PSYCHIATRY

ENDO-DIABETOLOGY

GENERAL MEDICINE

<p>A 32-year-old lady was taken to the emergency department because her behaviour had become more erratic during the preceding six months. She had only been sleeping on a sofa for a few hours each night and consuming just one meal each day for the four months before her presentation. She had shed 15 kg and was experiencing palpitations. Even though she put in long work hours, she was less productive than usual since her mind was racing. She had grown suspicious, telling her husband that even if her cell phone was off, she was still getting messages from it directly into her brain. She had been experiencing rising levels of anxiety, which was explained by &quot;stress&quot; and her financial problems. The initial diagnoses of her symptoms were &quot;anxiety,&quot; but as they worsened, she was transferred to acute psychiatry services and evaluated. The patient was easily distracted, made only fleeting eye contact, and was agitated, pacing the room as the liaison psychiatry nurse assessed her.Apart from a thyroid stimulating hormone (TSH) level of less than 0.1 mU/L (reference range: 0.3&ndash;4.2 mU/L), free thyroxine (T4) levels of more than 97.5 pmol/L (reference range: 12&ndash;22 pmol/L), and free triiodothyronine (T3) levels of 32.3 pmol/L (reference range: 3.1-6.8 pmol/L).</p>