Thyrotoxic psychosis: when things don't match.

Introduction: 50-years-old man, originary from Germany, living in Spain since he had 26 years old. Not known personal psychiatric record; first grade relative with alcohol use disorder. As somatic medical record he presented paroxysmal atrial fibrillation treated with bisoprolol and amiodarone. He is brought to the Emergency room with disorganized behaviour and delusional ideas of prejudice, surveillance and complot. He also presents organic symptoms: fluctuating disorientation, dysarthria, tremors, fever, heat intolerance, weight loss, swallowing pain, decreased need for sleep and an antecedent of a recent phototoxic reaction. Objectives: To report an exceptional case of organic psychosis and to remark the need to screen somatic ethiologies for psychoses. Methods: A lumbar puncture, EEG and brain MRI with normal results ruled out neurological causes. The blood test showed neutrophilic leucocytosis and elevated T3 with supressed TSH. Olanzapine 20 mg was started. The Endocrinology Service started treatment with prednisone 40 mg and Methimazole 25 mg was started. Bisoprolol was maintained and amiodarone was stopped. A thyroid ultrasound was performed and concluded type 2 thyroiditis diagnosis. Results: Psychotic symptoms remitted in 1 week. Neurological and infectious causes were ruled out. Psychosis was related to a hyperthyroidism state. Amiodarone was established as the trigger of thyroxicosis. Conclusions: 1. Thyroxicosis, though atypical, can present with psychiatric symptoms. 2. It is always required to screen somatic ethiologies for psychoses, especially when somatic features (as in the case) are present. 3. Amiodarone overuse can cause endocrine and dermatological symptoms, as well as secondary psychiatric symptoms. [ABSTRACT FROM AUTHOR]