Graves’ Disease Revealed by an Acute Psychotic Episode in A Young Patient: A Rare Clinical Presentation at the Intersection of Psychiatry and Endocrinology

Graves’ disease is a common autoimmune thyroid disorder; however, its initial psychiatric presentations, especially psychotic episodes, are rare and challenging. We report the case of a 25-year-old patient, initially treated for atypical depression, who developed an acute psychotic episode marked by auditory hallucinations, irritability, insomnia, and cognitive decline. Treatment with olanzapine led to improvement in psychiatric symptoms. Biological tests showed severe hyperthyroidism (suppressed TSH, significantly elevated free T4 and free T3), positive anti-thyroid antibodies, and high TSH receptor antibodies (TRAb), confirming Graves’ disease. Starting treatment with carbimazole and beta-blockers resulted in steady clinical improvement. This case highlights the importance of thoroughly investigating physical causes in any sudden, unusual psychiatric disorder, especially in young patients. Psychosis can sometimes be the only initial sign of autoimmune thyrotoxicosis, and early targeted treatment is vital for prognosis.