{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T02:16:19Z","timestamp":1773800179568,"version":"3.50.1"},"reference-count":19,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,9,23]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>A woman in her 30s with underlying Graves\u2019 disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient\u2019s own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.<\/jats:p>","DOI":"10.1136\/bcr-2021-242333","type":"journal-article","created":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T13:42:39Z","timestamp":1634218959000},"page":"e242333","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Deliberate self-harm in a patient with hyperthyroidism with acute psychosis"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1303-1271","authenticated-orcid":false,"given":"Haw Huo","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas Tze Ping","family":"Pang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"key":"2025082710593039000_14.10.e242333.1","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12074"},{"key":"2025082710593039000_14.10.e242333.2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1979.01780040083009"},{"key":"2025082710593039000_14.10.e242333.3","doi-asserted-by":"publisher","DOI":"10.1176\/ps.44.2.134"},{"key":"2025082710593039000_14.10.e242333.4","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1192\/S0007125000202080","article-title":"Thyroid abnormalities and violent suicide","volume":"144","author":"Drummond","year":"1984","journal-title":"Br J Psychiatry"},{"key":"2025082710593039000_14.10.e242333.5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-08-0749"},{"key":"2025082710593039000_14.10.e242333.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.genhosppsych.2012.12.006","article-title":"A case of a suicide attempt associated with hyperthyroidism","volume":"35","author":"Petrich","year":"2013","journal-title":"Gen Hosp Psychiatry"},{"key":"2025082710593039000_14.10.e242333.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2004.10.002"},{"key":"2025082710593039000_14.10.e242333.8","doi-asserted-by":"publisher","DOI":"10.1016\/0163-8343(88)90084-9"},{"key":"2025082710593039000_14.10.e242333.9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ecl.2013.05.005","article-title":"Neuropsychiatric manifestations of thyroid disease","volume":"42","author":"Feldman","year":"2013","journal-title":"Endocrinol Metab Clin North Am"},{"key":"2025082710593039000_14.10.e242333.10","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200620110-00003"},{"key":"2025082710593039000_14.10.e242333.11","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1192\/S0007125000298504","article-title":"Depression and endocrine disorders: focus on the thyroid and adrenal system","volume":"168","author":"Musselman","year":"1996","journal-title":"Br J Psychiatry Suppl"},{"key":"2025082710593039000_14.10.e242333.12","doi-asserted-by":"publisher","DOI":"10.1038\/sj.mp.4000963"},{"key":"2025082710593039000_14.10.e242333.13","first-page":"7","article-title":"Treatment of thyrotoxicosis-induced psychosis","volume":"36","author":"Gagliardi","year":"2002","journal-title":"Psychopharmacol Bull"},{"key":"2025082710593039000_14.10.e242333.14","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.autrev.2016.01.014","article-title":"Hashimoto's encephalopathy: a rare proteiform disorder","volume":"15","author":"Montagna","year":"2016","journal-title":"Autoimmun Rev"},{"key":"2025082710593039000_14.10.e242333.15","first-page":"45","article-title":"Masturbation or mutilation","volume":"25","author":"Favazza","year":"1991","journal-title":"Med Aspects Hum Sex"},{"key":"2025082710593039000_14.10.e242333.16","doi-asserted-by":"crossref","unstructured":"Favazza AR . 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