Case ReportA rare storm in a psychiatric ward: thyroid storm
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
References (18)
- et al.
Life-threatening thyrotoxicosis. Thyroid storm
Endocrinol Metab Clin North Am
(1993) - et al.
Thyrotoxicosis and thyroid storm
Endocrinol Metab Clin North Am
(2006) - et al.
Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves' disease
Gen Hosp Psychiatry
(2005) Hashimoto's encephalopathy: myth or reality? An endocrinologist's perspective
Best Pract Res Clin Endocrinol Metab
(2005)- et al.
Psychosis
Emerg Med Clin North Am
(2000) - et al.
Thyroid disease and mental disorders: cause and effect or only comorbidity?
Curr Opin Psychiatry
(2010) - et al.
The thyroid–brain interaction in thyroid disorders and mood disorders
J Neuroendocrinol
(2008) - et al.
Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association
JAMA
(1995) - et al.
Behavioral and psychiatric aspects of hypothyroidism
Cited by (6)
Postpartum psychosis in a woman with Graves' disease: A case report
2014, General Hospital PsychiatryPsychotic depression secondary to hyperthyroidism and lethal outcome by thyrotoxic storm: case report
2022, Revista de Neuro-PsiquiatriaThyroid emergencies in critically ill cancer patients
2019, Oncologic Critical CareEndocrine disease
2019, Fundamentals of Consultation Liaison Psychiatry: Principles and PracticeThyroid Storm Presenting as Psychosis
2018, Journal of Investigative Medicine High Impact Case ReportsSecondary psychoses: An update
2013, World Psychiatry