First Manic Episode With Psychotic Features in a Young Woman as the Initial Presentation of Graves’ Disease: A Case Report

Graves’ disease can manifest with psychiatric symptoms, notably manic symptoms. We report the case of a 31-year-old patient with no notable medical or psychiatric history, admitted for a first manic episode characterized by a labile mood, psychomotor agitation, and insomnia without fatigue, associated with delusional ideas. Clinical examination found exophthalmos with anterior neck swelling. Biological assessment showed hyperthyroidism with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine, and positive anti-TSH receptor antibodies, leading to the diagnosis of Graves’ disease. The patient benefited from treatment combining olanzapine, carbamazepine, methimazole, and propranolol. Clinical evolution was marked by rapid improvement of psychiatric symptoms. This case underlines the importance of performing a thorough clinical examination and excluding organic causes before concluding a psychiatric disorder.