We experienced a case of mania which appeared during the course of thyroxine therapy in a patient with myxedema psychosis. Progressive manic symptoms which were distinct from mental change associated with hypothyroidism occurred about one week after thyroxine replacement therapy. Thease symptoms were controlled by neuroleptics and rapidly abated within two weeks during the therapy. On her past history, she was suffered from hypothyroidism and concurrent mental symptoms at least for two years. Although her manic symptoms occurred in the context of a rapid administration of thyroxine, the underlying neurobiologic mechanisms are unclear. However, it is suggested that abruptly augumented catecholamine recptor sensitivity could participate hypercatecholaminergic state and manic symptomatologies. Some authors pointed out high risk profiles of thyroxine induced mania. One of them is pre-existing psychotic symptom like that of this patient. Patients who fit these profiles should be given a lower initiation dosage and closely observed for the onset of manic symptoms in the course of therapy.
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