Antipsychotics in Hyperthyroid-Related Psychosis: Case Report and Systematic Review

Abstract

Objectives: Hyperthyroidism has been associated with relatively rare presentations of psychotic symptoms. We report an example of the successful use of antipsychotics to manage psychotic symptoms in hyperthyroid-related psychosis. Furthermore, we systematically describe the available literature on the use of antipsychotics in this setting to determine the associated relative efficacies of the various antipsychotic agents.

Methods: Presentation of a case of hyperthyroid-related psychosis treated with an antipsychotic agent followed by a systematic review of all similar cases: PubMed, Ovid MEDLINE and PMC were searched for articles published between 1960 and 2017 that report on the use of specific antipsychotics in the management of hyperthyroid-related psychosis.

Results: An 81-year-old woman presented with hallucinations and delusions in the context of untreated Graves' Disease and was effectively treated with medical management of her thyroidopathy and psychopharmacologic management of psychotic symptoms. Systematic review revealed that typical and atypical antipsychotics have comparable efficacy in the management of psychotic symptoms in hyperthyroid-related psychosis.

Conclusion: Choice of antipsychotic in hyperthyroid-related psychosis should be primarily based on side-effect profile and medical comorbidities. Risperidone is the optimal and seemingly effective choice for treating hyperthyroid-related psychosis in an elderly thyrotoxic patient.