Thursday, September 22, 2005

30 Year Follow Up of Toxic Psychosis Secondary to Hyperthyroid Graves' disease

63 Y/O Female returns for her yearly examination, S/P subtotal thyroidectomy 30 years ago, for Graves' hyperthyroidism, on T4 replacement therapy. Her story is amazing.

At age 33 she had a 50 pound weight loss, and severe anxiety to the point of admission for psychosis. While being treated on the Psych ward, a total T4 was drawn and was 20. n 4.2-12.
She was paranoid, and stated 3 men broke into her house. One of them was a well known
actor. People were talking about her outside her window all night. She was mad all the time, and lost her temper, and could not work. Her employer stated she was a very normal employee for 10 years with no sick days. She had other Sx of hyperthyroidism, such as tremo.. Smooth soft skin, muscle weakness, sweats, and palpitations. There was no FH of thyroid disease, but her dad killed himself after returning from army combat.

I saw her 10 days after admission, and she had a dull stare, drooling from the mouth, and a coarse tremor. She had smooth soft skin, pulse of 136, and a diffuse smooth goiter 2-3 times normal size.

She was on large doses of Thorazine. She was under the care of a conservator due to her acute
mental illness. She was considered an endocrine emergency, and under Inderal blockade, she had an uneventful total thyroidectomy. She was kept on Thorazine for 6 week post surgery, became euthyroid and was never treated again for mental illness.Not even a tranquilizer, for 30 years! She had a recurrence of hyperthyroidism 3 years later, that was treated with radioiodine, but there was no flare up of mental illness. She return to her job, and has spent the last 30 years mentally "normal".
She had examinations by experts in mental illness after her recovery, and they found no abnormal thought processes. I have seen her twice a year since 1976, and she is a very normal lady.


No comments: