Deliberate self-harm in a patient with hyperthyroidism with acute psychosis

Haw Huo Wong and Pang, Nicholas Tze Ping (2021) Deliberate self-harm in a patient with hyperthyroidism with acute psychosis. Case Report in Neurology, 14. pp. 1-5. ISSN 1662-680X

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URL: https://casereports.bmj.com/content/14/10/e242333

Abstract

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.

Item Type:	Article
Keyword:	Deliberate self-harm , Hyperthyroidism , Psychosis
Subjects:	R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC321-571 Neurosciences. Biological psychiatry. Neuropsychiatry > RC346-429 Neurology. Diseases of the nervous system Including speech disorders > RC435-571 Psychiatry > RC512-569.5 Psychopathology > RC512-528 Psychoses
Department:	FACULTY > Faculty of Medicine and Health Sciences
Depositing User:	DG MASNIAH AHMAD -
Date Deposited:	15 Jun 2022 10:36
Last Modified:	15 Jun 2022 10:36
URI:	https://eprints.ums.edu.my/id/eprint/32776

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