Endocrine Abstracts

Background: The most common psychiatric syndromes in thyrotoxicosis are anxiety and mood disturbances. Psychosis, however, is a rare complication. Here is a report of such a case.

Case report: A twenty-six year old female presented with a 13 year history of palpitations, easy fatigability and anterior neck mass. Patient denies any comorbid conditions. No family history of psychiatric illness. On March 2011, she was admitted due to logorrhea, auditory hallucinations, delusion of persecution and frequent attention calling from family members, and suicidal ideations. Clinically she was thyrotoxic with a diffuse goiter. FT₄ 39.6 pmol/l (11–24) and TSH <0.005 μIU/l (0.3–2.8). There was no evidence of infection. Diagnosis of thyrotoxic psychosis was made, and was started on Propylthiouracil 150 mg q8 and Propranolol 40 mg BID.

After her marked improvement, she was discharged on Propylthiouracil, Propranolol, Olanzapine and Clonazepam. All her psychiatric symptoms gradually resolved and weaned off from Olanzapine and Clonazepam. During her regular follow up, there was note of occasional episodes of agitation. Six months later, after euthyroidism was achieved, patient underwent radioactive ablation, with complete resolution of her psychiatric symptoms.

Conclusion: Thyrotoxicosis may be a precipitant of acute psychosis. This can be promptly controlled with the use of anti-thyroid drugs. Concomitant psychotropic drugs maybe indicated if the symptoms are severe. In cases of treatment failure, a more radical approach such as radioactive iodine ablation and thyroidectomy maybe considered.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.