Mania as a presentation of primary hypothyroidism

Area of Science:

• Endocrinology
• Psychiatry
• Neuroscience

Background:

• Hypothyroidism, a common endocrine disorder, typically presents with diverse symptoms.
• Neuropsychiatric manifestations of hypothyroidism include depression, cognitive deficits, and psychosis.
• Mania is rarely reported as a primary presenting feature of hypothyroidism.

Observation:

• A case report details a 47-year-old woman with no prior psychiatric history presenting with mania and psychotic symptoms.
• The patient exhibited clear signs of severe hypothyroidism.
• Her symptoms improved with antipsychotic medication and thyroid hormone replacement therapy.

Findings:

• This case highlights mania as a potential presenting symptom of previously undiagnosed hypothyroidism.
• Literature review suggests a possible link between hypothyroidism and manic episodes, though pathogenesis remains unclear.
• A high index of suspicion for organic causes is necessary in patients with new-onset psychiatric disorders.

Implications:

• Clinicians should consider hypothyroidism in the differential diagnosis of mania, especially in the presence of other suggestive symptoms.
• Early detection and treatment of hypothyroidism can prevent prolonged or severe neuropsychiatric episodes.
• This case underscores the importance of a holistic approach integrating endocrine and psychiatric evaluations.