Thyrotoxicosis Masquerading as Late Onset Mania: A Case Report on Treatment of Mania in Thyroid Storm

Abstract

Manic episodes, typically associated with Bipolar Affective Disorder (BPAD), can also arise from medical conditions such as thyrotoxicosis, leading to “secondary” or “organic” mania. Thyrotoxicosis, characterised by excessive thyroid hormone levels, can cause neuropsychiatric symptoms and, in severe cases, result in a thyroid storm. Present case is of a middle-aged male patient without a prior psychiatric history who presented with manic symptoms such as overspending, over familiarity, and agitation, alongside physical signs of thyrotoxicosis, including weight loss and tachycardia. He was diagnosed with a thyroid storm secondary to Graves’ disease. Despite the rarity of the condition and the absence of established guidelines, management prioritised controlling sympathetic overactivity and restoring euthyroid status. Lithium, along with antipsychotics were chosen for their minimal impact on the QTc interval, was utilised to effectively address the manic symptoms. Aggressive medical management targeting both thyroid function and manic symptoms led to significant improvement. This case highlights the critical need to consider medical aetiologies in psychiatric presentations and underscores the importance of early diagnosis and multidisciplinary management to reduce morbidity. Collaborative efforts among medical specialties are essential to address the complexities of such cases.

Keywords

• bipolar disorder
• graves’ disease
• hyperthyroidism