Author/Authors :
Todorov, Louise AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Psychiatrie de l’Adulte et du SujetˆAg ́e - Paris, France , Raykeer, Rachel Pascal de AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Psychiatrie de l’Adulte et du SujetˆAg ́e - Paris, France , Lahlou-Laforêt, Khadija AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Psychiatrie de l’Adulte et du SujetˆAg ́e - Paris, France , Limosin, Frédéric AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Psychiatrie de l’Adulte et du SujetˆAg ́e - Paris, France , Lemogne, Cédric AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Psychiatrie de l’Adulte et du SujetˆAg ́e - Paris, France , Boudaoud, Amel Ait AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Nutrition - UF Endocrinologie-Diab ́etologie - Paris, France , Radu, Alina AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Nutrition - UF Endocrinologie-Diab ́etologie - Paris, France , Czernichow, Sébastien AP-HP - Hˆopitaux Universitaires Paris Ouest - Service de Nutrition - UF Endocrinologie-Diab ́etologie - Paris, France
Abstract :
Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported.However, less attention has been paid to suicidal behavior in these patients.Case Report. We report a case of suicide attempt byself-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves’ disease. Onclinicalexaminationremarkable signsofmyxedemawere foundandblood investigations showed hypothyroidism with anextremelyhigh thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptomsat the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapidphysical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse afterearly discontinuation of the antipsychotic treatment.Discussion. The most distinctive feature of our case is that the violent suicideattempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors,psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically considerordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violentsuicide attempts) are present and may result in premature transfer to psychiatric units
Keywords :
Violent Suicide Attempt , Context , Myxedema Psychosis following Radioiodine Treatment , Patient , Graves’ Disease , TSH
