A rare case of recurrent psychosis with hypothyroidism precipitating catatonia

Hypothyroidism is a common condition that is readily diagnosed but potentially fatal in severe cases if untreated. It may rarely present with acute psychosis or catatonia. A 40-year-old lady presented with a 15-day history of auditory hallucinations, delusions, and bilateral nonpitting pedal edema, followed by catatonic symptoms after stopping thyroxine. She has a history of hypothyroidism and has experienced two episodes of psychosis in the past, but she was not compliant. She was mute and uncooperative during the examination. After being diagnosed with catatonia, 2 mg of lorazepam was administered intravenously, and after 10 min, she began speaking. Thyroxine 100 μg/day (thyroid-stimulating hormone-10.78 IU/mL), risperidone, and lorazepam were prescribed for her. Within 5 days, she showed a 70% improvement in catatonic symptoms with residual psychotic symptoms. Psychosis with myxedema-induced catatonia is a rare, potentially fatal, hypothyroidism manifestation. Thus, hypothyroidism should be evaluated in all cases of acute psychosis.