Thyroid Deficiency

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The most common hormonal cause of memory loss is thyroid deficiency. A patient whom I saw early in the course of my career illustrates the effects of thyroid deficiency in the brain.

A Villager Misdiagnosed

After finishing medical school, I began my residency training at the National Institute of Mental Health and Neurosciences in Bangalore, India. I vividly remember the day in 1979 when a villager brought in his mother, Ponnamma. He stated that his mother had begun to hallucinate and talk to herself for no apparent reason, but he was a poor historian and could not specify if these symptoms were long-standing or recent. Ponnamma was obese and slow in her movements. I admitted her to the inpatient ward with the diagnosis of psychosis, a term that covers a broad range of severe mental illnesses, including schizophrenia. I ordered a set of blood and urine tests and started treatment with chlorpromazine (Thorazine), a medication commonly used to treat psychosis at that time. I went home quite pleased with the day's work.

The next morning, I received a stunning jolt. My senior resident, Dr. Raghuram, who had been on night call, summoned me into his office and lambasted me. Ponnamma had become nearly comatose during the night, and he had been urgently summoned to see her. After a quick examination, he correctly identified the physical features of obesity, slow movements, and absent reflexes as signs of classical myxedema caused by severe thyroid deficiency. He immediately started her on thyroid hormone replacement therapy. The blood test results, received the next day, confirmed the diagnosis. Ponnamma made a steady recovery on thyroid replacement and was discharged to her home four weeks later, free of psychosis and cognitive deficits.

This episode easily qualifies as the worst diagnostic mistake of my professional career, and the memory of that event is still crystal clear in my mind. The following year, I left the institute and emigrated to the United States. During my periodic visits to India, I make it a point to give a couple of lectures at my old institute and shoot the breeze with my former colleagues, including Raghuram. His clinical acumen, which helped straighten me out when I was a greenhorn, has been recognized and rewarded. He recently became the head of the department of psychiatry at the same institute.

"Myxedema madness'' is caused by severe, prolonged thyroid deficiency, and is rarely seen these days because screening blood tests lead to early diagnosis and treatment. However, mild memory loss can result from mild to moderate forms of thyroid deficiency.

Symptoms of Hypothyroidism

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