Treatment of Thyrotoxicosis-Induced Psychosis

Patients with acute psychosis are generally evaluated and managed by psychiatrists. Medical evaluation to rule out underlying causes of psychosis is an important part of the initial assessment. Thyrotoxicosis, a serious medical condition requiring medical treatment, is rarely associated with psychosis. We present the case of a female patient who was hospitalized for an episode of psychosis in the setting of thyrotoxicosis. In the acute hospital setting, while the patient received propylthiouracil and propranolol with normalization of vital signs, her psychotic symptoms were refractory to treatment with haloperidol and risperidone but responded well to olanzapine. The patient remained on antipsychotic medications for 2 months following hospitalization and underwent radioactive ablation of the thyroid gland. The patient remained symptom-free at her 6-month follow-up. This case demonstrates the importance of screening for thyroid derangements in acutely psychotic patients and reports successful treatment of thyrotoxic psychosis with olanzapine. Psychopharmacology Bulletin. 2002;36(4):7-13