Myxedema madness: exploring a reversible psychosis with case review and discussion

Myxedema madness is a rare but severe neuropsychiatric manifestation of profound hypothyroidism, frequently mistaken for primary psychiatric illness due to its striking psychotic symptoms. We present the case of a 52-year-old woman with no prior psychiatric history who developed progressive persecutory delusions, auditory hallucinations, cognitive impairment, and psychomotor slowing over three months. Despite initial treatment with antipsychotics, her symptoms persisted. A broader clinical assessment, prompted by systemic features including weight gain, cold intolerance, constipation, menorrhagia, and generalized swelling, led to the diagnosis of severe hypothyroidism (TSH >100 mIU/L, free T4 <0.3 ng/dL) due to Hashimoto’s thyroiditis. Levothyroxine replacement therapy resulted in the complete resolution of both psychiatric and systemic symptoms within six weeks. This case emphasizes the necessity of thyroid function screening in atypical psychosis, underscoring how early recognition can prevent misdiagnosis and unnecessary psychiatric treatment. A comprehensive discussion contextualizes this case within the existing literature, reinforcing its clinical significance.