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Old 09-22-2010, 02:01 PM   #1
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New thread, tons of info, Psych manifestations

Hypothyroidism & Iron Deficiency Diagnosed as a Psychiatric Disorder | Too Late Schmart | June 1999
Father’s story of his daughter’s encounter with psychiatric medicine and misdiagnosis.

http://www.drrichardhall.com/Articles/hashimoto.pdf
“Psychiatric Manifestations of Hashimoto’s Thyroiditis” by Richard C.W. Hall

http://www.psychiatrist.com/pcc/pccp...6/v05n0603.pdf
“Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited” by Thomas W. Heinrich, M.D. and Garth Grahm, M.D.

Hot Thyroidology - Journal owned by the European Thyroid Association
Thyroid hormone and depression.

Anxiety and Endocrine Disease
Article “Anxiety and Endocrine Disease” by Richard D. Hall, M.D. and Ryan C.W. Hall which includes sections “Anxiety Disorders in Patients with Thyroid Hormone Disturbance” and “Panic disorder/agoraphobia and thyroid disease”.

Official Fact Sheets and Reports on Psychiatry & Drugs
The Thyroid and the Mind and Emotions/Thyroid Dysfunction and Mental Disorders.

Thyroid Disease Information - Hypothyroidism - Hyperthyroidism - Thyroid Cancer - Autoimmune Disease - Hashimoto's - Graves' - Goiter - Nodules
Depression Explored, With Dr. Barry Durrant-Peatfield.

BioMed Central | Full text | The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future
Study “The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future.”

Relationship between anxiety and thyroid function in patients with panic disorder
Relationship between anxiety and thyroid function in patients with panic disorder.

Mood swings: a world-renowned expert on bipolar disorder discusses the latest research demonstrating that thyroid hormone can have a positive and profound effect on mood in bipolar patients.(Psychiatrist Peter Whybrow)(Interview) - The Saturday Eveni
A world-renowned expert on bipolar disorder discusses the latest research demonstrating that thyroid hormone can have a positive and profound effect on mood in bipolar patients.

Elsevier
Rapid-cycling bipolar disorder is associated with a latent hypofunction of the HPT system.

Clinical applications of levothyroxine in refractory mood disorders
A review of the evidence pertaining to the treatment of refractory affective disorders with supraphysiologic doses of T4.

Does Thyroid Supplementation Accelerate Tricyclic Antidepressant Response? A Review and Meta-Analysis of the Literature -- Altshuler et al. 158 (10): 1617 -- Am J Psychiatry
This meta-analysis supports the efficacy of T3 in accelerating clinical response to tricyclic antidepressants in patients with nonrefractory depression. Furthermore, women may be more likely than men to benefit from this intervention.

WebMD - Better information. Better health.
Antithyroid antibodies may signal difficult-to-treat depression.

Research zeros in on bipolar disorder genes, link with thyroid condition
Research zeros in on bipolar link with thyroid condition.

thyroid in bipolar
Thyroid and bipolar disorder.

PsychEducation
This clinician’s patient was bipolar and had not had any success with any anti-depressants or mood stabilizers but responded favorably to a T3/T4 combination.

Depression Case Study
Woman admitted to psychiatric hospital after suicide attempt and found to have hypothyroidism.

Thyroid Condition May Slow Depression Recovery - Medicine Online
Autoimmune thyroid condition may slow depression recovery.

Personality Disorders: Symptoms, Causes, Treatments, Support - HealthyPlace
1/3 of borderlines have symptoms of hypothyroidism, with “low normal” blood tests.

Role of thyroid hormone in brain development and behavior
Role of thyroid hormone in brain and behavior.

Prevalence of Psychiatric Disorders in Thyroid Diseased Patients
Abstract “Prevalence of Psychiatric Disorders in Thyroid Diseased Patients”.



The following is a sampling of related PubMed medical abstracts which can be searched at PubMed home

Psychiatric symptoms in endocrine diseases. Keys t... [Postgrad Med. 1985] - PubMed result
Psychiatric symptoms in endocrine diseases.
Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. Treatment with pychotrophic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders

Psychiatric presentations of hypothyroidism. [Am Fam Physician. 1981] - PubMed result
Psychiatric presentations of hypothyroidism.
Hypothyroidism often misdiagnosed as psychiatric illness. Thyroid screening recommended for patients presenting with depression, psychosis or organic mental disorder.

Masked "myxedema madness". [Acta Psychiatr Scand. 1977] - PubMed result
Masked “myxedema madness”.
Hypothyroidism can present a wide range of psychiatric manifestations, including personality disturbance, neurotic traits and psychotic features. Failure to recognize the endocrinopathy may not only produce recovery difficulties but also psychiatric and endocrine repercussions if psychotrophic medications are given in such masked cases.

[Psychotic manifestation of hypothyroidism. A case... [Nervenarzt. 1993] - PubMed result
Psychotic manifestations of hypothyroidism.
The case of a young woman who was treated one and one half years with psychopharmacologic agents and psychotherapy until hypothyroidism was diagnosed. Under administration of thyroid hormone the patient was free of psychiatric and somatic symptoms within 3 months.
.

[Psychiatric and cognitive aspects of hypothyroidi... [Tidsskr Nor Laegeforen. 2001] - PubMed result
Psychiatric and cognitive aspects of hypothyroidism.
All symptoms improved with thyroxine treatment, although patients did not necessarily reach premorbid functioning in 6-12. In the literature, depression in hypothyroidism is hypothesized to be at least partly caused by relative hypothyroidism in the central nervous system, and local brain triiodothyronine deficiency may be a possible explanation for affective and cognitive symptoms in subclinical hypothyroidism.

[Psychiatric manifestations as the only clinical s... [Encephale. 1998 Jan-Feb] - PubMed result
Psychiatric manifestations as the only clinical sign of hypothyroidism.
The presence of potentially irreversible cognitive deterioration, as well as the inocuity and sensibility of thyroid hormones examination justify the systematic thyroid evaluation for all new psychiatric patients.

[A case of 'hallucination of soliloquy' with hypot... [Seishin Shinkeigaku Zasshi. 2001] - PubMed result
A case of ‘hallucination of solioquy’ with hypothyroidism induced Hashimoto disease.
“Hallucination of soliloquy”, the autoimatic flow of meaningless words inside the patients’s mind. Symptoms disappeared soon after starting thyroid hormone treatment.

"Symptomless" autoimmune thyroiditis in depression. [Psychiatry Res. 1982] - PubMed result
“Symptomless” autoimmune thyroiditis in depression.
While patients with SAT are clinically euthyroid, what might be “symptomless” for the endocrinologist might be a syndrome presenting with psychiatric symptoms to the psychiatrist.

Myxedematous madness without myxedema. Selective d... [Acta Med Scand. 1976] - PubMed result
Myxedematous madness without myxedema.
A young woman, whose psychiatric history covered 16 years, has been treated several times as in-patient for psychotic depression, which was finally cured with thyroid replacement therapy.

Hypothyroidism and depression: a therapeutic chall... [Ann Pharmacother. 2000] - PubMed result
Hypothyroidism and depression: a therapeutic challenge.
Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone.

Psychotic states associated with disorders of thyr... [Int J Psychiatry Med. 1989] - PubMed result
Psychotic states associated with disorders of thyroid function.
Highlights the need to consider the possibility of thyroid disorder in all patients presenting with acute psychotic mental disorder.

The diagnostic dilemma of myxedema and madness, ax... [Int J Psychiatry Med. 1988] - PubMed result
The diagnostic dilemma of myxedema and madness, axis I and II.
A patient with presumed chronic paranoid schizophrenia had chronic thyroiditis and Grade I hypothyroidism. Psychosis cleared following treatment with thyroid replacement.

Thyroid function in clinical subtypes of major dep... [BMC Psychiatry. 2004] - PubMed result
Thyroid function in clinical subtypes of major depression: an exploratory study.
There is evidence suggesting the presence of an autoimmune process affecting the thyroid gland in depressive patients.

Studies on thyroid therapy and thyroid function in... [Folia Psychiatr Neurol Jpn. 1975] - PubMed result
Studies on thyroid therapy and thyroid function in depression patients.
A number of cases of depressed patients have latent hypothyroidism, possibly due to hypothalamus-pituitary dysfunction.

Experiences of fatigue and depression before and a... [Res Nurs Health. 1997] - PubMed result
Experiences of fatigue and depression before and after low-dose 1-thyroxine supplementation in essentially euthyroid individuals.
Individuals may experience thyroid-related symptoms such as fatigue and depression before thyroid indices become abnormal.

[Thyroid autoantibodies in depressive disorders] [Acta Med Austriaca. 1999] - PubMed result
Thyroid antibodies in depressive disorders.
Hashimoto’s/hypothyroidism is a risk factor for depression.

The presence of antithyroid antibodies in patients... [Biol Psychiatry. 1990] - PubMed result
The presence of antithyroid antibodies in patients with affective and nonaffective psychiatric disorders.
Thyroid disorders may be particularly common in patients with bipolar affective disorder.

Antithyroid antibodies in depressed patients. [Am J Psychiatry. 1985] - PubMed result
Antithyroid antibodies in depressed patients.
Findings support the hypothesis of subtle thyroid dysfunction in a sizable sample of psychiatric inpatients with prominent depressive symptoms.

Brain perfusion abnormalities in patients with eut... [Eur J Nucl Med Mol Imaging. 2004] - PubMed result
Brain perfusion abnormalities in patients with euthyroid autoimmune thyroiditis.
Findings suggest a higher than expected involvement of central nervous system in thyroid autoimmune disease.

Brain metabolism in hypothyroidism studied with 31... [Lancet. 1995] - PubMed result
Brain metabolism in hypothyroidism studied with 31P magnetic-resonance spectroscopy.
First direct evidence of cerebral metabolic effects of hypothyroidism on an adult brain.

Sub-laboratory hypothyroidism and the empirical us... [Altern Med Rev. 2004] - PubMed result
Sub-laboratory hypothyroidism and the empiral use of Armour Thyroid.
In some cases, treatment with desiccated thyroid has produced better clinical results than levothyroxine.

Psychoneuroendocrinology of mood disorders. The hy... [Psychiatr Clin North Am. 1998] - PubMed result
Psychoneuroendocinology of mood disorders. The hypothalamic-pituitary-thyroid axis.
Abnormal thyroid functioning can affect mood and influence the course of unipolar and bipolar disorder.

Regional cerebral blood flow in patients with mild... [J Nucl Med. 2004] - PubMed result
Regional cerebral blood flow in patients with mild hypothyroidism.
Decreased cerebral blood flow in mild hypothyroidism found in regions mediating attention, motor speed, memory, and visuospatial processing.

Myxedema psychosis--insanity defense in homicide. [J Clin Psychiatry. 1980] - PubMed result
Myxedema psychosis – insanity defense in homicide.
Man commits murder in course of hypothyroid psychosis. Later judged to be not guilty by reason of insanity.



Another excellent resource is the book, “The Thyroid Axis in Psychiatric Disorder” by Russell T. Joffe, M.D. and Anthony J. Levitt, M.D. A couple of quotes from this book:

A rich and diverse literature now exists on the relationship between thyroid function and a variety of psychiatric disorders.

…animal studies also suggest that brain utilization of thyroid hormones differs from that of peripheral organs. These advances create exciting possibilities for further studies examining the role of thyroid hormones in psychiatric illness.

…recurrent exacerbations of chronic or relapsing thyroiditis may lead to sporadic changes in thyroid hormone availability or cyclicity without necessarily grossly altering thyroid function tests.

Hashimoto’s disease is often occult and, therefore, frequently remains undiagnosed. It appears that, in some phases, dysregulation of hormone production may be subtle but associated changes in brain function may be unexpectedly prominent.

Because the diagnosis of autoimmune thyroid disease is so complex and sometimes so elusive, its identification as the cause of thyroid-related disorders of mental function is often delayed or even overlooked entirely.

Long-standing changes in thyroid function lead to considerable changes in dynamics of the cerebral circulation and these, rather than direct effects of the hormone in the brain, may be responsible for symptoms of brain dysfunction.

It can be speculated that the role of thyroid hormone in the brain may be different from that in peripheral tissues.



In summary, it is important for those having psychiatric and/or psychological symptoms to know that T3 is found in large quantities in the limbic system of the brain, the area that is important for emotions such as joy, panic, anger, and fear…and that if you don’t have enough T3, or if its action is blocked, an entire cascade of neurotransmitter abnormalities may ensue that can lead to mood and personality changes.
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Old 09-24-2010, 11:17 PM   #2
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Add on, about the "TSH" being the 'gold standard' test. It's not, read on.

Why aren’t health professionals more informed about psychiatric and psychological conditions resulting from a low thyroid condition?
Thyroid disease in general used to be treated by symptoms prior to the advent of the TSH test in the 1970s. People are now realizing this test does not detect many cases of low thyroid. It wasn’t until this lab test became the “gold standard” test for thyroid function that diseases like Chronic Fatigue Syndrome, Fibromyalgia, Irritable Bowel Syndrome and others came into existence. Many have surmised that these new “invisible disease” are simply low thyroid conditions that are not being detected by the standard TSH test. Therefore it is quite possible that many psychiatric disorders are actually hypothyroid conditions which are not being detected by the TSH tests. Although a health professional may know about the link to psychiatric/psychological conditions, the unreliable TSH test may cause them to rule out thyroid as an origin of the problems. Additionally, many health professionals think the TSH is the only test that is needed, and do not realize that thyroid antibodies alone can cause problems or that someone could be functionally hypo (low Free T3, normal TSH and Free T4). Free T3 and Free T4 are the tests that need to be run.
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Old 11-23-2011, 12:19 PM   #3
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Thyroid is Trigger for Psychiatric Trouble in Some
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Old 12-18-2011, 06:11 PM   #4
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I find this so discouraging.. I saw my doctor for insomnia in Jan and was prescribed an antidepressant. Year before I was in for swollen and painful fingers after a series of bad Raynaud's flare-ups and was told a daily aspirin might help, but I was too young to be taking aspirin every day (age 24), so there's nothing I could do. Also had long history of depression, anxiety, and eating disorders that in my mind, seemed to stem from nowhere. No therapist or doctor ever sought a physical cause for it though. Every time I've seen my doctor, I mention my mother's thyroid disease and my lifelong fear of getting it, but was told I'm too young and weight is healthy and "if you had thyroid disease you would know it".

This summer a routine blood panel at my yearly checkup shows thyroid disease - surprise! First time I've had thyroid blood tests, so who knows how long I've had this? It's really hard for me to not feel angry and bitter over the number of doctors I've seen throughout my life who saw me with thyroid symptoms, knew I had a family history of it, and didn't bother to do a simple blood test!
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Old 07-24-2012, 06:21 AM   #5
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it's sad when we have to educate our own doctors!
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Old 07-24-2012, 12:16 PM   #6
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It's not a case of educating our own doctors OR a 'simple blood test.'

Thyroid issues result in a variety of often vague symptoms, and two people rarely have the same symptoms. It is very, very common to be symptomatic and have lab values that show a perfectly normal thyroid.

I know because I'm hypothyroid, and although I was finally diagnosed and treated about ten years ago, I was symptomatic for at least 5 years prior, and my primary doctor insisted that my thyroid was 'fine.' It's a very, very difficult diagnosis because so many of its symptoms appear to be 'other issues.'

It's unfortunate, but that's how subtle thyroid disease can be.
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Old 08-05-2012, 10:23 PM   #7
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My biggest wish is that GPs would give more thorough tests to cover more than just the standard. I was told for 12 years that my thyroid tests all came back normal but I knew in my heart that I had Hashimotos hypothyroidism so I kept pushing my doctor to send me to an endocrinologist. I knew because my Mother had Graves, her sister had Graves, and all of my sisters had Hashimotos...and hypothyroidism also was in my Father's side of the family too, so I knew my symptoms were indicating that's what was wrong with me. After getting a complete physical, the doctor told me I was clinically depressed and tossed me a prescription for prozac. I got so tired of asking for thyroid tests, and was always specific with each doctor about testing for Hashimotos. FINALLY I got my endo referral, went and had the blood work done and the next day got the call that I did indeed have Hashimotos hypothyroidism. Twelve years...of weight gain, unable to lose, off and on bouts of depression, all of the joint pain, etc., etc., etc. I am so glad that I'm on meds now and starting to feel better but I suffered for too many years because I couldn't get anyone to truly hear me.

I started meds this past January...and just helped my daughter get her diagnosis too (just last week in fact). I am so thankful that we got hers diagnosed now, while she's still young so she won't have to go through what I did. When you keep telling doctors over and over and over again to please do specific tests and they don't, it's just so frustrating. I know it's a difficult diagnosis to get, but when someone tells you repeatedly about the family history being so strong and yet they still don't do the right tests, it's just so exhausting.

These links help a lot....thank you for taking the time to gather them and post them for us here. Now is more doctors would just get on board and really delve into family histories and/or go the extra mile with tests, the world would be a happier place! LOL
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Old 08-06-2012, 02:46 AM   #8
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JudyMS, the thing is, we can always get our own testing done via healthcheckusa online - IF we know about it. It's the Thyroid Panel II that includes TSH, Free T4 and Free T3 (just for a start). Use discount code 12345 for 10% off at check-out. Sign up online and they email back the results then later mail them also.
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