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Hyperthyroidism Associated with Delirium: 3 Cases Report
併有譫妄狀態的甲狀腺功能亢進：三病例報告
摘要
併有譫狀態的甲狀腺功能亢進是少見的，但值得注意，因為早期發現與治療都有不錯的預後。本文描述三個個案因併有譫妄狀態的甲狀腺功能亢進。三個個案全是女性，年齡從59-75歲，只有一位有甲狀腺疾病史。出現的精神症狀包括意識混亂、躁動、情緒不穩、妄想、幻覺、語無倫次、失去定向感及認知功能的缺損。治療方面，兩個病人接受抗甲狀腺和抗精神藥物治療，另一個病人僅接受抗甲狀腺藥物治療。三個個案的譫妄狀況在兩星期內都完全恢復。一般病史、身體和神經檢查及實驗室測驗將可確認大多數內科問題引起的譫妄狀況，但併有譫妄狀態的甲狀腺功能亢進卻常受忽略，因為有時呈現的症狀並不典型。患者若有甲狀腺疾病史或家族史、長期混亂狀態或年紀大的女性，特別需要測定其甲狀腺功能。治療方面以直接控制精神症狀和恢復甲狀腺正常功能為主，但抗精神藥物需及早停止，以避免神經毒性。內科和精神科醫師聯合照會併有譫妄狀態的甲狀腺功能亢進的個案，將更有助於這一類疾病的診斷與治療。
並列摘要
Delirium caused by hyperthyroidism is rarely described in the literature but, because it often has a good prognosis with early detection and treatment, it is important. Three cases are presented to illustrate hyperthyroidism, with a delirious state. All patients were female, aged from 59 to 75 years old. They presented different psychiatric, symptoms including conscious disturbance, incoherent speech, agitation, delusion, hallucination and impairment of cognitive function. Only one of them had a thyroid disorder history, and none had a psychiatric history. Two patients accepted both antithyroid and neuroleptic medication therapy. The third accepted antithyroid medication therapy alone. All the patients recovered completely within two weeks of treatment. It is suggested that thyroid function tests are needed in the study of delirium, especially when a patient has a past history or family history of thyroid disease, prolonged confused states, or is an elderly female. Treatment should be directed at control of psychotic symptoms and the restoration of thyroid function. Neuroleptics should be tapered early to avoid neurotoxicity. With adequate treatment, patients often completely recover from the delirious state. The incorporation of internist and psychiatrist into the routine care of hyperthyroid patients with delirious state may improve the mental and physical conditions of the patient.