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Bipolar? You Need Your Thyroid Checked
When a person is diagnosed with an illness, doctors do something called a differential diagnosis. Basically, this is when a doctor considers all the illnesses that may explain your symptoms and then decides on which one fits best. In the case of bipolar disorder, part of the differential may be considerations of anxiety disorders, Cushing syndrome, head trauma, thyroid disorders, and many others.
Tests are part of how a doctor decides which diagnosis fits best. In the case of possible bipolar disorder, a full blood panel should be run including tests on the thyroid. This can pinpoint deficiencies that may be contributing to mood alteration. Testing the thyroid is particularly important in bipolar disorder as higher levels of hypothyroidism have been found in the bipolar population.
Hypothyroidism vs. Hyperthyroidism
The thyroid has many important functions in the body including modulating how quickly the body uses energy, makes proteins, and controls how sensitive the body is to other hormones. An overactive or underactive thyroid is of major concern and needs correcting.
The main concern in bipolar disorder is hypothyroidism—which is an underactive thyroid—as opposed to hyperthyroidism, which is an overactive thyroid.
Presentation of Hypothyroidism
The signs and symptoms of hypothyroidism are very concerning and include:
- Hypothermia/intolerance to cold
- Bradycardia (slow heart rate)
- Hair loss
- Weight gain
- Dry skin
- Cognitive dysfunction
- And many others
Note that not all people experience all symptoms.
Hypothyroidism and Affective Disorders
The reason why it’s so critical to have your thyroid checked if you have an affective disorder like bipolar is because there are crossover symptoms between hypothyroidism and depression including: poor concentration, weight changes, memory issues, and low energy. Because of these crossover symptoms, without an actual blood test, it can very difficult to tell the difference.
Moreover, hypothyroidism can actually present with mania, although this is uncommon. In patients with hypothyroidism, the mania can resolve with thyroid disorder treatment as can rapid cycling bipolar disorder. Psychosis can also be secondary to some cases of hypothyroidism.
It should also be noted that subclinical hypothyroidism has also been more frequently found in bipolar disorder. Sometimes treating this condition can also help ease the symptoms of bipolar disorder but this type of treatment may be considered controversial.
Finally, it’s important to know that lithium may also affect the thyroid, causing hypothyroidism, and this can happen at any time during lithium treatment. Valproate and carbamazepine can also affect thyroid functioning.
Luckily, there are effective treatments for hypothyroidism. Thyroid hormone (thyroxine) replacement is the typical course of treatment. Normally, thyroid disorders require lifelong treatment.
Thyroid Blood Tests
In short, if you haven’t had your thyroid tested, you absolutely should and you should even have it done periodically if you’re on lithium, valproate or carbamazepine. It’s a simple test and a simple treatment that can make such a difference to mood.
Psychiatric Times, Hypothyroidism: An Important Diagnostic Consideration for the Psychiatrist by Kristi R. Estabrook, MD and Thomas W. Heinrich, MD
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