Here we report the case of Ms. H, a 46-year-old Caucasian woman with no past medical or psychiatric history who presented with complaints of slow speech, word-finding difficulties, and decreased concentration. Initial work-up including MRI and MRA, lumbar puncture, complete blood count, and basic metabolic panel were unremarkable with the exception of significantly elevated TSH levels. Symptoms were subsequently attributed to hypothyroidism. Despite treatment with levothyroxine and TSH levels that indicated a euthyroid state, Ms. H continued to experience cognitive difficulties resulting in repeat admission to the neurology floor. A psychiatric consultation was called to evaluate Ms. H for possible conversion disorder. Psychiatric evaluation revealed multiple psychosocial stressors in Ms. H's life; nonetheless, it was not believed that Ms. H's symptoms were due to conversion disorder but more likely psychological factors complicating hypothyroidism, and she was discharged home with this diagnosis. Ms. H presented to the Emergency Department several days later with delusions and paranoia in addition to continued slow speech and word-finding difficulty. She was subsequently admitted to the psychiatry floor to rule out a psychotic disorder. An EEG during her admission revealed abnormalities, and Ms. H was transferred to the neurology unit. Unfortunately, Ms. H's condition continued to decline without a known etiology despite aggressive work-up; eventually a repeat MRI showed new hyperintensities and a brain biopsy was performed, revealing changes consistent with spongiform encephalopathy. A diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) was later confirmed by Western blot analysis.