Psychotic mania associated with hypothyroidism: a case report

Thyroid hormone abnormalities may be associated with various psychotic disorders and mood disorders. A well-known relationship between mania and hyperthyroidism exists in the literature, whereas mania associated with hypothyroidism is rare. In this paper, we present a female patient diagnosed with hypothyroidism due to her noncompliance to thyroid hormone replacement therapy after total thyroidectomy and had comorbid psychotic mania with the symptoms including insomnia, irritability, increase in religious activities, visual and auditory hallucinations, and increased and aimless speech. The patient was effectively treated with the combination of thyroid hormone replacement therapy and antipsychotic treatment. In conclusion, regardless of their age all patients with psychiatric disorders should be examined for any thyroid hormone abnormalities; particularly those showing sudden onset of illness without any personal or familial psychiatric disorder history.