Case Report

"Thyrotoxic Psychosis" Associated With Subacute Thyroiditis

Authors: Ali A. Rizvi, MD, FACP, FACE

Abstract

Severe psychiatric derangements are a rare manifestation of Graves disease or toxic goiter. An 18-year-old male college student was hospitalized with depression and psychotic behavior. He was found to have thyrotoxicosis due to subacute thyroiditis, as evidenced by a reduced radioactive iodine uptake, elevated thyroglobulin level, and spontaneous remission into a hypothyroid phase. His behavioral abnormalities resolved with progressive normalization of thyroid function. To our knowledge, this is the first reported case of the self-limited condition of subacute thyroiditis causing ‘thyrotoxic psychosis' and serves to remind clinicians of this association when treating patients in clinical practice.


Key Points


* Behavioral abnormalities leading to psychosis can be a manifestation of severe thyrotoxicosis due to Graves disease and toxic goiter.


* Thyroidal inflammation as in subacute thyroiditis can precipitate features of schizophrenia, mania, psychotic depression and paranoid behavior severe enough to require inpatient treatment.


* These features ameliorate with resolution of the thyrotoxic state.


* A high index of suspicion, careful clinical evaluation, and the use of radioactive iodine uptake in suspected cases are all helpful for a definitive diagnosis of subacute thyroiditis.

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