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Sumi Y, Kawahara S, Fujii K, Yamaji M, Nakajima K, Nakamura T, Horikawa O, Fujita Y, Ozeki Y. Case report: Impact of hyperthyroidism on psychotic symptoms in schizophrenia comorbid with Graves' disease. Front Psychiatry 2023; 14:1219049. [PMID: 37496682 PMCID: PMC10366534 DOI: 10.3389/fpsyt.2023.1219049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Auditory hallucinations are the most common type of hallucinations observed in schizophrenia; however, visual hallucinations are not uncommon. In Graves' disease, depression, hypomania, and psychosis can occur. While the association between Graves' disease and psychosis has been explored, understanding of the specific impact of thyroid dysfunction severity on psychiatric symptom severity is limited. Here, we present a case report of a patient with schizophrenia comorbid with Graves' disease whose psychotic symptoms were impacted by hyperthyroidism. Case The patient was a 32-year-old Japanese woman who presented with auditory and visual hallucinations, agitation, and pressured speech. The patient was diagnosed with schizophrenia comorbid with Graves' disease and thyroid storm. The patient's psychotic symptoms were found to be associated with fluctuations in thyroid hormone levels, and visual hallucinations were observed only during thyroid storms. Treatment involved dexamethasone, potassium iodide, bisoprolol fumarate, and methimazole for thyrotoxicosis, and a blonanserin transdermal patch, paliperidone, and paliperidone palmitate for psychotic symptoms. The patient's auditory and visual hallucinations improved with antipsychotic treatment and decreased thyroid hormone levels. Conclusion This case highlights the importance of monitoring thyroid function in patients with schizophrenia, particularly those with comorbid Graves' disease. The correlation between psychiatric symptoms and thyroid hormone levels was demonstrated on an individual level over time, with symptoms worsening as thyroid hormone levels increased. Additionally, our case suggests that abnormally high thyroid hormone levels may trigger visual hallucinations in individuals with schizophrenia. Further studies are needed to elucidate the underlying mechanisms and potential treatment implications of this association.
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Affiliation(s)
- Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Sanae Kawahara
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kumiko Fujii
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Mayu Yamaji
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kou Nakajima
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tsubasa Nakamura
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Osamu Horikawa
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukihiro Fujita
- Department of Diabetology, Endocrinology and Nephrology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yuji Ozeki
- Department of Psychiatry, Shiga University of Medical Science, Otsu, Shiga, Japan
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Muacevic A, Adler JR, Shukla S, Kumar S. Neuropsychiatric Manifestations of Thyroid Diseases. Cureus 2023; 15:e33987. [PMID: 36811059 PMCID: PMC9938951 DOI: 10.7759/cureus.33987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Thyroid disorders are known to cause neuropsychiatric manifestations. Various neuropsychiatric manifestations are depression, dementia, mania, and autoimmune Hashimoto encephalopathy. Numerous investigations carried out in the previous 50-60 years have been evaluated critically. The pathophysiology of neuropsychiatric symptoms of thyroid diseases is described in the current study and its link with autoimmune Hashimoto encephalopathy is also discussed. Furthermore, this paper also describes the association between thyroid-stimulating hormones and cognitive impairment. Hypothyroidism is associated with depression and mania, and hyperthyroidism is linked with dementia and mania. The association between Graves' disease and various mental disorders such as depressive and anxiety disorders is also discussed. The aim of this study is to review the relationship between various neuropsychiatric disorders and thyroid diseases. A literature search from the PubMed database to find various neuropsychiatric manifestations of thyroid disorders in the adult population was conducted. According to the review of the studies, cognitive impairment can result from thyroid disease. It has not been possible to demonstrate how hyperthyroidism can hasten the process of developing dementia. However, subclinical hyperthyroidism, thyroid-stimulating hormone (TSH) levels below the normal range, and high free thyroxine (T4) levels all raise the risk of dementia in the elderly. Additionally, the potential mechanisms underlying this association have been examined. A quick summary of the research on mania as a clinical symptom of hypothyroidism and its likely causes and pathogenesis is also reviewed. There is no dearth of evidence that describes various neuropsychiatric manifestation in thyroid disorders.
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Asif H, Nwachukwu I, Khan A, Rodriguez G, Bahtiyar G. Hyperthyroidism Presenting With Mania and Psychosis: A Case Report. Cureus 2022; 14:e22322. [PMID: 35317040 PMCID: PMC8934034 DOI: 10.7759/cureus.22322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/29/2022] Open
Abstract
Graves' disease accounts for one of the most common causes of thyrotoxicosis. Most patients with Graves' disease present with classic signs and symptoms of hyperthyroidism. Psychosis and mood symptoms secondary to hyperthyroidism are rare. Here we report the case of a 37-year-old male with a history of Graves' disease with poor medication adherence who presented to the emergency department with psychotic features and hyperexcitability. He had excessive agitation, paranoia, and hyperactivity requiring restraints. He also endorsed insomnia and weight loss. He was admitted to the inpatient unit, and laboratory investigations were significant for a low thyroid-stimulating hormone, and elevated T3, T4, thyroid-stimulating antibodies, and thyroid peroxidase antibodies. The initial assessment was a primary psychiatric illness. The patient never had a personal or family history of psychiatric illness. Psychiatry and endocrinology were consulted for further recommendations. The patient was started on methimazole 30 mg, propranolol 100 mg, and hydrocortisone 100 mg, which resolved his symptoms.
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Ugwu ET, Maluze J, Onyebueke GC. Graves' Thyrotoxicosis Presenting as Schizophreniform Psychosis: A Case Report and Literature Review. Int J Endocrinol Metab 2017; 15:e41977. [PMID: 28835762 PMCID: PMC5554607 DOI: 10.5812/ijem.41977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/16/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022] Open
Abstract
Psychosis, as the first presentation of thyrotoxicosis, is extremely rare. Consequently, it is often misdiagnosed as a primary psychiatric disorder, especially in developing countries with poor healthcare facilities. Owing to the high level of illiteracy and lack of knowledge, it is fairly common to ascribe many illnesses to spiritual attacks in Nigeria and other African countries, especially when the disease is rarely seen or is associated with psychiatric manifestations. Herein, we present the case of a teenage female Nigerian and review the literature on this subject.
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Affiliation(s)
- Ejiofor T. Ugwu
- Department of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
- Corresponding author: Ejiofor T. Ugwu, Department of Internal Medicine, College of Medicine, Enugu State University of Science and Technology, PMB 01660, Enugu, Nigeria, E-mail:
| | - John Maluze
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Godwin C. Onyebueke
- Department of Psychiatry, Enugu State University of Science and Technology, Enugu, Nigeria
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Tomasik J, Rahmoune H, Guest PC, Bahn S. Neuroimmune biomarkers in schizophrenia. Schizophr Res 2016; 176:3-13. [PMID: 25124519 DOI: 10.1016/j.schres.2014.07.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/17/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023]
Abstract
Schizophrenia is a heterogeneous psychiatric disorder with a broad spectrum of clinical and biological manifestations. Due to the lack of objective tests, the accurate diagnosis and selection of effective treatments for schizophrenia remains challenging. Numerous technologies have been employed in search of schizophrenia biomarkers. These studies have suggested that neuroinflammatory processes may play a role in schizophrenia pathogenesis, at least in a subgroup of patients. The evidence indicates alterations in both pro- and anti-inflammatory molecules in the central nervous system, which have also been found in peripheral tissues and may correlate with schizophrenia symptoms. In line with these findings, certain immunomodulatory interventions have shown beneficial effects on psychotic symptoms in schizophrenia patients, in particular those with distinct immune signatures. In this review, we evaluate these findings and their potential for more targeted drug interventions and the development of companion diagnostics. Although currently no validated markers exist for schizophrenia patient stratification or the prediction of treatment efficacy, we propose that utilisation of inflammatory markers for diagnostic and theranostic purposes may lead to novel therapeutic approaches and deliver more effective care for schizophrenia patients.
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Affiliation(s)
- Jakub Tomasik
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hassan Rahmoune
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Paul C Guest
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Sabine Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Department of Neuroscience, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Dahale AB, Chandra PS, Sherine L, Thippeswamy H, Desai G, Reddy D. Postpartum psychosis in a woman with Graves' disease: a case report. Gen Hosp Psychiatry 2014; 36:761.e7-8. [PMID: 25194170 DOI: 10.1016/j.genhosppsych.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Thyroid dysfunction is common during pregnancy and the postpartum period and is known to cause psychiatric disturbances. A woman with Graves' disease and psychosis in the postpartum period is described. METHODS A 22-year-old woman with Graves' disease developed fluctuating orientation, catatonia, delusions of persecution and auditory hallucinations 3 days following childbirth. RESULTS The report discusses the clinical presentation. Treatment of both conditions led to the resolution of symptoms. CONCLUSION Graves' disease with postpartum psychosis may present with delirium, catatonia and prominent auditory hallucinations and responds well to a combination of psychotropic and antithyroid drugs. Thyroid dysfunction should be assessed for and managed adequately in postpartum psychosis.
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Affiliation(s)
- Ajit Bhalchandra Dahale
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India.
| | - Linda Sherine
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, (NIMHANS) Bangalore-560029, India
| | - Dharma Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and, Neuro Sciences (NIMHANS) Bangalore-560029, India
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Hamasaki H, Yoshimi T, Yanai H. A patient with Graves' disease showing only psychiatric symptoms and negativity for both TSH receptor autoantibody and thyroid stimulating antibody. Thyroid Res 2012. [PMID: 23206540 PMCID: PMC3526500 DOI: 10.1186/1756-6614-5-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Both thyroid stimulating hormone (TSH) and thyroid stimulating antibody (TSAb) negative Graves’s disease (GD) is extremely rare. Here we present such a patient. Case presentation The patient was a 76-year-old woman who was diagnosed as having schizophrenia forty years ago. She did not show characteristic symptoms for hyperthyroidism, such as swelling of thyroid, exophthalmos, tachycardia and tremor, however, she showed only psychomotor agitation. Serum free triiodothyronine and free thyroxine levels were elevated and TSH level was suppressed, suggesting the existence of hyperthyroidism. However, both the first generation TSH receptor autoantibody (TRAb1) and the thyroid stimulating autoantibody (TSAb) were negative. Slightly increased blood flow and swelling was detected by thyroid echography. Thyroid scintigraphy demonstrated diffuse and remarkably elevated uptake of 123I uptake. Finally, we diagnosed her as having GD. She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated. Discussion We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb. Thyroid autoantibody-negative GD is extremely rare. Thyroid scintigraphy was useful to diagnose such a patient.
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Affiliation(s)
- Hidetaka Hamasaki
- Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
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Chen J, Lee G, Fanous AH, Zhao Z, Jia P, O'Neill A, Walsh D, Kendler KS, Chen X. Two non-synonymous markers in PTPN21, identified by genome-wide association study data-mining and replication, are associated with schizophrenia. Schizophr Res 2011; 131:43-51. [PMID: 21752600 PMCID: PMC4117700 DOI: 10.1016/j.schres.2011.06.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 06/15/2011] [Accepted: 06/20/2011] [Indexed: 01/27/2023]
Abstract
We conducted data-mining analyses of genome wide association (GWA) studies of the CATIE and MGS-GAIN datasets, and found 13 markers in the two physically linked genes, PTPN21 and EML5, showing nominally significant association with schizophrenia. Linkage disequilibrium (LD) analysis indicated that all 7 markers from PTPN21 shared high LD (r(2)>0.8), including rs2274736 and rs2401751, the two non-synonymous markers with the most significant association signals (rs2401751, P=1.10 × 10(-3) and rs2274736, P=1.21 × 10(-3)). In a meta-analysis of all 13 replication datasets with a total of 13,940 subjects, we found that the two non-synonymous markers are significantly associated with schizophrenia (rs2274736, OR=0.92, 95% CI: 0.86-0.97, P=5.45 × 10(-3) and rs2401751, OR=0.92, 95% CI: 0.86-0.97, P=5.29 × 10(-3)). One SNP (rs7147796) in EML5 is also significantly associated with the disease (OR=1.08, 95% CI: 1.02-1.14, P=6.43 × 10(-3)). These 3 markers remain significant after Bonferroni correction. Furthermore, haplotype conditioned analyses indicated that the association signals observed between rs2274736/rs2401751 and rs7147796 are statistically independent. Given the results that 2 non-synonymous markers in PTPN21 are associated with schizophrenia, further investigation of this locus is warranted.
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Affiliation(s)
- Jingchun Chen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Psychiatry, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA
| | - Grace Lee
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Psychiatry, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA
| | - Ayman H. Fanous
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Psychiatry, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA,Washington VA Medical Center, Washington, DC 20422, USA,Department of Psychiatry, Georgetown University School of Medicine, Washington, DC 20057, USA
| | - Zhongming Zhao
- Departments of Biomedical Informatics and Psychiatry, Vanderbilt University, 2525 West End Avenue, Nashville, TN 37203, USA
| | - Peilin Jia
- Departments of Biomedical Informatics and Psychiatry, Vanderbilt University, 2525 West End Avenue, Nashville, TN 37203, USA
| | - Anthony O'Neill
- The Department of Psychiatry, The Queens University, Belfast, Northern Ireland, UK
| | | | - Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Psychiatry, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Molecular and Human Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA
| | - Xiangning Chen
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Psychiatry, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA,Department of Molecular and Human Genetics, Virginia Commonwealth University, Suite 390, 800 E. Leigh Street, Richmond, VA 23298, USA,Corresponding author at: Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Suite 390A, 800 E. Leigh Street, Richmond, VA 23298, USA. Tel.: +1 804 828 8124; fax: +1 804 628 1035
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