Graves’ Hyperthyroidism Induced Acute Psychosis- A Case Study

Abstract

Hyperthyroidism is a common medical condition that affects approximately 2-5% of all women during their lifetime. It is more common in females with a female to male ratio of 5:1 with the majority of women affected between the ages of 20-40. Most patients with hyperthyroidism have a common constellation of symptoms which include insomnia, irritability, restlessness, fatigue, tremor, palpitations, increased perspiration, heat intolerance and weight loss despite a normal or increased appetite.

Graves’ disease is the most common cause of hyperthyroidism. It is an autoimmune condition in which IgG antibodies bind to TSH receptors in the thyroid leading to the overproduction of T3 and T4. The presence of eye disease on clinical examination and IgG antibodies in serum is unique to Graves’ hyperthyroidism and helps distinguish it from other aetiologies. Graves’ disease opthalmopathy is caused by inflammation of orbital fat, muscle and connective tissue leading to exophthalmos, eyelid retraction, lid lag and periorbital oedema and conjunctivitis.

Patients with Graves’ disease may also experience personality and behavioural changes such as anxiety, emotional lability, psychosis, agitation and depression. These changes are often accompanied by cognitive impairments with patients often complaining of poor orientation, confusion and difficulty with concentration. Whilst the mechanism of cognitive, personality and behavioural changes in Graves’ disease is not known, treatment results in improvement in these domains.

Keywords: Hyperthyroidism, Graves’ disease, Psychosis, Graves’ Opthalmopathy, Neuropsychiatric Symptoms