Thyroid function tests in patients with acute psychosis

Hypo and hyperthyroidism can both cause mental disorders, but the effects of psychiatric disorders on thyroid function has not been determined. In acute psychosis, thyroid function tests are temporarily impaired. So that total and free T4 are increased in 35% and 20%, respectively, and TSH and T3 are changeable. All patients with different acute psychiatric disorders were studied. These included 144 patients (80 female, 64 male, aged 27.88±10.67 and 27.69±9.19, respectively). Patients were avaluated according to disease type, drugs, and the presence of goiter, and thyroid function tests were done during the acute attack. The tests were repeated 3 weeks later in those with abnormal results. 21 patients (14.5%) had abnormal TSH during disease attack. TSH was suppressed in 14 (TSH<0.3 mU/L, mean: 0.121±0.043), and increased in 7 (TSH>5.5 mU/L, mean: 13.8±10.8). T4 level was abnormal in 13 patients (9%), 12 of whom had high T4 (T4>12.8 μg/dl, mean: 16±3.85) and 1 had low T4 (T4<4.8 μg/dl). In eleven patients (8%) T3 was increased (T3>3nmol/L, mean: 5.8±3.08). Ten patients (7%) had abnormal FTI FTI was increased in 8 (FTI>4.4, mean: 7.55±1.66) and decreased in 2 (FTI<1.2, mean: 0.18±0.08). 7 patients had thyroid dysfunction (4 hyperthyroid, 3 hypothyroid) at the time of diagnosis of psychiatric disorder. When these were excluded, 14 patients (9.7%) with acute psychosis had abnormal TSH (suppressed in 10 and above normal in 4) and T4, FTI and T3 were abnormal in 8 (5.5%), 4 (2.7%), and 7 (5%) patients, respectively. Three weeks later, all thyroid function tests returned to normal. The prevalence of hyperthyroxinemia in acute psychotic patients was 2.7% in this study, which is much less than other studies. In management of acute psychosis, thyrotoxicosis must be considered as a possible cause of psychosis.