Psychiatric Problems in a Thyroid Clinic

In the clinical management of hyperthyroid conditions the psychiatrist is sometimes consulted for help in handling psychotic reactions and sometimes for advice in the management of lesser emotional disturbances. Such emergency consultations set a severe trial of the psychiatrist's clinical judgment and of his ability to cooperate helpfully with surgeons and internists. The psychiatrist often wishes that he had been consulted earlier, before the psychiatric emergency arose in such a ticklish situation, but it would not be possible to satisfy this desire, even with very cooperative clinical team work, because the emotional emergency has not infrequently appeared at the very onset of the thyroid disease. The literature on hyperthyroidism abounds with notations about emotional trauma as the apparent precipitating cause of hyperthyroidism.¹The first description of the syndrome by Parry²in 1803 contained comment on the sudden fright which preceded the illness. Studies between 1920 and 1935, particularly