Why does hyperthyroidism cause nervousness

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See more conditions. Request Appointment. It was established diagnosis of major depressive episode for which was instituted treatment with Fluoxetine 20mg per day. The treatment was followed for 2 month without a significant improvement of symptoms. July : patient shall be submitted for review therapy; when examining patient had: depressed mood, crying easily, tremor, palpitations, minor exophthalmos, weight loss of 3 kilograms.

The dose of Fluoxetine was increase to 40 mg per day. In this context was require endocrine evaluation. Blood analysis was performed with the following results: blood count and leukocyte formula in normal ranges, glucose in normal range, hepatic tests normal, normal urine sediment.

After an evaluation is established diagnosis of hyperthyroidism and establish treatment with Propiltiouracil mg per day Treatment was maintained 3 months. In October the patient is brought to the psychiatric emergency room for a delirious hallucinatory symptoms extraordinary irritability, visual and auditory hallucinations, delusions of persecution and pursuit, psychomotor agitation, stereotype behaviour. Somatic examination found: marked bilateral exophthalmos, hyperhidrosis, tremor of extremities, goiter, tachycardia, vomiting.

At this point we decided to interrupt antidepressant treatment and to maintain therapy with Propiltiouracil mg per day. With all this, the diagnosis of thyrotoxicosis is suspected. The term of thyrotoxicosis refers to clinical, psysiological and biochemical manifestations that occur after exposure and response of the tissues to the excessive supply of thyroid hormone [ 2 ]. It was established the diagnose of acute psychotic episode with symptoms of schizophrenia and patient received treatment with Risperidone 4mg per day.

After 6 weeks delirious hallucinatory symptoms were resolved incomplete hallucinations disappeared and the patient began to communicate verbally, but unstable delusions still remain. Interdisciplinary consultation recommended thyroid excision as therapeutic approach. The patient was prepared psychologically for the accomplishment of total thyroidectomy with full acceptance it was maintained treatment with risperidone 4 mg per day. January : thyroidectomy was performed and establish replacement therapy with levothyroxine microg per day.

Within 3 months thyroid tests were normalized and was dropped antipsychotic treatment the dose was gradually reduced to that with normalization of thyroid tests to give to antipsychotic treatment.

Psychiatric reassessment has highlighted the temporal correlation between psychotic symptoms and decompensation of thyroidian status.

Final psychiatric diagnosis was that the psychotic episode due to general medical condition thyrotoxicosis. This clinical case has questioned the diagnosis and treatment both in terms of psychiatric and endocrine conditions:. Lack of response to antidepressant treatment corroborated with clinical signs of hyperthyroidism oriented identification of underlying medical causes, that why the first and most important step in the assessment of a patient with psychiatric symptoms is to eliminate the somatic causes 3.

The efficiency of oral medication with Propiltiouracil proved to be less than expected, the psychiatric symptoms evolving towards a full blown psychotic episode; a differential diagnosis between an acute psychotic episode with schizophrenia symptoms and one induced by a general medical condition must be made.

Aspects that suggest an organic origin of the behavior disorders 4 :. Endocrine reevaluation is required due to the lack of pharmacological control of thyroid disease. Surgical ablation of thyroid decision allowed such control of endocrine disease.

The disappearance of psychotic phenomena, consecutive to normalization of thyroid tests led to antipsychotic discontinuation secure. Thyroid disease should be considered in the differential diagnosis of a large spectrum of psychiatric symptoms; early treatment of the hormone or metabolic alteration can minimize the morbidity of a secondary psychopathology.

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