Levothyroxine induced mania in the setting of juvenile hypothyroidism

Hypothyroidism is a common problem in clinical practice with diverse manifestations some of which are neuropsychiatric. Mania is commonly associated with hyperthyroidism. Only a few selected case reports mention mania as a presenting feature of hypothyroidism. We report a case of mania with psychotic symptoms in a 16-year-old Egyptian female who had no previous history of psychiatric disorder. She presented to the Endocrinology and Metabolism (EM) clinic with delayed puberty and short stature. Workup revealed primary hypothyroidism for which she was given replacement therapy and developed manic symptoms shortly after the initiation of thyroid replacement. She required both mood stabilizer and thyroxin replacement for the amelioration of her symptoms. We concluded that psychiatric assessment in approaching patients suffering from thyroid disorders is essential since the associated psychiatric disturbances might hinder adequate treatment plan for those patients.