Mental Disorder or Undiagnosed Hypothyroidism?

Mental Disorder or Undiagnosed Hypothyroidism?

I stopped breathing momentarily when I received a message from one of my blog readers…trying to think back to all my years of work with children and adults with various forms of mental disorder. Is it possible that some people suffering from mental disorder are in fact undiagnosed or under-treated hypothyroidism sufferers? This reader has left me thinking over all I have learned about mental disorders and all the cases of children and adults I have worked with over the past 20 years. She has turned my perspective on mental health literally upside down.

Dear Dana,

I found your blog Hypothyroid Mom and feel a need to contact you directly. I was an energetic successful person and in one year I fell down and literally broke. I was put in a mental health ward because I went days without sleeping, felt so tired I couldn’t function and found myself delusional and couldn’t stop the words running through my head. I was diagnosed bipolar and drugged up with medication. I saw the line of bipolar patients waiting every morning in the psych ward for electric shock therapy. The only thing that saved me from electric shock was my mother yelling NO.

For four years I was drugged up so bad that my mind wasn’t right. I told the psychiatrists and doctors that something wasn’t right with me. From 110 pounds my weight went up to 245. I was so tired, suffered pains from fibromyalgia. My heart rate was pounding at 155 and my blood pressure was through the roof. They just kept telling me I was bipolar and that I was a hypochondriac.

Finally after 4 years of bipolar medications to the max, a close family member was diagnosed with hypothyroidism so my doctor tested me too. I have a family history of thyroid disease. I was diagnosed with hypothyroidism. I’ve suffered so many of the symptoms of hypothyroidism you list on your blog for so many years.

Every single time I attend a bipolar support group I ask everyone if they are hypothyroid and every time half the people raise their hand and the other half have no clue what it is and they don’t know if they have been tested.

Jana

This reader’s message shook me to my core. I sat frozen in front of my computer.

Perhaps I need to step back and tell you a little bit about my educational and career background, to help you understand why this reader’s message has touched me so deeply. Why I feel guilty for having missed this critical piece to the mental health puzzle in my career.

During my undergraduate science degree in Toronto Canada in the early 1990s, I was fortunate to take a course with a professor who was passionate about neurobiology. The science of the brain was intriguing to me. I graduated with my Honors Bachelor of Science in Neuroscience. When I then graduated with my teaching degree to teach science at the high school level, a specialization in Special Education was a perfect fit with my educational background.

The year I graduated with my teaching degree, I was hired as a high school science teacher in a specialized school for students considered “unfit” for mainstream schools. Basically this meant children who were expelled from regular high schools, children considered “violent”, children struggling academically. Really it was a school where a good portion of the students, primarily males, were in and out of the juvenile justice system. My year at this school opened my eyes to a world I didn’t know existed. I bonded with these children. I cared about them. They told me their life stories. I had many students who were great people, truly wonderful caring people that found themselves on this path in and out of jail.

I was interviewed on Prisonworld Radio Hour about my experience as a teacher for these troubled children in and out of the juvenile justice system. We discussed the issues of race, gang violence and an educational system that is failing these children. Since receiving this message from my blog reader, I’ve thought back on that interview and wonder if I missed a critical piece to the puzzle. A great majority of my students were labeled with learning disabilities and various mental health issues including depression, anxiety, suicidal, bipolar, ADHD, conduct disorder and oppositional defiant disorder. No matter where I worked in my teaching career, from this special school for troubled kids to a gifted high school for academically talented children, I inevitably found children struggling with mental health issues.

Given the need of every cell of our body including the brain for thyroid hormones, is it possible that some of these children had undiagnosed thyroid disease? Hmmm….

In 2000 I moved to NYC for my graduate studies. I attended classes with Ivy-League professors well-renowned for their research contribution in the world of psychology and counseling. As a career counselor and trainer in New York City, I’ve worked for over 10 years with people who have lost their jobs or who are unsatisfied with their career progression. You can’t imagine the number of people that I have worked with suffering from depression, anxiety, and other mental health issues. Job loss and career dissatisfaction are powerful triggers for brain health issues.

According to the American Association of Clinical Endocrinologists and The American Thyroid Association, iodine deficiency is the most common cause of hypothyroidism on a worldwide basis. In areas of iodine sufficiency, such as the United States, the most common cause of hypothyroidism is the thyroid autoimmune condition Hashimoto’s thyroiditis.[1. ATA/AACE. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by The American Association of Clinical Endocrinologists and The American Thyroid Association. Endocr Pract. 2012;18(No.6):989-1028] With Hashimoto’s, our immune system creates thyroid antibodies to attack our own thyroid gland as if it is the enemy. Check out my post Hashimoto’s: Your Body Is Not Supposed To Destroy Itself Right? Once our immune system begins destroying our own thyroid gland, this attack can then spread to other parts of the body. Every part of the body becomes fair game for attack…why not the brain!

During my graduate studies, I was team leader for a prestigious professor’s research team. As a team we spent months of research to prepare just one research paper. I know very well the amount of time it took to create a published study. While one study alone is not enough to peak my interest, when I find multiple research papers all with a common finding my interest is caught. For multiple research teams to find similar findings, the findings deserve serious attention. This is the case with hypothyroidism and mental disorders.

Hashimoto’s disease often comes with ups and downs in TSH like a wild roller coaster ride, with people suffering swings between symptoms of hyperthyroidism (hyperactivity, irritability, inability to sleep) and hypothyroidism (fatigue, depression). These swings back and forth, don’t they sound very similar to the swings in Bipolar Disorder (manic depression)? Hmm…

Research – Hypothyroidism & Mental Disorders

A 2002 study entitled “High Rate of Autoimmune Thyroiditis in Bipolar Disorder: Lack of Association with Lithium Exposure” found that Hashimoto’s thyroid antibodies were highly prevalent in a sample of outpatients with bipolar disorder as compared to a control group.[2. Kupka, R.W., Nolen, W.A., Post, R.M., McElroy, S.L., Altshuler, L.L., Denicoff, K.D., Frye, M.A., Keck, P.E. Jr, Leverich, G.S., Rush, A.J., Suppes, T., Pollio, C., Drexhage, H.A. High Rate of Autoimmune Thyroiditis in Bipolar Disorder: Lack of Association With Lithium Exposure. Biological Psychiatry 2002 Feb 15;51(4):305-11]

What complicates studies with bipolar disorder is that patients with bipolar disorder are often treated with the drug Lithium. Thyroid problems are a common side effect of this drug. Lithium can cause hypothyroidism, goiters (enlarged thyroid), and autoimmune thyroiditis. So what came first, the hypothyroidism or the lithium treatment. The fact that so many bipolar patients on lithium treatment and so many not on lithium treatment are found to have Hashimoto’s thyroid antibodies is cause for real concern.

An interesting study of bipolar twins versus healthy control twins showed that autoimmune thyroiditis is related not only to bipolar disorder itself but also to the genetic vulnerability to develop the disorder.[3. Vonk, R., Van Der Schot, A.C., Kahn, R.S., Nolen, W.A., Drexhage, H.A. Is autoimmune thyroiditis part of the genetic vulnerability (or an endophenotype) for bipolar disorder? Biol Psychiatry 2007 Jul 15;62(2):135-40]

A 2004 study found a link between thyroid autoimmunity, specifically the presence of thyroid peroxidase antibodies (TPO Ab+), with anxiety and mood disorders in the community.[4. Carta, M.G., Loviselli, A., Hardoy, M.C., Massa, S., Cadeddu, M., Sardu, C., Carpiniello, B., Dell’Osso, L., Mariotti, S. 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. BMC Psychiatry 2004 Aug 18;4:25]

A 2005 study found that subjects with Hashimoto’s disease displayed high frequencies of lifetime Depressive Episodes, Generalized Anxiety Disorders, Social Phobia, and Primary Sleep Disorders.[5. Carta, M.G., Hardoy, M.C., Carpiniello, B., Murru, A., Marci, A.R., Carbone, F., Deiana, L., Cadeddu, M. Mariotti, S. A case control study on psychiatric disorders in Hashimoto disease and euthyroid goitre; not only depressive but also anxiety disorders are associated with thyroid autoimmunity. Clinical Practice and Epidemiology in Mental Health 2005 Nov 10;1:23]

A study entitled “TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers” reported:[6. Alvarez-Pedrerol, M. Ribas-Fito, N., Torrent, M., Julvez, J., Ferrer, C., Sunyer, J. TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers. Clinical Endocrinology 2007;66(6):890-898]

Despite being within the normal range, high TSH concentrations are associated with a lower cognitive function and high TSH and low Free T4 with ADHD symptoms in healthy preschoolers. Statistically significant differences were observed in the highest quartiles of TSH, suggesting a need for re-evaluation of the upper limit of the normal TSH range.

Never once in my educational training in education or counseling did I ever hear about the dangers of thyroid disease to brain health. Never once in these 20 years as a teacher and career counselor, have I ever considered thyroid disease as a possible cause for a person’s mental disorder. Never once…until now.

“When you know better you do better.”

-Maya Angelou

This is a call out to all my readers suffering from mental health issues to please be sure your thyroid has been checked properly. It is not enough to test for TSH alone. A full thyroid panel should at least include TSH, Total T4, Free T4, Total T3, Free T3, Reverse T3, and thyroid antibodies. Please read my post Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism.

T4-only Levothyroxine drugs like Synthroid are the main drugs prescribed but they don’t work for every person. Many of us do better on a combination of T4 and T3 thyroid meds yet many mainstream doctors refuse to consider the thyroid medication options. Hypothyroid people even when treated may be struggling with mental health symptoms because their thyroid treatment is not optimal for them.

Thyroid dysfunction can be inherited. To all my hypothyroid readers, please watch your children carefully. I am worried for our children. They may inherit thyroid dysfunction from us. I am devoted to building awareness for us, and I am compelled to do it for our children. If your child is suffering from learning disabilities, depression, anxiety, bipolar disorder, suicidal thoughts, conduct disorders or other mental health disorders, please please please have their thyroid properly tested. Please.

To all the teachers, special education teachers, school directors, child care workers, school counselors, school administrators, please please, if you are working with a child suffering from brain health issues, please recommend a child for thyroid testing.

To all the police officers, truant officers, juvenile justice system workers, lawyers, judges, please include proper thyroid testing for those with mental health issues.

To the psychologists, psychiatrists, counselors, social workers, mental health ward workers, please recommend proper thyroid testing and be your patient’s advocate with their doctor.

To researchers in the fields of psychology, psychiatry, counseling, education and neuroscience, please take a look at the number of studies linking hypothyroidism especially Hashimoto’s to mental health. There are multiple studies that warrant further attention and additional study.

To all doctors, pediatricians, ER staff, nurses, endocrinologists, psychiatric hospital staff, please read the large body of scientific research linking thyroid dysfunction and mental health. Please take a close look at this research and analyze the flaws in the current mainstream medical model for thyroid disorder and make change. Please.

To people in the media, please help us. We are an unrecognized and overlooked group in mainstream medicine. The Thyroid Federation International estimates there are up to 300 million people worldwide with thyroid dysfunction, yet over half are unaware of their condition.[7. Thyroid Federation International. International Thyroid Awareness Week. Retrieved from: http://www.thyroidweek.com/en/be-thyroid-aware.html] Please help us build awareness. Please help us make change.

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About Dana Trentini

Who knew that little butterfly-shaped thyroid gland at the base of my neck could affect my life so completely? I founded Hypothyroid Mom in memory of the unborn baby I lost to hypothyroidism. Winner of two 2014 WEGO Health Activist Awards: Health Activist Hero & Best In Show Twitter. *Hypothyroid Mom includes Affiliate links. Connect with me on Google+

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