Recognizing thyrotoxicosis in a patient with bipolar mania: a case report

Abstract

BackgroundA thyroid stimulating hormone level is commonly measured in patients presenting with symptoms of mania in order to rule out an underlying general medical condition such as hyperthyroidism or thyrotoxicosis. Indeed, many cases have been reported in which a patient is initially treated for bipolar mania, but is later found to have a thyroid condition. Several case reports have noted the development of a thyroid condition in bipolar patients either on lithium maintenance treatment or recently on lithium treatment.Case presentationWe review a case in which a patient with a long history of bipolar disorder presents with comorbid hyperthyroidism and bipolar mania after recent discontinuation of lithium treatment.ConclusionPhysicians should consider a comorbid hyperthyroidism in bipolar manic patients only partially responsive to standard care treatment with a mood stabilizer and antipsychotic.

Thyroid Functions and Bipolar Affective Disorder

“…However, overt psychiatric disorder is rare and occurs in only about 10% of the patients [ 1 , 5 ]. Manic episodes have been known to occur in patients with hyperthyroidism, but are quite unusual [ 9 ]. Occasionally, patients with late-onset mania are detected to have hyperthyroidism, which requires to be treated to achieve full recovery [ 10 ].…”

Psychosis as the sole presenting feature of hyperthyroidism: a case report

“…7 However, thyrotoxicosis by itself can aggravate the psychiatric manifestations. 8 Psychosis crisis must be evaluated thoroughly for common diseases as trauma, autoimmune diseases, drugs, iatrogenic causes, cerebrovascular accidents, malignancies, congenital disorders, metabolic disturbances (electrolytes, glucose levels), sepsis, neurological infections, Addison disease, hyperparathyroidism, temporal lobe epilepsy, and schizophrenia. 9,10 Thyroid hormones play an important role in the regulation of mood and the spectrum of neuropsychiatric features associated with thyroid diseases can be very wide.…”

Psychosis Crisis Associated with Thyrotoxicosis due to Graves’ Disease

“…In contrast, psychiatric manifestations are commonly associated with hypothyroidism in the form of “myxedema madness” or are related to a quick correction of high levels of thyroid hormones (fT4) [ 12 ]. However, even when psychosis could have an independent cause (e.g., a primary disease), thyrotoxicosis by itself could worsen psychiatric manifestations [ 13 ]. In fact, it seems that adrenergic hyperactivity observed in patients with hyperthyroidism could influence certain brain functions.…”