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Thyroid Storm Presenting as Psychosis
 Dimpi Desai, MD , Sara Zahedpour Anaraki, MD, Neetha Reddy, MD, ...
First Published May 18, 2018 Case Report https://doi.org/10.1177/2324709618777014

Abstract
Thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1% to 2%. It is a systemic condition of excessive thyroid hormone production and release leading to thermoregulatory, adrenergic, neuropsychiatric, cardiovascular, and abdominal manifestations. Although it is a rare condition, it carries a significant mortality rate. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment.

In this article, we present an unusual case of a young woman who presented with psychosis as the manifesting symptom of thyroid storm. She did not respond adequately to conventional medical treatment, requiring plasmapheresis and a definitive thyroidectomy, which ultimately led to the return of patient’s baseline mental status and a dramatic recovery.

Case Presentation
A 28-year-old Hispanic female with a past medical history of migraine, depression, and a family history of schizophrenia was brought to the emergency room by her family as she was not acting her usual self and was demonstrating strange behavior for 1 week prior to admission. The patient’s family described new onset, and rapidly worsening paranoid delusions along with auditory and visual hallucinations.

Associated symptoms included nausea, vomiting, and diarrhea. She denied taking any medications or supplements. Vital signs at the time of admission showed temperature of 99.6°F, heart rate of 144 beats per minute, and elevated blood pressure of 160/72 mm Hg. Physical examination was notable for an enlarged and smooth thyroid gland with an audible bruit. At the time of initial interview, she was emotional and tearful, talking and smiling inappropriately, and admitted to seeing people in the room who were not present.

Laboratory investigations showed severe hyperthyroidism with suppressed thyroid-stimulating hormone (TSH), elevated free and total thyroxine hormone (T4), elevated total triiodothyronine (T3), positive antithyroid peroxidase antibodies, and thyroid stimulating immunoglobulin