Management of Psychosis Associated with Graves’ Disease: A Rare Case Report

Abstract

Graves’ disease is an autoimmune disease in which patients can rarely present with psychiatric symptoms. In these patients, detailed history with psychiatric evaluation using a mental status examination is crucial for the early identification of psychiatric manifestations. Early intervention with medical and surgical therapy can help effectively treat the condition and prevent adverse outcomes such as catatonia. We reported the case of a 25-year-old African American female with Graves’ disease who had significant stressors and presented with auditory hallucinations. She was diagnosed with psychosis secondary to Graves’ disease and was managed medically using antithyroid drugs and beta-blockers. On failure of medical therapy, a surgical approach was employed. The patient was managed successfully, and her condition improved. Our case highlights that the importance of early intervention in these cases can lead to successful outcomes in patients with Graves’ disease-induced psychosis.

Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) presenting as subacute psychosis: Case report and literature review

“…This idea is based on dysregulation of TSH, which in a state of hypothyroidism can lead to hyperprolactinemia, leading to a risk of autoimmunity. 13 However, this speculation alone would not explain the basis of the disease, as we previously mentioned that not all patients have abnormal thyroid function when presenting with HE/SREAT. On the other hand, pathologic analysis of brain tissue is also limited and gives no evidence of specific characteristics, as patients improve after steroid therapy by the time a sample is taken.…”

“…Another theory suspects that HE/SREAT develops on the basis of dysregulated hormone production at the level of the hypothalamus. This idea is based on dysregulation of TSH, which in a state of hypothyroidism can lead to hyperprolactinemia, leading to a risk of autoimmunity 13 . However, this speculation alone would not explain the basis of the disease, as we previously mentioned that not all patients have abnormal thyroid function when presenting with HE/SREAT.…”

Graves Disease Presenting Psychosis: a Case Report

“…Management of the patient with hyperthyroidism showing psychosis or mania may require anti-thyroid medication and non-selective beta-blockers such as propranolol [19]. A non-selective beta-adrenoceptor antagonist, propranolol, could penetrate the blood-brain barrier and take action as a central beta-adrenoceptor antagonist, which makes propranolol an adequate treatment for mania [7,8,20]. In this case, the psychosis symptoms were managed with antipsychotics and benzodiazepine.…”

Case report: Impact of hyperthyroidism on psychotic symptoms in schizophrenia comorbid with Graves’ disease

“…Among them, the only case with coexisting psychosis spectrum disorder was that reported by Hamasaki et al of a 76-year-old woman who had been diagnosed with schizophrenia 40 years previously ( 9 ). In terms of psychotic symptoms, all nine patients experienced delusions, three experienced auditory hallucinations ( 10 , 11 , 14 ), and three experienced visual hallucinations ( 12–14 ); one patient had both auditory and visual hallucinations ( 14 ), and four patients had neither auditory nor visual hallucinations ( 6–9 ). The patients experiencing visual hallucinations had a subacute clinical course, with psychosis worsening within a range of 1 week to 1 month.…”