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This is the first longitudinal
possible psychosis resulting from the juvenile onset of hypothyroidism. A 10-year follow-up
the case of a 13-year-old boy published in this journal in 1993 is presented. The patient
with a diagnostic dilemma. Although psychosis resulting from hypothyroidism was
most parsimonious explanation of his symptoms (new-onset auditory
severe obsessions, and severe hypothyroidism), a primary psychiatric
(obsessive-compulsive disorder [OCD] or psychotic depression)
by hypothyroidism could not be excluded. The aim of this study was to
that the diagnosis and clinical interrelationships can be clarified by
Follow-Up Data: The patient’s
responded optimally to a combination of fluvoxamine, risperidone, and levothyroxine (LT4,
?g daily). He was free from severe symptoms until age 21, when he discontinued
psychotropic medications while continuing with LT4. Over 2 months later, he was
for thoughts of hurting himself or others. In the hospital, his LT4 was discontinued and
was started. He was discharged on multiple psychotropic medications, and was
6 days later for suicide risk. When LT4 (200 ?g daily) was added to his
regimen, he partially responded and was discharged.
The optimal response to treatment
only after he was placed on a combination of fluoxetine, risperidone, and LT4
?g daily). The patient remained stable for up to 12 months of follow-up.
Conclusions: This chronology
the optimal treatment in this patient probably required three components: a
Serotonin Reuptake Inhibitor, (SSRI) risperidone, and LT4 (300 g daily). Each
was apparently necessary but not sufficient individually for the optimal response. The
after the discontinuation of fluvoxamine and risperidone (but not LT4) suggests
presence of a primary psychiatric disorder (OCD with depression). The failure to improve
an adequate dosage of LT4 suggests that hypothyroidism
was probably an aggravating factor.
case illustrates the diagnostic difficulty
in distinguishing between
depressive ruminations, and delusions in children and the need to
hypothyroidism in the differential diagnosis of the sudden worsening of OCD, or in cases of
psychosis in children and adolescents.
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