The Delayed Diagnosis of Thyroid Storm in Patients with Psychosis: A Report of Two Cases复制标题

精神病患者甲状腺风暴的延迟诊断 (附2例报告)

In the first case, the patient recognized worsening of her depression, a decreased food intake, and extensive fatigue. However, she adopted the “wait and see” approach, presuming her CNS symptoms associated with thyroid storm to be psychiatric in origin. In the second case, the patient had a history of palpitation and chest tightness. However, he initially discounted the symptoms and not informed his doctor. Thyroid storm is a lethal disease that requires early detection and treatment. If these patients had undergone thyroid hormone measurements when their mental or physical statuses had changed, we might have been able to detect and treat their thyroid conditions earlier. CNS manifestations of thyroid storm may include restlessness, delirium, mental aberration, somnolence, convulsions, and coma. However, depression, hypomania, and anxiety disorders are the most frequently reported psychiatric findings in patients with hyperthyroidism. The mechanisms for underlying these are thought to involve sympathetic nerve activation, increased β-adrenergic activity, and the autoimmune process. In addition, thyroid hormones are thought to have a modulating effect on the serotonin system in the brain and induce direct effects on cerebral tissue, which cause electroencephalogram abnormalities. However, why CNS manifestations appear during a thyroid storm are unclear. In Japan, CNS manifestations were been reported in 67.4% of patients with thyroid storm and 84.4% of patients with a definite diagnosis. More than half of patients with a definite diagnosis had an abnormal GCS (53.5%) and/or Japan Coma Scale score (62.6%). A lower GCS has been significantly associated with the development of irreversible deficits, making it essential that we correctly identify CNS manifestations in patients with a thyroid storm.

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