Case Report

"Thyrotoxic Psychosis" Associated With Subacute Thyroiditis

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


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.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Bursten B. Psychoses associated with thyrotoxicosis. Arch Gen Psychiatry 1961;4:267–273.
2. Greer S, Parsons V. Schizophrenia-like psychosis in thyroid crisis. Br J Psychiatry 1968;114:1357–1362.
3. Fehling G, Mork JN. Thyrotoxicosis as a cause of psychosis. Minn Med 1977;60:169–171.
4. Kua EH. Hyperthyroid psychosis. Med J Malaysia 1982;37:60–61.
5. Tan Chee Khuan. Psychoses associated with thyrotoxicosis: a retrospective study of twenty cases.Med J Malaysia 1985;40:247–251.
6. Brownlie BE, Rae AM, Walshe JW, et al. Psychoses associated with thyrotoxicosis: ‘thyrotoxic psychosis': a report of 18 cases, with statistical analysis of incidence. Eur J Endocrinol 2000;142:438–444.
7. Irwin R, Ellis PM, Delahunt J. Psychosis following acute alteration of thyroid status. Aust N Z J Psychiatry 1997;31:762–764.
8. Caudill TG, Lardinois CK. Severe thyrotoxicosis presenting as acute psychosis. West J Med1991;155:292–293.
9. Ross DS. Syndromes of thyrotoxicosis with low radioactive iodine uptake. Endocrinol Metab Clin North Am 1998;27:169–185.
10. Joffe RT, Levitt AJ. Thyroid function in psychotic depression. Psychiatry Res 1990;33:321–322.
11. Spratt DI, Pont A, Miller MB, et al. Hyperthyroxinemia in patients with acute psychiatric disorders.Am J Med 1982;73:41–48.
12. Nader S, Warner MD, Doyle S, et al. Euthyroid sick syndrome in psychiatric inpatients. Biol Psychiatry 1996;40:1288–1293.
13. Lassen E, Ewald H. Acute organic psychosis caused by thyrotoxicosis and vitamin B12 deficiency: case report. J Clin Psychiatry 1985;46:106–107.
14. Gilvarry CM, Sham PC, Jones PB, et al. Family history of autoimmune diseases in psychosis.Schizophr Res 1996;19:33–40.
15. Lazarus A, Jaffe R. Resolution of thyroid-induced schizophreniform disorder following subtotal thyroidectomy: case report. Gen Hosp Psychiatry 1986;8:29–31.
16. Tikkanen MJ, Lamberg BA. Hypothyroidism following subacute thyroiditis. Acta Endocrinol (Copenh)1982;101:348–353.