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. http://Anne says

    This happened to me and if it wasn’t for my husband screaming CHECK HER THYROID!
    and a very wise and wonderful psychiatrist who listened to him, I would not be alive today or I would be hopeless trapped in a never ending AVOIDABLE and REVERSIBLE psychosis. I wouldn’t wish the experience on anyone but I am glad that I had it because I can educate other people and save them the agony of literally losing your mind.
    I have such compassion for those who never get well. I did and I am grateful but I shudder to think of those who are suffering needlessly. Thank you SOOO much for this article.

  2. http://Patsi%20isley says

    The problem is getting optimal treatment… at least there should be 6 basic thyroid tests( see Stop
    The thyroid madness site) you usually only get TSH…. told you’re in normal range… something has to change!!

  3. Hi! Thank you for this very insightful post. As a healthcare provider it’s incredibly important to remember that the thyroid gland is the master gland and as such, it impacts pretty much everything!
    Great post,
    Dr. JB Kirby

  4. http://Sue says

    My mother was diagnosed with Hashimito’s when she was in her mid-60s, I believe, and had her thyroid zapped with radioactive material and thereafter has been taking levothyroxine to replace it. She is now 97 and has done well on it; or so we’ve thought. I now wonder if she would have benefited from adjustment to her dosage or type of thyroid replacement, since several years later she was diagnosed with macular degeneration. Has there ever been a connection made between AMD and thyroid problems? Also, her memory is getting bad, although she’s doing better than her older sister did; maybe because she takes thyroid replacement at all, and her sister never got diagnosed and took any? I’m just guessing here, I have no real knowledge about my aunt’s medical background. But this article makes me wonder. And now, my mom is struggling with depression. I really think maybe she should go to a different doctor and have her thyroid levels reassessed.

  5. http://Michelle says

    I have a interactive thyroid had it for bout 24 yrs now I suffer with all these things bad depression no it swings the lot feel down all time & lots more carnt fully put into words how i am & feel

    • http://Nicole%20Panfil says

      I have thyroid problems as well. I was diagnosed with hyperthyroidism. But 2 weeks before my period, I have all of these symptoms. I almost drove to the hospital last week, I felt like I was crazy. My Dr diagnosed me with PMDD but it’s more than that, because I feel like I am in hell, and can’t stop it.

      • Nicole you should try nutritional cleansing. Cleans out all of the toxins in your body and nourishes with vitamins and nutrients. Our world and food are full of toxins and we don’t get the full vitamins and nutrients our soil used to put into our foods. Chemicals in the air, our clothing, our work environment all contribute to everyone being sick and getting autoimmune diseases. This worked for me. I was diagnosed with chronic fatigue and couldn’t function. Dr said I had chronic fatigue. It was actually my thyroid. I have incredible energy and have even lost 30 lbs. 😃

      • http://Ndod says

        I am hypo and have PMDD. PMDD is horrible! I hate who I become 1/2 the month. My mom had it too. It can be that bad. Still no answers here. The only thing that stopped it for me was pregnancy and breastfeeding, then it returned. Some people get suicidal every single month, I hope they figure out an answer for it!

  6. Yes Bipolar, mental illness goes hand and hand with Thyroid. Everytime I go into the psychiatric ward my Bipolar, depression and anxiety and panic disorder and paranoia and suicidal are so bad, and they take blood test and every single time my thyroid is off, every single time!!!

  7. http://Leslie says

    Read the book Brain on Fire. It actually talks about how researchers have found a link between mental illness and autoimmune diseases. I read that book and it opened my eyes.

    • http://H%20Amack says

      Can you please give information on this book, author etc., I looked for it and there are several. Thank you

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