title: Hyperthyroid rage: when bipolar disorder hides the real disorder.
abstract: Long-term lithium therapy has been associated with euthyroid goiter, hypothyroidism, and less commonly, hyperthyroidism. We report a case of a 19-year-old male patient with schizoaffective disorder who was hospitalized after trying to suffocate his mother. Severe psychomotor agitation persisted despite the high dose of antipsychotics. Initial laboratory tests showed elevated creatine kinase and free thyroxine. Lithium was replaced by sodium valproate, and new laboratory tests were obtained. After lithium discontinuation, the patient had a rapid improvement in agitation and tremors. Antithyroid drugs were not necessary, suggesting the diagnosis of lithium-associated thyrotoxicosis that progressed to spontaneous remission. There are only 2 other reports of lithium-associated thyrotoxicosis successfully treated with lithium withdrawal. Even patients on long-term use of lithium are not free from having acute thyroid dysfunction and may present with treatment-resistant symptoms.
authors.affiliation: *Centro Psiquiátrico Rio de Janeiro, Praça Coronel Assunção, S/N, Saúde, Rio de Janeiro, and †Walter Cantídio University Hospital, Federal University of Ceará, Ceará, Brazil.
authors.forename: Wagner
authors.initials: W
authors.lastname: de Sousa Gurgel
authors.forename: Pablo Eduardo Pereira
authors.initials: PE
authors.lastname: Dutra
authors.forename: Renato Alves
authors.initials: RA
authors.lastname: Higa
authors.forename: Carolina Barros Ferreira
authors.initials: CB
authors.lastname: da Costa
authors.forename: Fabio Gomes
authors.initials: FG
authors.lastname: de Matos e Souza
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced* / Q000188:drug therapy; D008094:Lithium / Q000009:adverse effects*; D008297:Male; D011595:Psychomotor Agitation / Q000209:etiology*; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D013960:Thyroid Function Tests; D014635:Valproic Acid / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D014635:Valproic Acid; D008094:Lithium; D003024:Clozapine