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Hyperthyroidism Presenting With Mania and Psychosis: A Case Report.

Haris Asif1, Ifediba Nwachukwu1, Arshan Khan2

  • 1Internal Medicine, Woodhull Medical Center, New York, USA.

Cureus
|March 23, 2022
PubMed
Summary

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This case highlights that psychosis can be a rare symptom of Graves' disease (an autoimmune thyroid disorder). Prompt diagnosis and treatment of hyperthyroidism are crucial for symptom resolution.

Area of Science:

  • Endocrinology
  • Psychiatry

Background:

  • Graves' disease is a common cause of thyrotoxicosis, typically presenting with hyperthyroid symptoms.
  • Psychiatric manifestations, such as psychosis, are uncommon in hyperthyroidism.

Observation:

  • A 37-year-old male with a history of Graves' disease and poor medication adherence presented with acute psychosis, agitation, paranoia, and hyperactivity.
  • Initial assessment suggested a primary psychiatric disorder due to the absence of prior psychiatric history.

Findings:

  • Laboratory results revealed suppressed thyroid-stimulating hormone (TSH) with elevated T3, T4, thyroid-stimulating antibodies (TSAb), and thyroid peroxidase antibodies (TPOAb).
  • The patient's symptoms resolved after treatment with methimazole, propranolol, and hydrocortisone, confirming thyrotoxicosis as the cause.
Keywords:
hyperthyroidismhyperthyroidism induced maniahyperthyroidism induced psychosismaniapsychosissecondary mania

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Implications:

  • This case underscores the importance of considering thyrotoxicosis in the differential diagnosis of new-onset psychosis, even without a prior psychiatric history.
  • Early recognition and management of Graves' disease are essential to prevent severe neuropsychiatric complications.