January - March 2008, Volume 4, Issue 1

Ursu HI, Barbu I, Sima D, Manea M, Suciu I, Alexandrescu D

Thyrotoxic psychosis - two case reports

Acta Endo (Buc) 2008, 4 (1): 99-105
doi: 10.4183/aeb.2008.99

Alteration in nervous system function in patients with thyrotoxicosis is frequent. In rare cases, mental disturbances may be severe: maniac-depressive, schizoid or paranoid reaction. The pathophysiologic basis of these nervous system findings is not well understood. The first patient, being on treatment with benzodiazepine and Risperidone for mood deterioration, was admitted in Thyroid Unit 1 for clinical features suggesting addition, he developed auditory and visual hallucinations, bizarre behavior, disorganized speech, disorientation, poor attention and loss memory for recent events, having a good clinical response after addition of antithyroid drug therapy. The second case developed clinical features suggesting thyrotoxicosis, associated with visual and auditory hallucinations, marked psychomotor agitation and bizarre behavior. After an unsuccessful monotherapy (Risperidone), a good response of clinical features (including psychiatric symptoms) to combined therapy (Methimazole and Risperidone) was recorded. The diagnosis of Graves’ disease was based on clinical and laboratory data (suppressed serum TSH level, elevated serum FT3) and ophthalmological examination or positive anti - TPO antibodies. Both patients were successfully treated with combined therapy - Methimazole and Risperidone. Both case reports demonstrate the importance of performing thyroid function tests in patients with acute psychosis.

Keywords: Graves’ disease, visual and auditory hallucination, acute psychosis

Correspondence: Horea Ursu, “C.I. Parhon” Institute of Endocrinology, 34-36 Bd Aviatorilor, Bucharest, 011836, Romania, e-mail: horeaursu@hotmail.com