Quite. The need for FT4 and FT3 to be done is just so obvious. To us.

[ShatteredofLee]

I find this report sad for many reasons. I strongly suspect my mother’s psychosis was undiagnosed hypothyroidism. Myself and her three daughters all have endocrine issues (2 hypos, 1 adrenal, 1 diabetic). This was 50 years ago and as a child I can remember the lack of care a middle aged woman received. No blood test. No investigations. She received ECT and anti psychotics. In hindsight the signs were all there, slow metabolism, short eyebrows, fluid retention, digestive issues. Maybe it’s the fact that a report like this reduces the human tragedy - maybe something more qualitative and from the grass roots up could provide a more humane explanation, and motivation to the medical profession of more in-depth tests and investigations when faced with psychosis. But it still doesn’t always happen.

[helvella in reply to ShatteredofLee]

When I post such things, I do see in my mind's eye some sort of picture of how people might be affected by what I quote and write.

But reading what you said is so much more powerful.

Thank you for replying.