Psychiatric Disturbances Associated with Hyperthyroidism: an Analysis Report of 30 Cases

Background: Hyperthyroidism has numerous physical and mental concomitants. This study attempted to explore the clinical features, treatment and outcome of a psychiatric disturbance which developed during hyperthyroid disease.

Methods: A retrospective study was made of 30 patients, hospitalized with psychiatric disturbances and concurrent diagnoses of hyperthyroidism between January 1990 and May 1994. Data included age, sex, date of admission or consultation, age of onset of thyroid and psychiatric disorders, duration of thyroid and psychiatric disorders, psychiatric discharge diagnoses, psychiatric symptoms/signs, treatment and outcome. Follow-up investigations were done after one year.

Results: Among the 30 patients, 27 (90.0%) were female and 3 (10.0%) were male. The psychiatric disturbances had persisted from a few days to a decade following the presenting hyperthyroidism, with an average of seventeen months. There were 6 (20.0%) patients who were diagnosed with neurotic disorders, 11 (36.7%) with mood disorders, 8 (26.7%) with schizophrenia-like syndromes and 5 (16.7%) with delirium. The psychiatric features were variable; insomnia, irritability and anxiety most commonly occurred. Most (96.7%) of these patients accepted both antithyroid and psychotropic medication therapy. Follow-up investigations were made after one year. Twenty-six patients were analyzed, including 13 (50%) who had recovered completely, 9 (34.6%) who recovered partially, and 4 (15.4%) who showed no change in mental status.

Conclusions: A variety of psychiatric features were found in the hyperthyroid patients, concomitantly with their psychiatric disturbances. Half of the patients showed a chronic or unremitting psychiatric condition after normalization of thyroid function tests. It is possible that the present psychiatric disturbances could be caused or precipitated by hyperthyroidism, or simply occur independently by chance. It is suggested a foremost benefit would be incorporation of internist and psychiatrist into the care of hyperthyroid patients with psychiatric disturbances which may improve the clinical condition.