SAT-360 Case Report of Acute Psychiatric Manifestations in Graves' Disease: A Diagnostic and Therapeutic Challenge

Abstract Disclosure: C.E. Del Muro Baeza: None. A. Segovia Palomo: None. M. Castaneda: None. A. Agurcia: None. R.E. Sevilla: None. The relationship between psychiatric disorders and thyrotoxicosis was described in the 19th century. Graves' disease is an autoimmune disorder that causes primary hyperthyroidism, ophthalmopathy, goiter, and can lead to psychiatric symptoms such as anxiety, euphoria, and cognitive dysfunction. Adrenergic hyperactivity sensitizes β-adrenergic receptors, exacerbating symptoms. Psychotic symptoms have been observed to fluctuate with hormonal levels, especially during thyroid crises.A case is presented of a 34-year-old woman with primary hyperthyroidism of 2 months' duration, with no prior treatment, showing symptoms such as tachycardia, distal tremors, diarrhea, a 10 kg weight loss, and neurological alterations. She was referred to the emergency room for neurological deterioration, agoraphobia, delirium, insomnia, hallucinations, and agitation. Antipsychotic treatment was initiated, and encephalitis was evaluated, which was ruled out through cerebrospinal fluid analysis, which reported 1 cell, glucose 59, and proteins 16. A cranial CT scan was requested, which showed no lesions suggestive of ischemia or hemorrhage. Additional tests were performed, highlighting TSH <0.008 mUI/ml (0.3-4.5), T4L 9.96 ng/dl (0.89-1.72), T3L >20 pg/ml (2.39-6.79), Hb 13.5 g/dl (12-16), Hct 41% (37-47), Platelets 249x10³/uL (150-450), WBC 9.1x10³/uL (3.5-10), Glucose 90 mg/dl (74-106), Cr 0.34 mg/dl (0.66-1.09), Urea 31 mg/dl (17-43), AST 38 U/L (0-35), ALT 46 U/L (0-35), K 3.5 mEq/L (3.5-5.1), Na 139 mEq/L (136-145), Total Bilirubin 0.26 mg/dl (0.30-1.2). A Wayne score of 23 and Burch-Wartofsky score of 35 were assigned, and treatment was started with thiamazole 20 mg every 12 hours, propranolol 40 mg every 8 hours, and dexamethasone 8 mg every 8 hours. After 48 hours, the therapy was adjusted with Lugol, and the patient was discharged 24 hours later with follow-up in 2 weeks. At the consultation, anti-TSH antibodies were found at 33.5 UI/L, and anti-TPO at 240 UI/ml (<14). At 4 weeks, TSH was 0.02 uUI/ml (0.4-4.5), and T4L was 1.57 ng/dl (0.89-1.72). The patient continued on treatment with thiamazole and propranolol, awaiting radioactive iodine therapy.The onset of acute psychiatric symptoms as the initial manifestation of hyperthyroidism is rare, but it can resolve without antipsychotics if the underlying cause is treated. It is necessary to investigate neuroendocrine biomarkers that predict the susceptibility of certain patients to develop psychiatric symptoms. This case opens up various research avenues at the intersection of endocrinology and psychiatry. Delving into these aspects could improve early identification, personalized treatment, and the quality of life of patients with Graves' disease and neuropsychiatric symptoms. Presentation: Saturday, July 12, 2025