Hyperthyroid Disorders

Lesson 8: Accompanying Conditions and Complications

Anxiety and Graves' Rage

Anxiety is one of the most common symptoms of hyperthyroidism, closely followed by nervousness and irritability. In severe instances these symptoms can escalate to a condition of Graves’ Rage.

Behavioral Changes
Mental changes are common in patients with thyrotoxicosis and include insomnia, poor concentration, anxiety, irritability, hyperactivity, and whimsical behavior to severe disturbances in cognitive function and behavior. The latter changes include agitated delirium, confusion, apathy, depression and mania. Patients with thyroid storm can show symptoms of confusion, agitation and delirium. Rarely these patients have seizures, psychosis, stupor or coma.

The effects of stimulants and alcohol are pronounced in thyrotoxicosis and this can also contribute to behavioral changes. Nutrient deficiencies, particularly deficiencies of B vitamins and magnesium can also contribute to irritability and other behavioral changes. Patients may also feel fatigued and distracted, compounding the problem.

Emotional lability is often a predominant symptom in thyrotoxicosis, with patients complaining of mood swings. Moods can quickly change from euphoria to despair. Patients may appear irritable, jittery and easily moved to tears, and some patients report having feelings of paranoia and experiencing disjointed, rambling speech disturbances. Mania is manifested by rapid speech, quick movements, and disorganization of thought content.

Graves’ Rage
Graves’ rage is a temporary condition in which the behavioral changes associated with thyrotoxicosis become extreme. Paranoia and psychosis can occur, and patients show exaggerated reactions to stress. Graves’ rage appears to occur when thyroid hormone levels change abruptly with psychosis more likely to occur in patients given aggressive treatment causing a sudden swing from hyperthyroidism to hypothyroidism.

Stress is considered an important precipitating factor in Graves’ rage. Several studies have been conducted in an attempt to show that patients with Graves’ disease have a heightened reaction to stress. These studies have been inconclusive.

Graves rage has been unsuccessfully presented as the reason for actions leading to murder and robbery in several prominent court cases. The mechanisms behind Graves’ rage especially when they occur in patients who are no longer hyperthyroid can apparently be difficult to comprehend.

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