Eating disorders (ED) are among the most challenging topics encountered in psychiatry clinics, as they are associated with highest morbidity and mortality rates, affecting both physical health and psycho-social functioning. In spite of classified under a common title, various clinical manifestations might be associated with ED presentation. Restrictive behavior, binge eating, purgative behavior, excessive exercise, body checking and avoidance, body image disturbances and physical symptoms such as weight loss, amenorrhea, and reduced beard growth are frequently seen symptoms in patients suffering from EDs. But there are also less prevalent ways of clinical presentation. Here we present a case of recurrent confusional states caused by chronic levothyroxine use in an effort to lose weight. A 48-year-old female was admitted to psychiatric emergency unit (PEU) with an acute onset confusion, disorientation, mutism and irritability. In her mental status examination, she had blunted affect, ambivalence, verbal stereotypy. Because she was not fully cooperative, no further information could be revealed. In her history, she had had a similar episode which needed her to be hospitalized for ten days. She was hospitalized again with the provisional diagnosis of acute confusional state. Routine laboratory workup revealed severe thyrotoxicosis. Further laboratory analyses supported an external thyrotoxic agent use. When questioned, she denied taking any medication apart from the prescribed ones. A detailed anamnesis obtained from family members suggested a purging disorder. After administering propranolol and olanzapine, her symptoms resolved gradually in three days. Considering all of the information, final diagnosis was made as purging disorder which is classified under other feeding and eating disorders title in DSM-5 and she was discharged with olanzapine 15 mg/day. Although there are numerous ED diagnoses and manifestations exist in literature, presentation with confusional state in patients with ED is a rare entity. Also both ED and thyrotoxicosis are rare causes of confusional state. Thus, with this report we would like to point out that clinicians should not fail to notice less frequent presentations of psychiatric conditions.