Deliberate self-harm in a patient with hyperthyroidism with acute psychosis
A woman in her 30s with underlying Graves’ disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and...
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| Main Authors: | , |
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| Format: | Article |
| Language: | en en |
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S. Karger AG
2021
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| Online Access: | https://eprints.ums.edu.my/id/eprint/32776/1/Deliberate%20self-harm%20in%20a%20patient%20with%20hyperthyroidism%20with%20acute%20psychosis.ABSTRACT.pdf https://eprints.ums.edu.my/id/eprint/32776/2/Deliberate%20self-harm%20in%20a%20patient%20with%20hyperthyroidism%20with%20acute%20psychosis.pdf https://eprints.ums.edu.my/id/eprint/32776/ https://casereports.bmj.com/content/14/10/e242333 http://dx.doi.org/10.1136/bcr-2021-242333 |
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| Summary: | A woman in her 30s with underlying Graves’ disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient’s own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible. |
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