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Thyroid Deficiency

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