%0 Journal Article
%T Recognizing thyrotoxicosis in a patient with bipolar mania: a case report
%A Catherine Lee
%A Burton Hutto
%J Annals of General Psychiatry
%D 2008
%I BioMed Central
%R 10.1186/1744-859x-7-3
%X We review a case in which a patient with a long history of bipolar disorder presents with comorbid hyperthyroidism and bipolar mania after recent discontinuation of lithium treatment.Physicians should consider a comorbid hyperthyroidism in bipolar manic patients only partially responsive to standard care treatment with a mood stabilizer and antipsychotic.Multiple cases of patients with thyrotoxicosis presenting with symptoms clinically indistinguishable from bipolar mania have been reported [1-8]. Moreover, lithium for the management of preexisting bipolar disorder has many known effects on thyroid function [1,2,4,6,8-10]. We report the case of a patient whose chronic lithium was discontinued owing to other concerns and who then presented with manic and psychotic symptoms apparently related to thyrotoxicosis.Ms F is a 59-year-old female with a long history of bipolar disorder, previously well controlled on a stable dose of lithium carbonate, who presented for hospitalization with an apparent manic episode. She reported four weeks of decreased sleep, hypersexuality, mood lability, increased spending, impulsive behavior and psychotic symptoms. The patient and her sister both noted that the symptoms were consistent with her manic episodes in the remote past. Ms F reported a recent change in her medication from lithium carbonate to aripiprazole, made by a new psychiatrist, who was uncomfortable with prescribing lithium after the patient had been hospitalized for lithium toxicity a month prior to admission.Her psychiatric history included multiple episodes of mania with subsequent hospitalizations in the remote past. Past medication trials included risperidone, aripiprazole, quetiapine, lithium carbonate and depakote. The past medical history was significant for arthritis, hypercholesterolemia, irritable bowel disorder and a history of depressed thyroid-stimulating hormone (TSH), with normal free T4. On transfer from an outside psychiatric hospital, her medications were
%U http://www.annals-general-psychiatry.com/content/7/1/3