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] 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]

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]

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]

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]

A study entitled “TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers” reported:[6]

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] Please help us build awareness. Please help us make change.

References:

  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.
  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.
  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.
  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.
  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.
  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.
  7. Thyroid Federation International. International Thyroid Awareness Week. Retrieved from: http://www.thyroidweek.com/en/be-thyroid-aware.html.
  8. Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T., & Giovannucci, E. L. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA 2015, 314(17), 1818-1831.

Take Back Your Thyroid Health! Sign up and never miss a post - it's FREE


About Dana Trentini

I founded Hypothyroid Mom October 2012 in memory of the unborn baby I lost to hypothyroidism. Hypothyroid Mom is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links to favorite resources including the Amazon Services LLC Associates Program. Connect with me on Google+

Comments

  1. PLEASE Contact me As Soon As You possibly can!! Please. I have hypothyroidism Hashimotoes, and have been diagnosed with bi Polar yrs back. i am in a crisis situation trying to decide if this is physical or mental. I have questions that you may be able to help me answer. My name is Christine

    • Please help Me as I’ve been taking levoxyl 100mg
      For many years for hypothyroidism and a host of meds for Bipolar 1 rapid cycling.
      This above bipolar diagnosis was made back in 2000 after I went to a hospital because I wasn’t able to sleep, at times I was bouncing off the walls etc.
      These symptoms along with weight gain inspire of not eating began after I had to have a partial hysterectomy not long after giving birth to my daughter. My hormones had always been a mess as I have my ovaries but throughout the years I’ve had many laparoscopic surgery’s for endometriosis and polycystic ovaries but I still have both of them and they are still actively producing hormones anyway
      Before this crisis I was a nurse working, wife, mother, Daughter, Sister And student.
      Like I said I got slapped with the bipolar diagnosis
      Put on so many different psychiatric medications that completely rendered me Incapable of full filling Anything.
      I kept seeking help and it got worse and worse.
      I finally went into a Thyroid storm as I put on so much water weight that I also experienced congestive heart failure as I ended up in a coma at Baylor all Saints in Fort Worth Texas.
      Finally I got a diagnosis of hypothyroidism and
      Eventually I started coming back.
      I never received the initial somatic testing, like blood work to rule out endocrine diseases especially Hypothyroidism that the DSM recquirs before a bipolar diagnosis can even be made.
      I’m angry As to why didn’t The Doctors missed this. Why didn’t They do blood work???
      I had and still have insurance.
      This ruined my marriage, my career but mostly My abilities to be a mommy to my small children so long back.
      Now my kids are grown and my husband passed away although We stayed married He and I never recovered from the trauma that All of Us endured .
      Now that I’m realizing this to be true I want off of these bipolar meds that I still take to this day along with My Levoxyl. I also have my thyroid levels checked every 3 months and have sense this date.
      I’ve raised suspicions about this over 5 years ago to My Psychiarist and even went to an endocrinologist
      To have Them collaborate together about this issue and They blew me off.
      Because I got so sick I applied for SSD and I got it as I had already paid enough in working as a nurse
      I should’ve been able to continue with my career as I’m willing to give up my SSD and to have my diagnosis of bipolar type 1 rapid cycling reversed to only Hypothyroidism.
      I take medicine for this and I have all documentation through out these years
      I’m going to attempt to come out of this foggy place I’m in and have been in by getting off these bipolar medicines with help from my Doctors as I’m so down about loosing so much time to this but as with any hardship if this Tragedy can help one person than it will make sense to me.
      Please get in touch with Me.

      • I can relate with your story. My boys are 13 and 16. They have grown up seeing me exhausted all the time. I have spent many years laying on my bed…tired. If they wanted something they knew where to find me. I take Adderall just so I can make it to work. Then Xanax to help with my anxiety. I have not had much of a life for many years. Even though I have 90% of the symptoms for hypothyroid my TSH is always normal. So I get depression and anxiety meds for 2 symptoms but nothing for weight gain, hair falling out, no eyebrows, dry hair and the list goes on. So when your doctor doesn’t help you who will?

        • You could have been me. My story is very similar. Numbers always “normal” because traditional doctors don’t test everything. Exhaustion. Hair falling out. Anxiety. Etc. find yourself a FUNCTIONAL MEDICINE doctor and get some real answers. Mine sent me to get an extensive workup. The test was called “Boston heart diagnostic” and has answered MANY questions for me. Please. I encourage you to do this. Traditional doctors are just not going to do what’s in your best interest.

  2. Would you like to be enlightened? I have been battling bipolar symptoms my whole life. My mothers family ALL have it and my father’s side many as well. Last year my wife took me to a counselor whom referred me to a psychiatrist, so I could try medication.. Well, I told her of my food allergies which she totally ignored, prescribed me depakote. I went frickin nuts asap!! When I came to I looked up depakote, its bound with lactose. Milk causes my manic episodes, gluten causes me to be hostile. I saw the client lists of this counselor, he had about 100 or so bipolar patients, literally ALL were in jails.. He told me most lost it when they drink.. Alcohol is grain, mostly wheat so draw your own conclusions.. There is NO help out there if the doctor is part of the AMA, they have a protocol they must follow no matter what your symptoms are.. I could write their manuals..lol.. What if you have graves but seem to have hashimotos also?? The meds I took made me worse actually.. Have battled this so long I am on the verge of giving up.. My 5 year old daughter keeps me from hanging myself honestly.. Met 1 true doctor, he had same issues as me, got sick had to retire before he was done heloing me.. Feel like a Tuskegee Airman.. I don’t mean that disrespectfully at all..
    Excuse my hyper rant..:)
    Blessings

  3. I have identical mirror image twin daughters. Both have always been extremely physical and active in sports an in life. Three years ago the rug came out from under my oldest. In the course of six months she went from running a sub 5 minute mile to struggling to post a seven minute mile. She saw her doctor repeatedly during that time frame and was diagnosed with everything from anxiety, depression to asthma. The medication she was given just made matters worse. If I didn’t know my daughter better I may have misinterpreted her rages, mood swings etc to drug use. A family acquaintance pointed out the goiter on her throat at a cross country race. After the observation we demanded a full blood workup. She was diagnosed with hyperthyroidism due to graves disease. She opted for full thyroid removal. She is on a daily synthetic now and maintaining. Her identical twin however has taken a nosedive ever since her sister’s surgery. She battles with anxiety, depression, binge eating disorder etc. We have had her TSH levels tested a couple of times and she is “within range”. I am so lost and so frustrated that these girls have lost so much to this damn gland. We are dealing with two extremely intelligent individuals who have researched this disease themselves. Any further suggestions would be appreciated. I am at a cross roads: has one twin stayed strong to support her sister and just gone into an emotional two year tailspin or does she have an underlying thyroid/health issue that has gone undiagnosed?
    any guidance or ideas are greatly appreciated!

    • Have her get the FULL panel! Not just TSH! And if she’s even CLOSE to either high or low on their range ask them to treat it. If they won’t, see someone else! I have also found that not every doctor/lab have the same “normal” range! So they may say normal but another doctor may say it’s not normal?!

  4. I study and research as much as I can. I have Hashimoto’s hypothyroidism. I’ve been told I have to learn to live with my brain fog. I keep being put off regarding my weight (was 130 when I got sick, now tipping 200 pounds). I just keep gaining. I’m exhausted most of the time. But I dont sleep much. I also have edema in my legs and feet. My doc just tests for TSH. I also suffer from anxiety and migraines. Both got exponentially worse when my thyroid got sick. It’s so frustrating. My family has asked me to stop reading up on thyroid issues because they can’t understand that so many things are directly affected by the thyroid. Thank you for this article and being an advocate for us. I am learning that I must be an informed advocate for myself. No one else has as much at stake as I do.

  5. REBECCA RYAN-HIGDEN says:

    The mental and emotional disorders in people with thyroid diseases are not exclusive to hypothyroidism. I have Graves. Before my tt I was hyperthyroid. I went into thyroid storm. I was cautioned by my doctor not to sign any legal documents or make any big changes in my life. I was absolutely manic. I also had fears that kept me from fully enjoying my life. Not even 50 years ago, people with Graves disease were committed to asylums. Tied to their beds. Cruel treatments. Graves disease attacks the brain and that brain stays under attack even after the thyroid is removed, but now in a completely different way. The hypothyroid way, even when meds are optimal. Exactly as you’ve mentioned. We need to re-classify autoimmune disorders that affect the thyroid. They should be classified as autoimmune disorders that use hormones, specifically thyroid hormones, to attack potentially every cell in the body. They only become visible after they begin the attack on the thyroid My Graves has taken 1st my tonsils then my reproductive system, eyes, brain, thyroid, skin, and now my cardiovascular system. Plus a whole lotta other crap in between. Every single cell and organ, just like hashi’s. I’m not complaining about my health here. I’ve accepted me. I’m complaining about the fact that no real further studies about autoimmune thyroid disorders have been done since it was named more than a hundred years ago, and doctors then had zero idea about the autoimmune response involved. The focus has been one one aspect and that’s the thyroid. Then doctors dismiss us if we bring up very real and debilitating symptoms. They say its not related to thyroid disease. Well, no kidding. It IS related to the way our bodies are using those hormones. We need to change this. I have no idea where to begin when no one even listens..

    • Thank you for sharing your story Rebecca. Absolutely all forms of thyroid disease including Graves’ disease can affect the entire body including the brain. I’ve had on my mind to write another mental health article about all forms of thyroid disease at Hypothyroid Mom so thank you for the reminder.

Speak Your Mind

*