Acute psychosis and concurrent rhabdomyolysis unveiling diagnosis of hypothyroidism

Abstract

Neuropsychiatric and muscular symptoms can develop as part of hypothyroidism. However, frank psychosis or rhabdomyolysis due to hypothyroidism are uncommon and have been reported rarely as the first presenting features of hypothyroidism. We report a case of a 44-year-old man who presented with a 2-week history of delusions, hallucinations and mild bilateral leg pain, without apparent signs of myxedema. Investigations revealed raised thyroid stimulation hormone >100 mIU/L and high creatine kinase >21 000 U/L. Diagnosis of hypothyroidism-induced psychosis and rhabdomyolysis was made. He received thyroxine, olanzapine and a short course of steroids. His symptoms improved after 2 weeks of treatment and he remained free of symptoms at 6 months of follow-up. To the best of our knowledge, this is the first case of concomitant psychosis and rhabdomyolysis leading to hypothyroidism diagnosis. This case highlights the importance of hypothyroidism screening when faced with unexplained psychosis or rhabdomyolysis, especially if combined.

Keywords: endocrine system; endocrinology; psychiatry; psychotic disorders (incl schizophrenia); thyroid disease.

Figure 1

Serum creatine kinase (CK) level during the patient’s hospitalisation. *The patient absconded on day five and did not take his thyroid treatment, which may explain the rise in CK in the following days, followed by a drop. *CK level was measured until day 12 of hospitalisation, and no further values could be obtained.