PT  - JOURNAL ARTICLE
AU  - Haw Huo Wong
AU  - Nicholas Tze Ping Pang
TI  - Deliberate self-harm in a patient with hyperthyroidism with acute psychosis
AID  - 10.1136/bcr-2021-242333
DP  - 2021 Oct 01
TA  - BMJ Case Reports
PG  - e242333
VI  - 14
IP  - 10
4099  - http://casereports.bmj.com/content/14/10/e242333.short
4100  - http://casereports.bmj.com/content/14/10/e242333.full
SO  - BMJ Case Reports2021 Oct 01; 14
AB  - 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.