Hypothyroidism-Induced Psychotic Disorder with Prolonged Antipsychotic Treatment: A Case Report

Hypothyroidism, a common thyroid disorder, is typically associated with affective and cognitive symptoms. However, up to 15% of patients may also present psychotic symptoms, which represents a relatively rare and poorly understood manifestation. Existing literature on this condition consists primarily of isolated case reports, which describe short courses of antipsychotic treatment. In contrast, the present case illustrates a prolonged and more complex trajectory, contributing to a better understanding of the psychiatric presentations of hypothyroidism and their management.

We report the case of a 42-year-old man hospitalized for violent behavior toward others and overt psychotic symptoms in untreated hypothyroidism. Tests revealed elevated thyroid-stimulating hormone levels of 34.925 mIU/L. Clinical evaluation confirmed significant psychiatric disturbance necessitating inpatient care. A diagnosis of secondary psychotic disorder due to hypothyroidism was established. The patient required prolonged antipsychotic treatment, and an initial attempt to discontinue treatment was unsuccessful. A second withdrawal attempt made several months later was successful, with full recovery and complete remission of symptoms. This remission was maintained despite recurrent thyroid-stimulating hormone level elevation, while thyroxine hormone levels remained within the normal range.

This case illustrates the importance of ruling out non-psychiatric medical causes in the differential diagnosis of psychiatric symptoms. It also highlights the need for individualized treatment plans and sustained follow-up, particularly in rare and poorly understood conditions for which no formal guidelines or standardized management protocols exist.