Psychiatric Admission Leading to Diagnosis of Thyroid Hormone Resistance Syndrome: An Adolescent Case Report

Introduction Resistance to thyroid hormone (RTH) is a rare congenital condition characterized by thyroid hormone resistance at target tissues. The syndrome results from a mutation in the thyroid hormone receptor beta (THR-β) gene and affects approximately 1 in every 40,000 live births (Rivas AM, Lado-Abeal J. Thyroid hormone resistance and its management. Proc (Bayl Univ Med Cent). 2016;29(2):209–211). RTH has well-known psychiatric manifestations, but it is not often considered when a patient presents for acute or subacute psychiatric treatment. Case This article details the case of a 13-year-old adopted male with new auditory hallucinations and increased aggression toward family and self. Thyroid function screening revealed laboratory abnormalities consistent with RTH; subsequent review of systems revealed clinical hyperthyroidism. The diagnosis of RTH was ultimately confirmed through genetic testing, and symptomatic treatment with a beta-blocker proved successful. Discussion and Conclusion This case underscores the importance of proper thyroid screening in patients whose family history is unknown or suggestive of hereditary thyroid abnormalities. It also highlights the utility of genetic testing as a diagnostic tool for complex behavioral presentations. Proper diagnosis and treatment of this patient required collaboration between multiple pediatric specialties, demonstrating the value of interdisciplinary care. Early identification of RTH benefits patients and their families in many regards, allowing them to better contextualize their symptoms and avoid unnecessary thyroid interventions.