Elsevier

General Hospital Psychiatry

Volume 34, Issue 2, March–April 2012, Pages 210.e1-210.e4
General Hospital Psychiatry

Case Report
A rare storm in a psychiatric ward: thyroid storm

https://doi.org/10.1016/j.genhosppsych.2011.08.013Get rights and content

Abstract

We present the case of a previously healthy man in whom acute psychosis masked the major symptomatology of thyroid storm. This patient highlights the importance of taking into consideration a life-threatening condition, thyroid storm, in the differential diagnosis of acute psychosis, even in the absence of a history of thyrotoxicosis.

Introduction

Thyroid hormones play important roles in brain development and function. Most adults with thyroid dysfunction will develop mental symptoms. In patients with thyrotoxicosis, adrenergic hyperactivity by thyroid hormones may be a major cause of psychiatric symptoms [1]. Thyroid–brain interactions and neuropsychiatric symptoms in thyroid disorders have been discussed in detail in the review by Bauer et al [2]. Thyroid storm is a rare but life-threatening condition caused by exaggerated thyrotoxic manifestations. The most important clinical management in thyroid storm is early recognition and treatment. We discuss the case of a patient with thyroid storm who initially presented with acute psychosis, which was followed by suspected gastrointestinal tract infection that developed while he was in the psychiatric ward. This case serves to illustrate that psychiatric disorders can be manifestations of an endocrine emergency.

Section snippets

Case report

In September 2010, a 55-year-old man was admitted to our psychiatric ward with a 1-week history of visual and auditory hallucination, violent behavior and persecutory delusion. No fluctuation in consciousness was noted. His medical and family history did not reveal any psychiatric disorders. Screening for alcohol and drug ingestion yielded negative results. He was initially treated with midazolam and quetiapine.

On the third day of hospitalization, spiking fever was up to 39°C and diarrhea

Discussion

Thyroid storm is a rare but life-threatening condition caused by exaggerated thyrotoxic manifestations, including advanced fever, marked tachycardia, gastrointestinal dysfunction and central nervous system involvement varying from agitation and psychosis to coma [3]. The overall mortality rate is between 10% and 75% [3]. The most important clinical management in thyroid storm is early recognition and treatment. Herein, we reported a rare case in which the patient presented initially with acute

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