Case ReportsHyperthyroid Rage When Bipolar Disorder Hides the Real Disorderde Sousa Gurgel, Wagner MD; Dutra, Pablo Eduardo Pereira MD; Higa, Renato Alves MD; da Costa, Carolina Barros Ferreira MD; de Matos e Souza, Fabio Gomes MD, PhDAuthor Information *Centro Psiquiátrico Rio de Janeiro, Praça Coronel Assunção, S/N, Saúde, Rio de Janeiro, and †Walter Cantídio University Hospital, Federal University of Ceará, Ceará, Brazil. Address correspondence and reprint requests to Fabio Gomes de Matos e Souza, MD, PhD, Praça Coronel Assunção, S/N, Saúde, Rio de Janeiro, Rio de Janeiro, Brazil 20220-480; E-mail: firstname.lastname@example.org Conflicts of Interest and Source of Funding: The authors have no conflicts of interest to declare. Clinical Neuropharmacology: January/February 2015 - Volume 38 - Issue 1 - p 38-39 doi: 10.1097/WNF.0000000000000059 Buy Metrics Abstract Long-term lithium therapy has been associated with euthyroid goiter, hypothyroidism, and less commonly, hyperthyroidism. We report a case of a 19-year-old male patient with schizoaffective disorder who was hospitalized after trying to suffocate his mother. Severe psychomotor agitation persisted despite the high dose of antipsychotics. Initial laboratory tests showed elevated creatine kinase and free thyroxine. Lithium was replaced by sodium valproate, and new laboratory tests were obtained. After lithium discontinuation, the patient had a rapid improvement in agitation and tremors. Antithyroid drugs were not necessary, suggesting the diagnosis of lithium-associated thyrotoxicosis that progressed to spontaneous remission. There are only 2 other reports of lithium-associated thyrotoxicosis successfully treated with lithium withdrawal. Even patients on long-term use of lithium are not free from having acute thyroid dysfunction and may present with treatment-resistant symptoms. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.