Objective: Mania with psychotic features presenting following abrupt normalisation of thyroid function from severe Graves's disease is reported.
Clinical picture: A 33-year-old man with severe, untreated Graves's disease was treated aggressively, with rapid restoration of normal serum thyroid hormone levels. Symptoms of mania and psychosis then developed.
Treatment: Time limited anti psychotic medication and continuing medical treatment.
Outcome: There was resolution of psychiatric symptoms.
Conclusions: The association of mania and psychosis with thyroid disease is rare, but aggressive medical treatment and rapid restoration of normal serum thyroid levels may increase the risk of the emergence of such symptoms.