When the thyroid speaks through the mind: a case report from local health unit of Algarve

Abstract

Thyroid storm is a rare but potentially life-threatening complication of Graves' disease that may manifest with severe neuropsychiatric symptoms, making diagnosis and management particularly challenging. This study aims to describe the case of a 23-year-old female with a previous diagnosis of Graves’ disease who was not undergoing regular treatment and was admitted to the Emergency Department presenting psychomotor agitation, referential delusions, auditory hallucinations, and behavioral disorganization. To this end, a clinical and laboratory evaluation was performed, revealing severe hyperthyroidism characterized by suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine (T4) and free triiodothyronine (T3) levels, and positive TSH receptor antibodies (TRAb). Therapeutic management included the administration of a beta-blocker, antithyroid medication, and an atypical antipsychotic under close multidisciplinary monitoring. Progressive improvement of psychiatric manifestations and clinical stabilization were observed throughout hospitalization. These findings highlight the importance of early recognition of thyroid storm with psychiatric presentation and reinforce the need for an integrated multidisciplinary approach to optimize diagnosis, treatment, and patient recovery.