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Deliberate self-harm in a patient with hyperthyroidism with acute psychosis
  1. Haw Huo Wong1 and
  2. Nicholas Tze Ping Pang2
  1. 1Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
  2. 2Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
  1. Correspondence to Dr Nicholas Tze Ping Pang; nicholas86{at}


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.

  • thyroid disease
  • psychotic disorders (incl schizophrenia)
  • suicide (psychiatry)
  • vulvovaginal disorders
  • general surgery

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  • Contributors HHW contributed to conceptualising and authorship. NTPP contributed to editing and proofreading.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.