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EV0340

Reversible psychosis and mania in hyperthyroidism: a systematic review of case reports and case series

REVERSIBLE PSYCHOSIS AND MANIA IN HYPERTHYROIDISM: A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES

Although psychosis and mania associated with hyperthyroidism are rare, they are usually reversible with normalization of thyroid function and may precede recognition of the underlying endocrine disorder.

The aim of this study was to evaluate the clinical features, etiologies, and outcomes of psychosis and manic episodes associated with hyperthyroidism. A systematic review was conducted of published case reports and case series describing psychosis or manic symptoms in patients with confirmed hyperthyroidism. Electronic databases were searched, and data from eligible studies were synthesized using pooled descriptive analysis. A total of 398 patients were included: 44 from case reports and 354 from case series. Patients were predominantly female, and most presentations occurred in adulthood; reported neuropsychiatric symptoms included delusions, hallucinations, mania, and delirium. The most frequently identified etiology was Graves’ disease, followed by thyroid storm and other forms of thyrotoxicosis; in many cases, psychiatric symptoms were the first manifestation of previously unrecognized thyroid dysfunction. Most patients showed marked improvement or complete resolution of psychiatric symptoms following treatment of hyperthyroidism and normalization of thyroid hormone levels, often with adjunctive antipsychotic treatment. Case series data likewise reported complete or partial psychiatric recovery in a substantial proportion of patients following appropriate endocrine treatment. The authors emphasize that routine thyroid function testing, particularly in cases of new-onset or atypical psychosis and mania in patients without a psychiatric history or with accompanying signs of thyrotoxicosis, may facilitate early diagnosis, prevent misclassification as a primary psychiatric disorder, and enable timely initiation of targeted endocrine treatment.

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