, Volume 4, Issue 4, pp 359-360
Date: 19 May 2009

Psychosis as the first presentation of hyperthyroidism

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A 40-year-old married woman was brought to the emergency department (ED) by her family members for agitation, paranoia and hallucinations. Before 6 months, she had gradually increasing appetite, thirst, loss of weight, insomnia and occasional nervousness without any apparent reason. Three months prior, she started having anxiety, was preoccupied, irritable and restless. Subsequent worsening led to additional features of psychomotor agitation, paranoid ideas and auditory hallucinations. She had otherwise been healthy, and did well on her job and with interpersonal relations. She had a history of Graves’ disease 5 years earlier, which was in remission after treatment with propylthiouracil (PTU) for 2 years. She denied any history of substance abuse.

Physical examination revealed a normal temperature, tachycardia with a heart rate of 110 beats/min, moist skin, fine tremors and a lid lag with a facial appearance of staring. A diffusely enlarged thyroid gland with bruit was also noted. Relap