Thyroid. The tiny, but mighty, psychiatric imposter.

Thyroid. The tiny, but mighty, psychiatric imposter.

A frantic email. A son. His mother. A psychotic episode at work. An involuntary admittance to a psychiatric unit. No prior history of mental health issues. Her severe hypothyroidism diagnosis months before. Is there a connection? Came the plea. Psychiatrists insisted no. But then the discovery of Hypothyroid Mom online. “Please, please help my mother,” he wrote.

Fear rippled through my veins. An urgent need to help this woman and the countless others. All being overcome by their brains, or so it may seem.

Connection, he asked. Where do I begin?

History of thyroid and psychiatric disorders

In 1874, Queen Victoria’s court physician Sir William Withey Gull recorded the very first accounts of the clinical features of adult hypothyroidism.[1] Gull described the unusual symptoms of a Miss B, and he noted the distinct change in her mental state.[2] What we now call “hypothyroidism” was termed myxoedema or myxedema (myx meaning “mucus” & edema meaning “swelling” from ancient Greek) in 1878 by William Ord.[3]

In 1888, hypothyroidism was first linked to psychosis by the Committee on Myxoedema of the Clinical Society of London. Based on 198 patients with myxoedema, the committee reported that nearly half the cases presented with delusions and hallucinations, mainly in cases where the disease was advanced. They also reported mental disturbances including acute or chronic mania, dementia, melancholia, suspicion, and agoraphobia.[4,5]

It was then in 1949 that Asher introduced the term “myxoedema madness”. In all fourteen cases of myxoedema patients showed psychosis amounting to complete “madness”, ten admitted to mental observation wards with non-myxoedema diagnoses. The average doctor may not be aware that frank psychosis can occur with myxoedema, Asher noted.[6]

Every mental disorder and every thyroid disease

It would be simple to dismiss these early discoveries. Medicine has advanced by leaps and bounds in over a century with profound improvements in diagnosis, treatment and prognosis of major illnesses, after all. Surely, this connection is insignificant by this time given our vast advancements in endocrinology and psychiatry. I wish it were that simple.

The prevalence of thyroid disease is downright shocking. 1.6 billion people worldwide are thought to be at risk of thyroid dysfunction with the World Health Organization estimating 750 million people are living with a thyroid condition right now.[7,8] And the most dreadful part of this problem is that up to 60 percent of those living with a thyroid disorder are currently undiagnosed. For this considerable number of people, the truth can be far worse than imaginable with people living in such poor states of body and mind that no one can begin to imagine. One look at the Hypothyroid Mom poll that I conducted to determine the top thyroid hormone replacement medication for hypothyroidism will make it painfully clear that even those diagnosed with thyroid disease are struggling to find optimal treatment.

How many people with thyroid dysfunction are in mental wards this moment with no one to put the pieces of their health problems together? If it were so simple, researchers would have long lost interest in this topic, yet the research rages on to present day. And it’s not just about hypothyroidism, it’s all forms of thyroid disease. And it’s not just about one type of mental disorder, it’s all forms of psychiatric conditions.

Just take a look at the titles of the articles in the reference list at the bottom of this article to plainly see the topics that researchers are writing about in this day and age. Case after case of women, men, adolescents and children brought to psychiatric emergency departments in hospitals around the world from the U.S. to Canada to Brazil to Greece to Turkey to India to Korea to China to Japan presenting with paranoid behavior, confusion, disorientation, hallucinations, delusions, depression, altered mood, suicide attempt, aggression, acute mania, OCD, psychosis, with all different types of thyroid disease from severe hypothyroidism, non-adherence to thyroid hormone replacement medication, Hashimoto’s thyroiditis, thyroid nodules, methimazole-induced hypothyroidism (antithyroid drug used to treat hyperthyroidism), Graves’ disease, postpartum thyroiditis, thyroid storm, hypothyroidism from thyroidectomy, abrupt hypothyroidism from radioactive iodine treatment to thyroidectomy for thyroid cancer.[9-30]

It is eerie to read the words from thyroid pioneers written well over one hundred years ago. The mental disturbances associated with thyroid disease were noted over a century ago. All these years later, people with thyroid disease continue to suffer from what appear to be signs of mental disorder with insufficient or complete lack of attention paid to the possible biological causes of psychiatric conditions. Is it a psychiatric disorder or is it a flashing neon sign of disturbance of that tiny, but of so very mighty, thyroid gland? There is little doubt that thyroid hormone dysfunction can manifest in a number of psychiatric complaints. They may be some of the earliest signs of thyroid disease and easily misdiagnosed as psychiatric disorders.

Thyroid disease is one of the most critical, one of the most least understood, and one of the most frequently overlooked causes of psychiatric disorder.

Optimal thyroid treatment has the power to improve even the most devastating of mental disorders. I hear from Hypothyroid Mom readers every day finally finding reversal of mental health symptoms that once seemed hopeless. This is not to suggest that every mental disorder is connected to a thyroid problem. It is not that at all and far more complex. This is however to suggest that a full evaluation of thyroid testing and treatment should be part of the workup of every single person that presents with psychiatric symptoms.

Medical diseases presenting with psychotic symptoms

In 1909, one of the fathers of organic psychiatry, Karl Bonhoeffer, presented his concept of symptomatic psychoses. “The number of medical diseases that can present with psychotic symptoms (ie, delusions, hallucinations) is legion. A thorough differential diagnosis of possible medical and toxic causes of psychosis is necessary to avoid the mistaken attribution of psychosis to a psychiatric disorder.”[31]

It was this 100 year old concept that rang through my ears as I read the email from that son. He was desperately trying to save his mother from being institutionalized in a psychiatric hospital for the rest of her life. That gut instinct of his that there was something more to her sudden, new-onset and rapidly worsening psychiatric story is what saved his mom. With hypothyroidism so severe her TSH was raging over 60, that tiny, butterfly-shaped thyroid gland at the base of her neck had the power to savagely disrupt every single part of her body, including her brain.

REFERENCES

  1. Pearce, J.M.S. Wir William Witten Gull (1816-1890). Eur Neurol. 2006;55:53-56.
  2. Gull WW. On a Cretinoid State supervening in Adult Life in Women. Transactions, Clinical Society of London. 1874;7:180-5.
  3. Ord, W.M. On myxoedema, a term proposed to be applied to an essential condition in the “cretinoid” affection occasionally observed in middle-aged women. Medico-Chirurgical Transactions. 1878;61:57-74.
  4. Clinical Society of London to investigate the subject of myxoedema. Trans Clin Soc Lond. 1888;21(Suppl):1-215.
  5. Easson, W.M. Myxedema with Psychosis. Arch Gen Psychiatry. 1966;14(3):277-283.
  6. Asher R. Myxoedematous madness. Br Med J. 1949;2:555–562.
  7. Merck KGaA. News Release. Merck KGaA, Darmstadt, Germany, Survey Reveals Most Thyroid Disorder Patients Find Road to Diagnosis Long and Distressing. 2018 May 22. Retrieved from: https://www.emdgroup.com/en/news/thyroid-awareness-week-22-05-2018.html
  8. American Thyroid Association. News Release. American Thyroid Association Announces 7th Annual World Thyroid Day May 25, 2014. Retrieved from: https://www.newswise.com/articles/american-thyroid-association-announces-7th-annual-world-thyroid-day-may-25-2014
  9. Zorkin, N.G., et al. Severe Hypothyroidism Presenting with Acute Mania and Psychosis: A Case Report and Literature Review. Bipolar Disord. 2017;3(1):1.
  10. Ueno, S., et al. Acute psychosis as an initial manifestation of hypothyroidism: a case report. J Med Case Rep. 2015 Nov 17;9:264.
  11. Alex, C., Kumar, R. An interesting case of Myxedema Mania – A case report. RGUHS Med Sciences. 2015;5(1):27-29.
  12. Mavroson, M.M., et al. Myxedema Psychosis in a Patient With Undiagnosed Hashimoto Thyroiditis. J Am Osteopath Assoc. 2017 Jan 1;117(1):50-54.
  13. Nazou, M., et al. [Psychotic episode due to Hashimoto’s thyroiditis]. Psychiatriki. 2016 Apr-Jun;27(2):144-7.
  14. DAS, S., et al. Autoimmune Thyroiditis Presenting as Psychosis. Shanghai Arch Psychiatry. 2017;29(3):174-176.
  15. Agachanli, R., et al. Psychosis related with Hashimoto thyroiditis: a case report. Düşünen Adam The Journal of Psychiatry and Neurological Sciences. 2016 Jun;29(2):181-6.
  16. Kapoor, N., Couch, J. A Case of Hashimoto’s Encephalopathy treated with only Oral Thyroid medication and symptomatic therapy for seizures and psychosis, but Without Steroids (P2.257). Neurology. Apr 2016;86(16 Supplement):P2.257.
  17. Delichatsios, H.K., et al. Case 14-2016: A Woman with a Thyroid Nodule and Psychosis. N Engl J Med. 2016; 375:e20.
  18. Lazaro, P.C.F., et al. Psychosis associated with methimazole-induced hypothyroidism: a case report. J. bras. psiquiatr. 2013;62(2):171-3.
  19. Lee, K.A., et al. Subacute thyroiditis presenting as acute psychosis: a case report and literature review. Korean J Intern Med. 2013;28(2):242-6.
  20. Kolawole, I.A., et al. Delusional Psychosis in Graves’ Disease. Prim Care Companion CNS Disord. 2018;20(1):17l02145.
  21. Kuno, F., et al. [Case of graves’ disease with remarkable psychiatric symptoms]. J UOEH. 2015 Mar 1;37(1):49-53.
  22. Desai, D., et al. Thyroid Storm Presenting as Psychosis. J Investig Med High Impact Case Rep. 2018;6.
  23. Cota, E., Lentz, J. Gland New Psychosis: New Onset Adult Psychosis with Suicidal Ideation and Attempt in the Setting of Thyroid Storm. Case Rep Psychiatry. 2017;2017:7402923.
  24. Kandukuri, R.C., et al. Nonadherence to Medication in Hypothyroidism. A Case Report. Prim Care Companion J Clin Psychiatry. 2010;12(3):PCC.09m00863.
  25. Brockington, I. Non-reproductive triggers of postpartum psychosis. Arch Womens Ment Health. 2017;20:61.
  26. Capetillo-Ventura, N., Baeza, I. Psychiatric Symptoms due to Thyroid Disease in a Female Adolescent. Case Rep Endocrinol. 2014;2014:972348.
  27. Hazen, E.P., et al. Case 10-2015 — A 15-Year-Old Girl with Graves’ Disease and Psychotic Symptoms. N Engl J Med. 2015 Mar 26;372:1250-1258
  28. Al-Mendalawi, M. Encephalopathy associated with autoimmune thyroid disease in an 11-year-old girl, a rare clinical presentation. Thyroid Research and Practice. 2017;14(3):133.
  29. Freeman, S.A. Radioactive Iodine-Induced Psychosis. American Journal of Psychiatry. 2009 Sep 1;166(9):1067–1068.
  30. Morosán Allo, Y.J., et al. Myxedema madness complicating postoperative follow-up of thyroid cancer. Arch Endocrinol Metab. 2015 Aug;59(4):359-63.
  31. Freudenreich, O. Differential Diagnosis of Psychotic Symptoms: Medical “Mimics”. Psychiatric Times. [online]. 2012 Dec 3;27(12). Retrieved from: https://www.psychiatrictimes.com/forensic-psychiatry/differential-diagnosis-psychotic-symptoms-medical-“mimics”

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About Dana Trentini

Dana Trentini M.A., Ed.M., founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This 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 including the Amazon Services LLC Associates Program. Connect with Dana on Google+

Comments

  1. And still after 35 years in the same thyroid medication, I have every single symptom and am made to feel it’s all in my head. No one will listen. No one will help. The rest of my old life will be just as it is. Sick all the time.

  2. Lisa Williams says

    Hello, I have been sick for 8 years, diagnosis – OSA on CPAP machine, Essential hypertension, hypothyroidism, Arthritis, Menopause, autoimmune disease, depression, eczema, elevated liver enzymes, Chronic fatigue and fibromyalgia. I have doctors that treat each condition that they specialize. I have 164 symptoms of the 300 plus listed. I do everything that most have tried that is listed on this web site. Thank you for all the reading helpful information. Wish I could find a online support buddy to help cope with these symptoms and try to balance the stress with some laughter talk therapy.

    • Try eating a Whole30 diet. Google Whole30. It’s amazing how many of your symptoms will clear up when you delete corn, sugar, gluten and dairy from your diet. It takes four to six weeks but you will feel better. It’s not easy but it is worth it.

  3. Did I miss the part where you sell a product?

  4. Did I miss the part where you sell a product?

  5. Barbara Hicklin says

    Thank you very much for sharing this, I believe this is what my mom had and doctors did not do the full tests on her <3

    • There are several lifetimes of pain behind the simple statement, “My situation was the same Barbara”

      It tore our family apart.

  6. Hi Lisa
    I’m wondering if desiccated thyroid helps hyperthyroidism too
    Do you think eating sweet breads is affective if I can get them from the butcher

  7. Robin L Bugos says

    NOW if only the medical field would remove their heads from their bums…..With all the knowledge so many of us still struggle for some sense of normality that we once had…if your weak this disease will mentally destroy you before you find the help you need.

  8. This article helps me to understand I’m not crazy. I just hope I can find the right treatment and get my life back.

    • I just got over something that lasted 7 days. I was having random instant anxiety-despair moments in my head. I can’t explain it but I attributed it to my thyroid because it has NEVER happened before. My mom went on to tell me my grandmother was on THORAZINE for years because of her thyroid issues. The medical community needs to do extensive work on this topic. It’s an epidemic.

  9. Thank you for this article, it means a lot to me!
    The reason you gave for writing it could have came from my own son. I just wish you would have taken the article further and addressed what happened to the mom/son.
    Did she ever get better? If so, how?! Did the son ever get his mom back? Was he ever able to heal from the experience! Did he ever go back to being a child or did this change him forever?! What’s his life like now?
    For me, I’m trying to get better, my main goal is to just fade in the background (stay out of the hospital and not create additional drama) so I don’t damage his childhood anymore than I already have. Just staying out of the hospital (it’s been two years) has been great for him but I want more. I want to be healed and leave this part of my life behind.
    So far, real solutions have eluded me, although I continue to search.
    Synthroid makes me feel different- worse actually, I more suicideal “cravings – more exposed, hyper sensitive maybe? Anyway, I quit taking it and almost everything else prescribed. But I’m tired all the time as I still have to deal with high bouts of anxiety, panic attacks and depression (that I know isn’t real) and I battle feelings of hopelessness mixed with memory/thinking problem but I also honestly feel that solutions to these issues must exist!
    If I can just get over all of the inflammation issues by finding the right supplements, maybe restore my gut by eat healthy, detoxing, or addressing vitamin deficiencies and eventually exercising again, that I could get my mind back, my life back and more importantly be the mom my high schooler deserves before he enters college next year…
    Anyway, I’m trying but I also can’t really find the right resources (although I think I’ve gotten close) or anyone to really help me get through it… I’m also a disabled veteran and have become really leary of western medicine, psychological drugs and the VA system… other words, I’m trapped hun?!
    So, I guess in conclusion, I’m really just asking you to finish your story as I’m wondering if you know of or have any direction for someone like me?
    Any guidance you could provide would be greatly advantageous…
    Please advice, thank you!

    • Have you tried Natural Desiccated Thyroid or T3 medications? Most hypothyroid patients find one or both of these make a huge difference for them. You also need to get proper bloodwork done, not just TSH but also thyroid antibodies, Free T3 and Free T4. If you have inflammation issues, you may need to go gluten and dairy free as well.

      There’s many places online that can help you understand the numbers and get treatment that actually helps.

    • Another vote for T3 only treatment here. Definately clean up your diet (gluten, dairy, etc.), but vitamins and supplements wont cure hypothyroidism, you need replacement hormones…but Synthroid will never help you. Buy the book, Stop the Thyroid Madness, and read it with a highlighter…several times if you have to. You can feel a world better in months (!) If you stop waiting to find a doc that will help you, and just help yourself. It feels impossible, I know. But you can do it.

    • Fastgramma says

      I feel for you! Please do not give up, it takes quite awhile to repair the damaged thyroid. I tried many products and combinations. Synthroid comes in a couple different doses and also taken at different times of the day can produce different/better results. It actually takes MONTHS to see a decent result, a year would be a better test. And don’t let them give you the generic, it is NOT equivalent! Bloodwork is key! Also, antidepressants can help while getting to your optimal place. And, all the time your thyroid was depleted could have and most likely caused your Vit D to deplete as well as your B12. They can test for it too. I’ve had to continuously supplement, but with both, they work synergistically. Best wishes for great health this new year!!

  10. I have twin girls, both Hypothyroid around age 10 both experienced episodes requiring hospitilization and mis diagnosis. When I brought this connection up over and over again they say it is not a reason, why? Top hospitals, medical teams and endocronologists but all deny the connection. Frustrating, with no medical degee of my own, I know the cause and simply missing the meds two days can create an onset. Thank you for sharing the information until they 100% embrace it, they will continue to treat it as something else. “they” – the medical professionals. Everyone is different until the data sets show the common traits.

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