Graves’ disease presenting with psychosis crisis: A case report

Psychotic symptoms in Graves’ disease are relatively uncommon and may mimic primary psychiatric disorders which may result in delayed diagnosis and management especially in limited resource settings.We report the case of a 22-year-old male, who presented with gradual onset of psychotic symptoms which were auditory hallucinations, visual hallucinations and psychomotor agitation. Medical therapy with maximum doses of carbimazole, propranolol, and antipsychotics (haloperidol, risperidone, zuclopenthixol decanoate) administered over 18 weeks resulted in only a mild reduction in thyroid hormone levels with no improvement in psychotic symptoms.Following multidisciplinary evaluation, the patient underwent total thyroidectomy. Psychotic symptoms resolved completely within two weeks post-thyroidectomy. Follow-up thyroid hormone monitoring demonstrated normalization of free T3, free T4, and thyroid-stimulating hormone levels.This case emphasizes the importance of routine thyroid function screening in patients presenting with psychotic symptoms, particularly in resource-limited settings. It also highlights the need for timely escalation to surgical management when medical therapy fails.