Case 14-2016: A Woman with a Thyroid Nodule and Psychosis

To the Editor: In the Case Record, Delichatsios et al. (May 12 issue) 1 discussed the development of abrupt adult-onset psychosis and delusional thinking in a 37-year-old woman with Hashimoto’s thyroiditis and a clinically significant weight loss. A unifying diagnosis of celiac disease was made. During a 3-month hospitalization, the patient did not eat gluten-containing foods, and her psychiatric symptoms remitted. The symptoms returned when she ate gluten-containing foods. I propose that the patient could have Hashimoto’s encephalopathy, which is a well-known cause of psychosis. 2 Remissions and relapses are common. Her lapse in adhering to a gluten-free diet may have been . . .