Catatonia Associated with Thyrotoxicosis

INTRODUCTION: Catatonia is a neuropsychiatric disease and can be observed in mental, neurological and medical conditions. Catatonia with thyroid abnormality is rarely seen. This case report attempts to add information regarding the need for a high index of suspicion for an organic etiology in cases presenting with catatonia. CASE SUMMARY: A 36 years, married female presented with muttering to self for 1 week, inability to walk, decreased social interaction, decrease intake of meals, disturbed sleep for 3 days. Illness had acute onset continuous course and deteriorating progress. On examination pulse was 130/min, temperature 100.4°F, 5*4cm swelling over neck region. Patient had mutism, staring, tremors, posturing, negativism, ambitendancy. Investigation revealed sinus tachycardia, hyperthyroidism (TSH<0.001 mIU/ml, FT4 >5ng/ml, FT3:13.78ng/ml).USG neck revealed bilateral thyromegaly with multinodular goitrous appearance.MRI of brain revealed no abnormality. Burch-Wartofsky Point Scale, score was >45 suggestive of thyroid storm. The patient was started on Tab Lorazepam 8 mg, Tab Propanolol 40 mg, Tab Olanazapine 5mg and after 1 week showed significant improvement in catatonic symptoms. DISCUSSION: Neuropsychiatric symptoms including catatonia could be a presenting feature of thyroid storm.