Abstracting and Indexing

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Introduction: Hyperthyroidism commonly presents with hypermetabolic symptoms such as weight loss, tachycardia, and tremors. While neuropsychiatric manifestations like anxiety and insomnia are frequently observed, the occurrence of overt psychosis without prior psychiatric history is rare, affecting less than 1% of hyperthyroid patients.

Methods: We report the case of a 47-year-old female who presented with acute-onset psychosis, including persecutory delusions, second-person auditory hallucinations, and severe agitation. A detailed physical and biochemical evaluation was conducted alongside psychiatric and endocrinological assessments.

Results: The patient exhibited fine distal tremors, a low-grade fever (37.8 °C), and tachycardia (heart rate 128 bpm). Laboratory findings showed elevated free thyroxine (56 pmol/L; reference: 9–20), triiodothyronine (19 pmol/L; reference: 3–6), and suppressed TSH (<0.01 mIU/L). Thyroid-stimulating immunoglobulins and ultrasound findings confirmed Graves’ disease. She was treated with carbimazole (20 mg/day), propranolol (40 mg TID), and low-dose haloperidol (5 mg/day), resulting in full resolution of psychiatric symptoms within two weeks.

Conclusion: This case highlights the importance of considering thyroid dysfunction in the differential diagnosis of acute psychosis.