A Rare Presentation of Severe Hypothyroidism With Catatonia and Psychosis: Myxedema Madness

Myxedema psychosis or “myxedema madness” is a rare, treatable, but potentially fatal neuropsychiatric manifestation of severe hypothyroidism. This case report presents a 46-year-old, unemployed, childless woman with progressive deterioration of her health over the last six months, including progressive lethargy, social withdrawal, poor intake, irritability, sound sensitivity, auditory hallucinations, urine and fecal incontinence, and complete neglect of personal hygiene. She had undergone total thyroidectomy and parathyroidectomy for which she was on levothyroxine, which she had discontinued. On physical examination, she was disoriented, having disorganized thinking, false belief of having cancer, fecal soiling, non-pitting edema of the lower limbs, and rigidity of the upper and lower limbs. Laboratory investigations showed hypoglycemia, hypokalemia, hypophosphatemia, severe hypothyroidism, and low morning cortisol. The CT scan of the brain revealed symmetrical calcification of bilateral basal ganglia, thalami, right corona radiata, and bifrontal subcortical white matter. She was started on levothyroxine, hydrocortisone, and aripiprazole. On day 16, she developed catatonic features, for which she was treated with lorazepam and aripiprazole, resulting in gradual improvement.