[Case of graves' disease with remarkable psychiatric symptoms]

A 42-year-old woman visited our hospital with palpitations, excessive sweating, and finger tremors in March 2011. She was diagnosed with Graves' disease based on the following test results: thyroid stimulating hormone < 0.01 μU/ml, free thyroxine 6.15 ng/ml, and thyrotropin receptor antibody 7.8 U/ml. Treatment with methimazole 30 mg and propranolol 30 mg was started, and her thyroid function showed improvement. However, significant manic symptoms, irritability, hallucinations, and delusions were noted, and she was hospitalized for her own protection in May 2011. Although treatment with aripiprazole 24 mg and lithium 400 mg was started, the hallucinatory and delusional symptoms persisted, necessitating adjustment of the antipsychotics. Her psychiatric symptoms showed amelioration in July 2011 after improvement in her thyroid function, and she was discharged from our hospital. After discharge, her thyroid function remained normal with methimazole 10 mg, and administration of the antipsychotics was discontinued. Affective psychotic symptoms such as altered mood and activity are frequently observed in cases with Graves' disease, but there have been few reports describing cases with full-blown psychiatric disorders manifesting with features such as hallucinations and delusions as the chief symptoms requiring hospitalized treatment, as in the present case. In symptomatic psychosis associated with Graves' disease, prolonged psychiatric symptoms might develop, and close cooperation with psychiatrists is thus important.