Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

[摘要] Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary tolong-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madnessfollowing 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 delusions3 months after treatment with radioactive iodine ablation for Graves’ disease. Her psychiatric symptoms abated withlevothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronismfrom bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be acomplication of acute hypothyroidism following radioactive iodine ablation of Graves’ disease and that primaryhyperaldosteronism may be associated with autoimmune hyperthyroidism.

[学科分类] 血液学

[关键词] Adult;Female;Other;Canada;Thyroid;Thyroid;Aldosterone;Mineralocorticoids;Hyperaldosteronism;Conn's syndrome;Idiopathic bilateral adrenal hyperplasia;Iatrogenic disorder;Graves' disease;Psychosis;Myxoedema;Hypokalaemia;Hypertension;Paranoia;Anxiety;Aldosterone (blood);Aldosterone to renin ratio;Cortisol;Renin (blood);CT scan;Blood pressure;Salt loading;ACTH stimulation;FT4;Thyroid antibodies;FT3;TSH;Adrenal venous sampling;Radionuclide therapy;Levothyroxine;Potassium chloride;Risperidone;Amiloride;Dopamine antagonists;Nifedipine;General Internal Medicine;Unique/unexpected symptoms or presentations of a disease;October;2015