Inpatient and follow-up care of psychiatric patients with hyperthyroidism

Individuals with hyperthyroidism, especially those undiagnosed and untreated, are at much increased risk for a psychiatric admission. The severity of their psychiatric symptoms often demands the immediate use of psychotropic medications and, thus, shifts the focus of care from prompt medical diagnosis and treatment. Thyroid function screening tests and a thorough history and examination with vigilance for signs and symptoms more suggestive of a hyperthyroid state can often be useful in diagnosis. Because of the high incidence of stress-induced hyperthyroninemia, it also seems prudent to repeat thyroid function tests when initial values are suggestive of hyperthyroidism. Any subsequent thyroid function test should, in particular, include T3 measurements, because many patients with Grave's disease can exhibit with predominantly elevated T3 levels. Furthermore, when the use of lithium is considered for treating psychiatric illnesses, a thyroid antibody panel may be useful since a positive result is associated with increased risk of future thyroid abnormalities. Finally, once treatment is initiated, ensuring that patients obtain adequate follow up is also as important for avoiding future psychiatric relapses.