Graves’ Disease Presenting as Refractory Panic Attacks: Diagnostic Clarification Through Thyroid Scintigraphy

Graves’ disease (GD) is the most common cause of hyperthyroidism and is caused by autoantibodies against the TSH receptor. It typically presents with classic thyroid symptoms but may rarely present with predominant psychiatric features such as severe anxiety and panic attacks. This can lead to misdiagnosis and delay in treatment, especially when thyroid function tests are fluctuating or inconclusive, making differentiation from thyroiditis difficult. In such cases, thyroid scintigraphy is useful for distinguishing GD (increased uptake) from thyroiditis (reduced uptake). We report a case of a patient with severe refractory panic attacks and mild ophthalmopathy, where GD was confirmed only after thyroid scintigraphy despite non-diagnostic thyroid function tests.