Graves' Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy

Graves' disease may rarely present with predominant neuropsychiatric symptoms, such as severe, treatment-resistant panic attacks, leading to misdiagnosis as a primary psychiatric disorder. We describe a 30-year-old woman with refractory panic attacks and night terrors who was initially treated with anxiolytics and antidepressants. Despite fluctuating thyroid function test results, which raised diagnostic uncertainty between evolving hyperthyroidism and thyroiditis, the presence of ophthalmopathy and autonomic hyperactivity prompted further evaluation. Thyroid scintigraphy demonstrated diffuse uptake consistent with Graves' disease and effectively excluded thyroiditis, allowing prompt initiation of antithyroid therapy and propranolol. Following treatment, the patient showed significant clinical improvement with resolution of autonomic symptoms. This case highlights the diagnostic challenge of atypical Graves' disease presentations and emphasizes the importance of considering endocrine causes in refractory neuropsychiatric symptoms. Functional imaging, alongside careful clinical assessment, may help resolve clinical-biochemical discrepancies and support timely diagnosis in selected patients with atypical presentations.