Document Type : Case Report


1 Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

4 Kharazmi University, Tehran, Iran

5 School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran



Introduction: Hypothyroidism is a common disorder of the endocrine system in which the production of thyroid hormones is inadequate. In addition to various physical manifestations, patients who suffer from hypothyroidism may also present with psychological problems, as described in previous studies.
Case Presentation: Herein, the reports of 2 patients who suffered from hypothyroidism and experienced improvement in their psychological symptoms after levothyroxine therapy are presented. The patients referred with depressive mood with psychotic features and psychomotor retardation. Treatment simultaneously with psychopharmacotherapy and hormone therapy was considered.
Conclusion: Although hypothyroidism and depressive disorders are separate issues, hypothyroidism can induce depression and psychosis, and psychopharmacotherapy plus hormone therapy can be effective and boost treatment.


  1. Ferreira AC, Caldeira M, Fraga C. Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited. Eur J Intern Med. 2011;22 Suppl 1:S15. doi:10.1016/S0953-6205(11)60058-7.
  2. Rao AC, Bhat VK, Kini S. Myxoedema presenting with psychosis. Indian J Psychiatry. 1990;32(3):287-289.
  3. Dayan CM, Panicker V. Hypothyroidism and depression. Eur Thyroid J. 2013;2(3):168-179. doi:10.1159/000353777.
  4. Engum A, Bjoro T, Mykletun A, Dahl AA. An association between depression, anxiety and thyroid function--a clinical fact or an artefact? Acta Psychiatr Scand. 2002;106(1):27-34. doi:10.1034/j.1600-0447.2002.01250.x.
  5. Forman-Hoffman V, Philibert RA. Lower TSH and higher T4 levels are associated with current depressive syndrome in young adults. Acta Psychiatr Scand. 2006;114(2):132-139. doi:10.1111/j.1600-0447.2005.00703.x.
  6. Roberts LM, Pattison H, Roalfe A, et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med. 2006;145(8):573-581. doi:10.7326/0003-4819-145-8-200610170-00006.
  7. Almeida OP, Alfonso H, Flicker L, Hankey G, Chubb SA, Yeap BB. Thyroid hormones and depression: the Health in Men study. Am J Geriatr Psychiatry. 2011;19(9):763-770. doi:10.1097/JGP.0b013e31820dcad5.
  8. Panicker V, Evans J, Bjoro T, Asvold BO, Dayan CM, Bjerkeset O. A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin Endocrinol (Oxf). 2009;71(4):574-580. doi:10.1111/j.1365-2265.2008.03521.x.
  9. Saravanan P, Visser TJ, Dayan CM. Psychological well-being correlates with free thyroxine but not free 3,5,3’-triiodothyronine levels in patients on thyroid hormone replacement. J Clin Endocrinol Metab. 2006;91(9):3389-3393. doi:10.1210/jc.2006-0414.
  10. Wekking EM, Appelhof BC, Fliers E, et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol. 2005;153(6):747-753. doi:10.1530/eje.1.02025.
  11. Whynbrow PC, Bauer M. Behavioral and psychiatric aspects of thyrotoxicosis. In:Braverman LE, Utiger RD, eds. Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Textbook. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2000:673-678.
  12. Whynbrow PC. Behavioral and psychiatric aspects of hypothyroidism. In: Braverman LE, Utiger RD, eds. Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Textbook. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2000:837-842.
  13. The Clinical Society of London. Report of acommittee to investigate the subject of myxoedema. Trans Clin Soc London. 1888;21(suppl):1-215.
  14. Reed K, Bland RC. Masked “myxedema madness”. Acta Psychiatr Scand. 1977;56(5):421-426. doi:10.1111/j.1600-0447.1977.tb06682.x.
  15. Dastjerdi G. Delusional type psychosis associated with hypothyroidism: A case report. Procedia Soc Behav Sci. 2013;84:1050-1052. doi:10.1016/j.sbspro.2013.06.697.