{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T17:27:33Z","timestamp":1779902853880,"version":"3.53.1"},"reference-count":14,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,3,28]]},"abstract":"<jats:p>A previously healthy 36-year-old woman presented with visual hallucinations and acute psychosis manifested predominantly as hypersexuality. Laboratory testing demonstrated elevated free thyroxine levels, suppressed thyroid-stimulating hormone levels and presence of thyroid-stimulating immunoglobulin and <jats:italic>thyroid peroxidase (TPO) antibodies<\/jats:italic> consistent with Graves\u2019 disease. Despite achieving biochemical euthyroidism, she remained profoundly hypersexual. She did not respond to additional treatment with antipsychotics and corticosteroids, prompting further evaluation. Cerebrospinal fluid analysis detected pleocytosis, elevated IgG, and presence of antibodies against anti-N-methyl-D-aspartate receptor (NMDAR), glutamic acid decarboxylase 65 and TPO. These results suggested a diagnosis of anti-NMDAR encephalitis. Prior to initiation of immunomodulator therapy, she was discovered to be pregnant with date of conception around the time of her original presentation. She received plasmapheresis with resolution of psychosis and decrease in free thyroxine levels. Graves\u2019 disease remitted during the remainder of the pregnancy but relapsed 5\u2005months post partum. She has not had further neuropsychiatric symptoms.<\/jats:p>","DOI":"10.1136\/bcr-2014-208052","type":"journal-article","created":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T06:57:02Z","timestamp":1429685822000},"page":"bcr2014208052","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Acute psychosis in a pregnant patient with Graves\u2019 hyperthyroidism and anti-NMDA receptor encephalitis"],"prefix":"10.1136","volume":"2015","author":[{"given":"Jesslyn","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Medicine\/Endocrinology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Samson","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Endocrinology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Kass","sequence":"additional","affiliation":[{"name":"Department of Neurology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini","family":"Ram","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Endocrinology, Baylor College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,4,22]]},"reference":[{"key":"2025082800063233000_2015.apr22_1.bcr2014208052.1","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200620110-00003"},{"key":"2025082800063233000_2015.apr22_1.bcr2014208052.2","doi-asserted-by":"publisher","DOI":"10.1176\/jnp.8.2.181"},{"key":"2025082800063233000_2015.apr22_1.bcr2014208052.3","unstructured":"Whybrow PC , Bauer M . 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