Hyperthyroidism

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Hyperthyroidism is an endocrine disorder characterized by excessive thyroid hormone activity, resulting in multisystemic effects.

It can present with psychiatric features such as anxiety, irritability, agitation, emotional lability, insomnia, impaired concentration, mood disturbance, and, less commonly, psychosis (thyrotoxic psychosis), particularly in the context of severe or untreated hyperthyroidism.

Other characteristic features include neurological manifestations such as tremor, hyperreflexia, restlessness, and, in severe cases, delirium or altered consciousness (thyroid storm). Cognitive impairment and affective symptoms may occur.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Cardiovascular: palpitations, sinus tachycardia, atrial fibrillation (particularly in older adults), increased cardiac output, and potential heart failure in severe or prolonged disease.

  • Respiratory: exertional dyspnoea may occur secondary to increased metabolic demand or cardiovascular effects.

  • Gastrointestinal: increased bowel frequency, diarrhoea, and weight loss despite preserved or increased appetite are characteristic.

  • Endocrine: autoimmune thyroid disease, particularly Graves disease, is a common cause; associated autoimmune clustering may occur.

  • Musculoskeletal: proximal muscle weakness, fatigue, muscle wasting, and accelerated bone loss may occur.

  • Dermatologic: warm moist skin, excessive sweating, hair thinning, and, in Graves disease, pretibial myxoedema may occur.

Early diagnosis is important to enable treatment of thyroid hormone excess, reduce the risk of serious cardiovascular and neurological complications, identify and manage associated autoimmune disease, and improve psychiatric symptoms, functional outcomes, and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.