A Case Report: Post-Traumatic Stress Disorder (PTSD) with Thyrotoxicosis and Psychosocial Stress

Authors

  • Masyita Kusuma Maharani Universitas Nahdlatul Ulama Surabaya image/svg+xml
  • Hafid Algristian Universitas Nahdlatul Ulama Surabaya image/svg+xml
  • Ariyani Sri Suwarti Radjiman Wediodiningrat Hospital Lawang Malang

DOI:

https://doi.org/10.61194/psychology.v4i1.872

Keywords:

ptsd, thyrotoxicosis, psychosocial stress, psychopharmacology, biopsychosocial model

Abstract

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition triggered by trauma, often exacerbated by medical comorbidities like thyrotoxicosis. This report aims to illustrate the complex interaction between PTSD, endocrine dysfunction, and psychosocial stress, highlighting the need for an integrated treatment approach. This case report is based on a clinical case of a 31-year-old female with PTSD and comorbid thyrotoxicosis treated at a hospital in Indonesia. Data were collected through clinical history, physical and psychiatric examinations, and a review of relevant literature. The patient developed PTSD symptoms following a motorcycle accident, including nightmares, hyperarousal, insomnia, and avoidance behavior. Her pre-existing thyrotoxicosis amplified anxiety and physiological arousal, while psychosocial stressors such as legal issues and unemployment perpetuated her symptoms. A combined treatment of Sertraline 50 mg/day, short-term Alprazolam, trauma-focused therapy, and spiritual coping strategies resulted in initial improvement in anxiety and emotional regulation. Managing PTSD with comorbid thyrotoxicosis and psychosocial stress requires a biopsychosocial-endocrine approach. Coordinated pharmacological, psychotherapeutic, and psychosocial interventions are essential for symptom control and functional recovery. This case underscores the importance of multidisciplinary collaboration in complex PTSD presentations.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596 DOI: https://doi.org/10.1176/appi.books.9780890425596

Bourvis, N. (2022). Stress and trauma: the role of thyroid hormones. Current Psychiatry Reports, 24(6), 287–297. https://doi.org/10.1007/s11920-022-01338-z DOI: https://doi.org/10.1007/s11920-022-01338-z

Daddah, D., Glèlè Ahanhanzo, Y., Kpozehouen, A., Hounkpe Dos Santos, B., Ouendo, E. M., & Levêque, A. (2022). Prevalence and risk factors of post-traumatic stress disorder in survivors of a cohort of road accident victims in Benin: Results of a 12-month cross-sectional study. Journal of Multidisciplinary Healthcare, 15, 719–731. https://doi.org/10.2147/JMDH.S358395 DOI: https://doi.org/10.2147/JMDH.S358395

Díaz-Tamayo, A. M., Ordóñez-Hernández, C. A., Bravo, D. F. V, & García-Perdomo, H. A. (2024). Posttraumatic stress disorder and psychosocial risk factors in first response workers to emergencies: Mixed method. European Journal of Trauma & Dissociation, 8(2), 100405. https://doi.org/10.1016/j.ejtd.2024.100405 DOI: https://doi.org/10.1016/j.ejtd.2024.100405

Duval, F., Mokrani, M. C., Crocq, M. A., Bailey, P. E., Diep, T. S., & Macher, J. P. (2015). Thyroid axis activity and suicidal behavior in depressed patients. Psychoneuroendocrinology, 25(6), 575–587. https://doi.org/10.1016/S0306-4530(00)00011-2

International Labour Organization. (2016). List of occupational diseases. https://www.ilo.org

Johnson, H., & Thompson, A. (2019). The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: A review. Clinical Psychology Review, 29(1), 36–47. https://doi.org/10.1016/j.cpr.2007.01.017 DOI: https://doi.org/10.1016/j.cpr.2007.01.017

Kementerian Kesehatan Republik Indonesia. (1993). Pedoman Penggolongan dan Diagnosis Gangguan Jiwa (PPDGJ-III).

Koenen, K. C. (2023). Posttraumatic stress disorder in the World Mental Health Surveys. Psychological Medicine, 53(4), 1206–1217. https://doi.org/10.1017/S0033291721002678

Mann, S. K., Marwaha, R., & Torrico, T. J. (2024). Posttraumatic stress disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559129/

Morris, M. C. (2021). Cortisol, thyroid hormones and neuroendocrine signaling in PTSD. Psychoneuroendocrinology, 134, 105422. https://doi.org/10.1016/j.psyneuen.2021.105422 DOI: https://doi.org/10.1016/j.psyneuen.2021.105422

Olff, M. (2022). Trauma-focused psychotherapy for PTSD: current evidence and future directions. The Lancet Psychiatry, 9(12), 989–1002.

Pan, X. (2022). Catecholamines in Post-traumatic Stress Disorder: A Systematic Review and Meta-Analysis. Frontiers in Molecular Neuroscience, 15, 919892.

Paul, K. I., & Moser, K. (2009). Unemployment impairs mental health: Meta-analyses. Journal of Vocational Behavior, 74(3), 264–282. https://doi.org/10.1016/j.jvb.2009.01.001 DOI: https://doi.org/10.1016/j.jvb.2009.01.001

Raise-Abdullahi, P., Meamar, M., Vafaei, A. A., Alizadeh, M., Dadkhah, M.,Shafia, S., Ghalandari-Shamami, M., Naderian, R., Samaei, A. S., & Rashidy-Pour, A. (2023). Hypothalamus and post-traumatic stress disorder: A review. Brain Sciences, 13(7). https://doi.org/10.3390/brainsci13071010 DOI: https://doi.org/10.3390/brainsci13071010

Rosenberg, L. (2024). Psychosocial interventions for comorbid PTSD and physical health conditions: A systematic review. Journal of Traumatic Stress, 37(1), 22–35.

Samuels, M. H. (2014). Psychiatric and cognitive manifestations of hypothyroidism and hyperthyroidism. Current Opinion in Endocrinology, Diabetes and Obesity, 21(5), 377–383. https://doi.org/10.1097/MED.0000000000000081 DOI: https://doi.org/10.1097/MED.0000000000000089

Sanchez, A. R., Patlán Pérez, R., & Organización Panamericana de la Salud (OPS). (2015). Resource page. https://www.paho.org

Schmidt, U. (2023). Biomarkers for posttraumatic stress disorder: an overview of systematic reviews. CNS Spectrums, 28(2), 148–161. https://doi.org/10.1017/S1092852922000015

Smith, M. E. (2018). Legal stress and mental health: A systematic review. International Journal of Law and Psychiatry, 58, 102–113. https://doi.org/10.1016/j.ijlp.2018.03.002 DOI: https://doi.org/10.1016/j.ijlp.2018.03.002

Spoont, M. R. (2024). The Impact of Comorbid Medical Conditions on PTSD Treatment Outcomes. Journal of Clinical Psychiatry, 85(1). https://doi.org/10.4088/JCP.23m14876

Stein, D. J., Ipser, J. C., & Seedat, S. (2006). Pharmacotherapy for post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, (1), CD002795. https://doi.org/10.1002/14651858.CD002795.pub2 DOI: https://doi.org/10.1002/14651858.CD002795.pub2

Toloza, F. J. K., Mao, Y., Menon, L. P., George, G., Borikar, M., Erwin, P. J., Owen, R. R., & Maraka, S. (2020). Association of thyroid function with posttraumatic stress disorder: A systematic review and meta-analysis. Endocrine Practice, 26(10), 1173–1185. https://doi.org/10.4158/EP-2020-0104 DOI: https://doi.org/10.4158/EP-2020-0104

Williamson, J. B. (2023). The role of the prefrontal-amygdala circuit in PTSD: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 153, 105372. https://doi.org/10.1016/j.neubiorev.2023.105372 DOI: https://doi.org/10.1016/j.neubiorev.2023.105372

Zoellner, L. A. (2024). Optimizing PTSD treatment: sequencing and combining interventions. Nature Reviews Psychology, 3(4), 245–259.

Downloads

Published

2026-02-11