title: Subacute thyroiditis presenting as acute psychosis: a case report and literature review.
abstract: We describe herein an unusual case of subacute thyroiditis presenting as acute psychosis. An 18-year-old male presented at the emergency department due to abnormal behavior, psychomotor agitation, sexual hyperactivity, and a paranoid mental state. Laboratory findings included an erythrocyte sedimentation rate of 36 mm/hr (normal range, 0 to 9), free T4 of 100.0 pmol/L (normal range, 11.5 to 22.7), and thyroid stimulating hormone of 0.018 mU/L (normal range, 0.35 to 5.5). A technetium-99m pertechnetate scan revealed homogeneously reduced activity in the thyroid gland. These results were compatible with subacute thyroiditis, and symptomatic conservative management was initiated. The patient's behavioral abnormalities and painful neck swelling gradually resolved and his thyroid function steadily recovered. Although a primary psychotic disorder should be strongly considered in the differential diagnosis, patients with an abrupt and unusual onset of psychotic symptoms should be screened for thyroid abnormalities. Furthermore, transient thyroiditis should be considered a possible underlying etiology, along with primary hyperthyroidism.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University and Chonbuk National University Hospital, Jeonju, Korea.
authors.forename: Kyung Ae
authors.initials: KA
authors.lastname: Lee
authors.forename: Kyung Taek
authors.initials: KT
authors.lastname: Park
authors.forename: Hea Min
authors.initials: HM
authors.lastname: Yu
authors.forename: Heung Yong
authors.initials: HY
authors.lastname: Jin
authors.forename: Hong Sun
authors.initials: HS
authors.lastname: Baek
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D013968:Thyroiditis, Subacute / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Psychotic disorders; Thyroiditis, subacute; Thyrotoxicosis