Thyroid dysfunction is known to have a significant impact on mental health. Hypothyroidism, in particular, has been linked to mood disorders and acute psychosis. Though most commonly associated with depression, hypothyroidism has been linked to psychosis since the late 1800s, in reports of delusions and hallucinations in patients with myxedema. In 1949, Asher coined the term “myxoedematous madness” to identify the psychotic manifestations of hypothyroidism, reporting 14 cases of psychosis with hypothyroidism.
More recent literature highlights the incidence and coexistence of hypothyroidism and psychiatric disorders, describing possible mechanisms contributing to the pathophysiology of these disorders. The link between hypothyroidism and mania, however, is less clear, with few reports in the literature. We present a case report of a 40 year old Caucasian male presenting with acute onset mania with psychosis and previously undiagnosed severe hypothyroidism.