Psychosis Crisis Associated with Thyrotoxicosis due to Graves’ Disease

Abstract

We present the case of a patient with previous psychiatric illness, acutely exacerbated by thyroid storm due to Graves' disease, in whom treatment with antipsychotics induced catatonia. These associations are extremely rare and may be confused with Hashimoto's encephalopathy, especially in the presence of anti-thyroid antibodies in cerebrospinal fluid. The treatment consists in the control of the triggering disease (in this case the resolution of the thyrotoxicosis) and the use of benzodiazepines. However, in some cases, the resolution of psychiatric symptoms is partial and may require the use of electroconvulsive therapy.

The Intertwined Relationship Between an Overactive Thyroid and an Overactive Mind: A Case Report and Review of Literature

“…It is not uncommon for individuals with Graves' disease and other forms of thyrotoxicosis to display subtle neuropsychiatric abnormalities such as irritability, anxiety, sleep disturbances, confusion, mood changes, and memory deficits [ 4 ]. In the United States, thyrotoxicosis affects 1.2% of the population, with 0.5% overt cases and 0.7% subclinical cases [ 6 ].…”

“…Traditionally, psychiatric manifestations were predominantly linked to hypothyroidism. However, emerging research has revealed that hyperthyroidism, characterized by an excess of thyroid hormones, can also lead to a wide range of psychiatric symptoms [ 3 , 4 ]. Patients with thyrotoxicosis, the state of excessive thyroid hormone production, may exhibit symptoms such as anxiety, restlessness, emotional lability, depression, mania, and, in rare cases, acute psychosis, paranoia, and schizophreniform features [ 1 , 4 ].…”

“…The connection between thyroid dysfunction and mental health has been a subject of interest in the medical community for many years. While the association between hypothyroidism and psychiatric symptoms is well-established, there is a growing body of evidence suggesting a strong link between hyperthyroidism, particularly in the form of Graves' disease, and acute psychosis [ 3 , 4 ].…”

Management of Psychosis Associated with Graves’ Disease: A Rare Case Report

“…The psychosis can be managed with the administration of antipsychotic agents [ 8 ]. However, caution should be maintained as treatment with antipsychotics may lead to catatonia [ 9 ]. In addition, mood stabilizers and antidepressant can be used for better control of symptoms [ 8 , 10 , 11 ].…”

Catatonia and the immune system: a review

“…82,83 Dietary vitamin B12 deficiency might also cause catatonia. 84,85 In thyroid disease, catatonia has been reported in patients with thyroid autoantibodies with hyper thyroid, [86][87][88] hypothyroid, 90,91 and euthyroid 91,92 states. However, catatonia has also occurred in hypothyroidism due to thyroidectomy; 93 whether thyroid status or the presence of the autoantibodies is the causally relevant factor therefore remains unclear.…”