{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:26Z","timestamp":1784557046601,"version":"3.55.0"},"reference-count":24,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2015,10,1]]},"abstract":"Summary<\/jats:title>\n Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism.<\/jats:p>\n \n Learning points<\/jats:title>\n \n \n \n Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease.<\/jats:p>\n <\/jats:list-item>\n \n Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging.<\/jats:p>\n <\/jats:list-item>\n \n Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically.<\/jats:p>\n <\/jats:list-item>\n \n The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding \u03b2 blockers.<\/jats:p>\n <\/jats:list-item>\n \n Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1530\/edm-15-0087","type":"journal-article","created":{"date-parts":[[2015,10,7]],"date-time":"2015-10-07T08:27:38Z","timestamp":1444206458000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":5,"title":["Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism"],"prefix":"10.1530","volume":"2015","author":[{"given":"V","family":"Larouche","sequence":"first","affiliation":[{"name":"1 Resident, Internal Medicine Residency Training Program, Department of Medicine, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Snell","sequence":"additional","affiliation":[{"name":"2 Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D V","family":"Morris","sequence":"additional","affiliation":[{"name":"3 Division of Endocrinology, McGill University Health Centre, Montreal, Quebec, H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref171","first-page":"26","article-title":"Acute psychosis caused by hypothyroidism following radioactive iodine treatment of Graves' disease","volume":"4","year":"2013","journal-title":"Journal of the Royal Society of Medicine Short Reports"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"922","DOI":"10.4103\/2230-8210.117220","article-title":"Acute mania after thyroxin supplementation in hypothyroid state","volume":"17","journal-title":"Indian Journal of Endocrinology and Metabolism"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.2169\/naika.72.1583","article-title":"Hypokalemia paralysis in a case with hyperthyroidism and idiopathic aldosteronism","volume":"72","year":"1983","journal-title":"Nihon Naika Gakkai zasshi. 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