Abstract Disclosure: S. Bilichodu Rangappa: None. S. Avula: None. Z.A. Anderson: None. A. Kumar: None. Introduction: Traditionally, psychiatric symptoms were thought to be common manifestation of hypothyroidism. However, in the recent times the trend has changed. Various studies have shown a strong association of hyperthyroidism and psychosis. Thyrotoxicosis is associated with various psychiatric symptoms such as anxiety, restlessness, emotional liability, depression, mania, and rarely acute psychosis. Association between thyroid and mental health is a long-known entity but poorly understood pathophysiology. Here we present a case of graves disease presenting as acute psychosis as initial presentation. Clinical Case: A 45-year-old male with no significant past medical history was brought to emergency department (ED) by police after he was found to be walking in front of a shopping mall and was severely agitated. On arrival to ED, he was found to be very restless, irritable, and aggressive. Patient was found to have persecutory delusions and auditory hallucinations. His blood pressure was elevated, and he had tachycardia. He was given Haloperidol to calm down. Patient was evaluated with blood work and urine toxicology. Blood work up showed thyroid stimulating hormone (TSH) of <0.01m IU/L, Free T4 of 4 ng/dl and Total T3 of 380 ng/dl. Patient was started on Methimazole and propranolol. On further work up for thyrotoxicosis there was elevated thyroid stimulating immunoglobulin (TSI) which was consistent with Grave’s disease. Ultrasound thyroid revealed diffuse enlarged thyroid with increased vascularity. Once the patient was stable, he was further interviewed, he gave a history of palpitations, increased anxiety, and weight loss for two months, but he didn’t seek any medical attention. By the time of discharge, he symptomatically improved and his Free T4 and total T3 trended down. Patient was discharged on methimazole 10 mg daily along with propranolol. Conclusion: Graves’s disease can mimic psychosis. Psychosis may develop in the wake of thyroid hormone excess. Future research is warranted to find out the relation between psychotic disorders and excess thyroid hormone and the pathological process involved. It also helps in having clear treatment guidelines which will reduce the morbidity and improves the quality of life. Identifying somatic causes for psychiatric issues will help in treating them and might lead to complete recovery and not needing any further psychiatric medications. Presentation: Friday, June 16, 2023
Read full abstract