The case of a person who developed episodic psychotic depression both during hypothyroid and hyperthyroid states is presented. This case illustrates the clinical interaction between an endocrine disorder and predisposing and concurrent psychologic risk factors for an affective disorder. The patient's troubled clinical course demonstrates the critical importance of expert clinical attention to both the psychologic and neuroendocrinologic factors involved. Successful management requires a collaborative interdisciplinary treatment plan as well as cross specialty knowledge. Finally, this case offers information about that complex interaction between the limbic and endocrine systems and their respective contributions to the development of affective disorders.