When the thyroid goes silent: a case report of severe hypothyroidism leading to psychiatric crisis

Background

Historically, the term myxedema madness has been used to describe neuropsychiatric manifestations of advanced hypothyroidism. First documented in 1888 by the Clinical Society of London, it encompasses a spectrum of mental disturbances including delusions, hallucinations, melancholia, and paranoia. Although autoimmune hypothyroidism is common in clinical practice, its presentation with acute psychosis and suicidal behavior remains rare. Case Presentation: This paper presents a compelling case of a 28-year-old male migrant worker in Qatar with no prior psychiatric history, who was admitted following a serious suicide attempt. The patient exhibited florid psychotic symptoms, including hallucinations, religious delusions, and overwhelming guilt, culminating in self-injurious behavior. Laboratory investigations revealed profound hypothyroidism with markedly elevated thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase (anti-TPO) antibodies, confirming autoimmune etiology. The episode was later attributed to severe hypothyroidism. Prompt multidisciplinary intervention; comprising levothyroxine replacement and antipsychotic therapy led to rapid resolution of psychiatric symptoms and full clinical remission. The patient’s complete recovery following hormonal and psychiatric treatment supports the necessity of heightened clinical suspicion for endocrine etiologies in acute psychiatric settings.