From the Research
Hypothyroidism can potentially cause auditory hallucinations, though this is not a common symptom, and treatment with levothyroxine (T4) is usually effective in resolving these symptoms. Severe untreated hypothyroidism, particularly myxedema, can lead to psychiatric symptoms including hallucinations, delusions, and psychosis. These neuropsychiatric manifestations occur because thyroid hormones are essential for normal brain function, and their deficiency can disrupt neurotransmitter systems and cerebral metabolism. The hallucinations typically resolve with proper thyroid hormone replacement therapy, usually with levothyroxine (T4) at doses individualized based on lab results and symptoms, starting at 25-50 mcg daily for older adults or those with cardiac issues, and 50-100 mcg daily for others, with adjustments every 6-8 weeks until thyroid levels normalize, as supported by recent studies such as 1.
Some key points to consider in the management of hypothyroidism and its potential psychiatric manifestations include:
- The importance of accurate diagnosis and treatment of hypothyroidism to prevent complications such as psychiatric symptoms
- The use of levothyroxine (T4) as the first-line treatment for hypothyroidism, with doses adjusted based on individual patient needs and lab results
- The potential for other causes of hallucinations to be present, and the need to investigate these thoroughly
- The importance of seeking immediate medical attention if hallucinations occur, as this represents a serious manifestation requiring prompt treatment, as discussed in 2.
It's also important to note that other causes of hallucinations should also be investigated, as they are more common than thyroid-related psychosis. The functional integrity of the thalamocortical projections to the primary auditory cortex and association cortex can be affected in hypothyroidism, as shown in 3, and treatment with thyroid hormone can improve these abnormalities. Overall, while hypothyroidism is not a common cause of auditory hallucinations, it is an important consideration in the differential diagnosis and treatment of patients with these symptoms.