Q:  Q's re:  Bipolar Disorder & Thyroid

Dr. Phelps,

A brief synopsis of my case -- I was diagnosed with Graves Disease in 2006.  My thyroid was irradiated.  My TSH plummeted to 46.  I was tried on Unithroid for 6 months without success in stablizing my thyroid.  The medication was  changed to Armour Thyroid and 7 months later one "normal" TSH level was achieved.  My PCP believes that an annual thyroid panel is sufficient monitoring.  I have been mentally unstable since the TSH of 46 (more than a year ago).  I have an intolerable anxiety (nearly constant adrenaline rush-like sensation and fade in and out of derealization), profound depression and cognite impairment (short-term memory and brain fog) and feel like I'm teetering on the edge of insanity (although no psychotic symptoms yet).  My psychiatrist has titrated Lamictal up to 300 mg/day.  He has diagnosed me with "atypical bipolar" and disregards any correlation between thyroid disease and my mental changes.  I have no previous history of any serious mental/emotional difficulties.  My mind has taken on a life of it's own and everyday is an endurance test.  I read Mrs. B's testimony and could identify with the description of her condition.  Can you give a diagnostic impression?  Any suggestions for appropriate medications?  Any advice I could take to my psychiatrist?  I want my life back.....and don't know how to reclaim it.


Dear Ellen --
First of all, we can ask whether there is evidence of some sort of connection between thyroid abnormalities and bipolar disorder. Some of that evidence is summarized on my page about thyroid and bipolar disorder. With your question in mind, I took a look just now at PUB MED (The National Library of Medicine website for medical research literature) and searched "thyroid bipolar disorder". 

Thinking "what might help your psychiatrist pay more attention to the possible role of thyroid in all of this?", in case that would be a means to an important form of treatment for you -- which it would be most unfortunate to overlook -- I was struck by an article from just several months ago published by one of the Stanford bipolar researchers, which she performed in conjunction with the UCLA bipolar researchers who have been interested in thyroid. The very fact that they went looking for effects of thyroid on bipolar disorder again serves as a least some indirect evidence of a presumed connection.^Rasgon  Their finding that treatment with thyroid hormone had an impact on other hormones thought to be related to mood is also rather suggestive.

Better yet, however, looking further down the list of the results of my literature search at PUB MED, I find another recent article which duplicates and extends the previous results connecting auto-immune thyroid problems and bipolar disorder.  There was a previous study of this connection by Kupka and colleagues listed on my webpage, from 2002.  But now comes a 2007 replication by Vonk et al that might be the study you would want to try showing your psychiatrist (or my webpage, linked above, which has been updated with this new study). The first line of their conclusion: "This study shows that autoimmune thyroiditis is related not only to bipolar disorder itself but also to the genetic vulnerability to develop the disorder." 

If there is a connection between the two conditions, does this mean that treatment with thyroid hormones might help?  Unfortunately, I don't think the connection is that direct.  However, your psychiatrist might also want to be aware of the most recent data on use of thyroid hormone as a "mood stabilizer".  These data are limited because of the small size of the research studies so far.  So this is not a very strong leg to stand on, but it is a very interesting one, especially in your circumstances. Those studies are summarized on my separate webpage about High-Dose Thyroid In Bipolar Disorder.

Be careful: don't necessarily assume that thyroid hormone is the key solution to your problem.  Raised hopes can lead to dashed hopes. Check out the information and see if you think it is worth sharing with your psychiatrist.  Good luck with the process.

Dr. Phelps