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2015 ; 2015
(ä): 150087
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Iatrogenic myxoedema madness following radioactive iodine ablation for Graves
disease, with a concurrent diagnosis of primary hyperaldosteronism
#MMPMID26525086
Larouche V
; Snell L
; Morris DV
Endocrinol Diabetes Metab Case Rep
2015[]; 2015
(ä): 150087
PMID26525086
show ga
Myxoedema madness was first described as a consequence of severe hypothyroidism
in 1949. Most cases were secondary to long-standing untreated primary
hypothyroidism. We present the first reported case of iatrogenic myxoedema
madness following radioactive iodine ablation for Graves' disease, with a second
concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented
with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid
delusions 3 months after treatment with radioactive iodine ablation for Graves'
disease. Her psychiatric symptoms abated with levothyroxine replacement. She was
concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism
from bilateral adrenal hyperplasia was diagnosed. This case report serves as a
reminder that myxoedema madness can be a complication of acute hypothyroidism
following radioactive iodine ablation of Graves' disease and that primary
hyperaldosteronism may be associated with autoimmune hyperthyroidism. LEARNING
POINTS: Psychosis (myxoedema madness) can present as a neuropsychiatric
manifestation of acute hypothyroidism following radioactive iodine ablation of
Graves' disease.Primary hyperaldosteronism may be caused by idiopathic bilateral
adrenal hyperplasia even in the presence of an adrenal adenoma seen on
imaging.Adrenal vein sampling is a useful tool for differentiating between a
unilateral aldosterone-producing adenoma, which is managed surgically, and an
idiopathic bilateral adrenal hyperplasia, which is managed medically.The
management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary
hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients
planning pregnancy includes delaying pregnancy 6 months following radioactive
iodine treatment and until patient is euthyroid for 3 months, using amiloride as
opposed to spironolactone, controlling blood pressure with agents safe in
pregnancy such as nifedipine and avoiding ? blockers.Autoimmune hyperthyroidism
and primary hyperaldosteronism rarely coexist; any underlying mechanism
associating the two is still unclear.