15 Little Known Things About Your Thyroid That Can Affect Your Mental Health

Thyroid Gland and Psychiatric DisordersEver wondered if your thyroid gland is playing a role in your depression, anxiety or psychosis? Problems with your Thyroid gland can mimic a number of psychiatric disorders ranging from depression, anxiety and even psychosis. It is thus extremely important that mental health professionals be aware of some important but little known facts.

  1. The brain has amongst the highest expression of thyroid hormone receptors of any organ and neurons are often more sensitive to thyroid abnormalities than other cells.
  2. TSH levels have a circadian rhythm; the most accurate measurement is obtained in the morning before 9 am.
  3. Psychiatrists may be the first professionals that hypo/hyperthyroid patients may consult due to point 1.
  4. Affective spectrum disorders are most common.
  5. Panic disorder can precede Graves disease by 4-5 years in some cases.
  6. Increased prolactin may be a clue to hypothyroidism and not just attributable to antipsychotics.
  7. T3 is the active hormone and the conversion from T4 to T3 requires selenium.
  8. Iodine deficiency and Autoimmune thyroiditis are common causes of hypothyroidism.
  9. TSH > 3.0 requires follow up and clinical correlation.
  10. Increased antithyroid antibody titres have been linked with psychotic and depressive syndromes in Borderline personality disorder.
  11. Antithyroid antibodies are associated with increased risk of developing frank or subclinical hypothyroidism.
  12. Autoimmune thyroiditis is an endophenotype of bipolar disorder (both conditions may have the same genetic origin) and can be present independent of lithium use.
  13. Supraphysiological dose of thyroxine in bipolar disorder may convert a non responder to mood stabilizer to a responder.
  14. Transthyretin (TTR), a carrier protein for thyroxine and retinol in plasma and cerebrospinal fluid (CSF), has been shown to bind the amyloid beta peptide and reduced levels of transthyretin are found in alzheimer’s disease.
  15. TSH levels on their own may not accurately describe thyroid dysfunction.  Circulating T3, Free T3 or free T4 levels near the margin of normal range and or TSH > 3.5 -4.0 mIU/ml may be indications for prescribing thyroid replacement.

In an earlier post we covered the role of thyroid gland in psychiatry and why the TSH may not be an accurate indicator. History taking and examination of the thyroid gland is an integral part of psychiatric evaluation and can’t be ignored. We covered it as part of the physical examinations in psychinterview.com.

I’d like to hear how commonly you find psychiatric patients with thyroid dysfunction and how you manage it.

References:

  1. Geracioti, T. D. (2006). Identifying hypothyroidism’s psychiatric presentations. Current Psychiatry, 5(11), 98.
  2. Sakurai, A., Nakai, A., & DeGroot, L. J. (1989). Expression of three forms of thyroid hormone receptor in human tissues. Molecular Endocrinology, 3(2), 392-399.
  3. Sousa, J. C., Cardoso, I., Marques, F., Saraiva, M. J., & Palha, J. A. (2007). Transthyretin and Alzheimer’s disease: Where in the brain?. Neurobiology of aging, 28(5), 713-718.

This article is written by Dr Sanil Rege. Sanil is a Consultant Psychiatrist on the Mornington Peninsula and co-founder of psychscene.com. He is pursuing an MBA at the Melbourne Business School.  You can follow him on Google+


8 Responses to "15 Little Known Things About Your Thyroid That Can Affect Your Mental Health"

  1. Babu Sevagram says:

    Good points to remember! Especially when assessing persons with mood and cognitive symptoms. The clinical significance of detecting anti thyroid antibodies in persons with psychiatric symptoms is confounded by the prevalence of asymptomatic subjects with high titres of TPO and TG antibodies on community sampling. In 2013, as with many other autoimmune markers, we await research findings that will help determine the factors that push them from benign presence to malignant manifestation. Keep your clinical skills honed as that day may be not too far!

    • great point babu ,
      Hashimoto’s encephalopathy for example is a real conundrum. Anti TPO ab antibodies and Anti TG ab are commonly found in psychiatric patients and I have seen them at very high titres.
      The mechanisms with hashimoto’s are quite varied though: vasculitis, Anti NAE antibodies and recent paper has found anti glutamate antibodies against the metabotropic glutamate receptors ( Chiba Y et al , Feb 2013).
      I think those are very wise words, that day may not be far.

  2. Faith says:

    Hopefully, clinicians are not discounting c/o’s indicative of hypothyroidism based on a low normal TSH (or, on the contrary, discounting the opposite with high normals). Some of us seem to have a much narrower range.

    • Psychscene insights says:

      I have met clinicians with wide ranging views on this. It is important for the patient to discuss the situation with the clinician . Often the symptoms of hypothyroidism may be very distressing and often don’t get asked or told to the clinician. They may be attributed to depression, or the heat …or cold …..or sometimes just “stress”.
      As Paul white said in Clues in the Diagnosis and Treatment of Heart Disease: “A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.”

  3. Randy Higson says:

    While hyperthyroidism may cause thyrotoxicosis they are not synonymous medical conditions; some patients may develop thyrotoxicosis as a result of inflammation of the thyroid gland (thyroiditis), which may cause the release of excessive thyroid hormone already stored in the gland but does not cause accelerated hormone production. .::-

  4. Blossom Danese says:

    Iodine deficiency is often cited as the most common cause of hypothyroidism worldwide but it can be caused by many other factors. It can result from the lack of a thyroid gland or from iodine-131 treatment, and can also be associated with increased stress. Severe hypothyroidism in infants can result in cretinism.-“;’

  5. demaris says:

    I had a tsh level of 27 and experienced psychosis at what lab value could the onset of psychosis exhibit symptoms

  6. Psysh Scene Insights says:

    Demaris, There is no fixed level at which psychosis would manifest, but TSH at 27 is quite high if the normal range is 0.5-5 in your lab. I have had patients presenting with psychosis at TSH of 20 ( Normal (0.5-5))
    Hypothyroidism (High TSH with Low T4 and T3 ) is known to be an established cause of psychosis.

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