Why Hashimoto’s thyroiditis can be mistaken for bipolar

I have hashimoto’s thyroiditis. Officially diagnosed by a endocrinologist specializing in thyroid nodules (who I went to go see when my GP thought I had one that had a slight chance of being cancerous.  I spent a harrowing 24 hours preparing myself for the possibility before I was diagnosed).

Just wanted to put this on my blog, as I use my blog to help me remember where I found information.  Maybe it may help you or someone you know.

When Hashimoto’s is Misdiagnosed as Bipolar Disorder

When autoimmune Hashimoto’s flares up, the immune system attacks and destroys the thyroid gland. As the thyroid tissue is destroyed, it spills excess thyroid hormone into the bloodstream. This causes symptoms that can easily be confused with the manic episode of bipolar disorder, such as hyperactivity, irritability, and an inability to sleep.

When the immune attack dies down, more thyroid tissue is lost and the person returns to a hypothyroid state that frequently includes depression and fatigue, which can look like the depressive state of bipolar disorder. Also for someone who has gone a period of time without sleeping much and operating on overdrive, a crash it to be expected.

Studies on Hashimoto’s and bipolar

Studies back up the connection between bipolar disorder and thyroid disorders.[1] A 2009 study showed a high rate of Hashimoto’s disease in those with bipolar disorder compared to the control group.[2] Additional studies have shown that outcomes in treatment for bipolar disorder are poor unless a thyroid condition is treated.[3] Bipolar is not only the mental disorder mixed up with Hashimoto’s. Research shows a significant correlation between the presence of thyroid antibodies used to identify Hashimoto’s and mood and anxiety disorders, including depression.[4] Subjects with Hashimoto’s disease show higher frequencies of lifetime depressive episode, generalized anxiety disorders and social phobias.[5] Complicating the issue is the fact that lithium, the drug used to treat bipolar, suppresses thyroid function.

Which means since my endocrinologist told me he won’t give me synthroid until my thyroid completely dies out, I will be stuck with bipolar-like symptoms or depression.   Oh, joy.

[Have I mentioned I have a self-paid insurance that doesn’t cover prescriptions and dear husband and I make peanuts these days?]

I’m going to try the autoimmune thyroid diet and see if I can keep my thyroid from totally destroying itself or going mad in the process.  Wish me luck (please).

***

Update 1.22.14  I wanted to share this other link from Jim Phelps, M.D. regarding thyroid hormone regulation and bipolar:

Here are two reasons to care about thyroid:

1. There is a clear connection between the process of thyroid hormone regulation and bipolar disorder.  The problem is, this connection is only just now beginning to become evident, and how the connection works is basically a mystery.  Two studies recently showed a strikingly high rate of autoimmune-caused thyroid problems in people with bipolar disorder, far more than you would expect to find.Vonk, Kupka  Thyroid problems are more common in the complex forms of bipolar disorder (mixed states and rapid cycling) than in classic bipolar manic patients.Chang  Signs of thyroid auto-immunity are much more common in people with anxiety and depression, particularly the forms of anxiety which don’t easily fit into typical “anxiety disorder” labels.Carta

2. Two studies have shown that people with bipolar depression were less likely to get better if they had low thyroid levels, whereas the ones with higher levels responded pretty well.Cole, Frye . The same phenomenon was recently shown in “unipolar” depression.Gitlin,Abulseoud  These four studies are the basis for a treatment approach you could consider, particularly if depression is your main problem:  gently pushing your thyroid status over toward the “hyperthyroid” end of normal, if you happen now to be toward the hypothyroid end of normal (the lab testing we use to place you on this spectrum is explained below). Update 4/2008: this approach, using just a little bit of the standard form of thyroid hormone — T4, explained below — was recently tested directly.  The results were very positive, but it was a preliminary test with no control group.Lojko

Update 10/09: another research team recently concluded that “reduction in thyroid function can exacerbate bipolar symptoms even in euthyroid subjects.” Frye In other words, people who are in the normal range (“euthyroid”) can see their bipolar symptoms getting worse if their thyroid levels get low, even if that reduction leaves them still in the normal range.  

(Finally, you should also know that some people think the standard lab testing for thyroid status does not do a good job of figuring out who’s “normal” and who’s not.  In other words, they think that people who are not normal, who are low on thyroid hormone, will actually test “normal” using the standard measures.  More on that controversy below). 

Let’s take a quick look at that complexity before turning back to why you might want to learn more about thyroid and bipolar disorder. There are reports linking the entire stress hormone system (here are some basics on stress and depression) to changes in thyroid function.  This part is really complicated.  The short version, translating from two amazing reviews of stress and mental health, is that stress hormones interfere with the production of thyroid hormone and with the conversion of thyroid hormone to its active form. Tsigos,Charmandari 

It is also clear that people whose symptoms look the kinds of “bipolar disorder” explained on this website, have thyroid problems — and family members with thyroid problems — at a greater rate than would be expected.  Is that because the thyroid problems somehow actually cause “bipolar”-like symptoms?  Could it be that some of what looks like “bipolar” is actually a thyroid problem?  There may be some such folks.  In addition, there are clearly cases which seem to be “bipolar disorder” for sure, that get better with thyroid hormones as part of the treatment.  In many of these cases it is clear that thyroid hormone was not enough, by itself, to make mood “normal”.  So, for now I think it is safe to say that bipolar disorder has something to do with thyroid regulation in many cases, though not the majority; and that treating with thyroid alone is only rarely going to lead to full remission of symptoms (with a few notable exceptions…).

So, you need to know about thyroid and bipolar disorder for several reasons:

1. There is some relationship between the two, though poorly understood.

2. You need to make sure your thyroid is okay before you begin treatment for bipolar disorder, because

  • if it’s not okay, you might not respond fully to treatment; and
  • it’s usually pretty easy to get your thyroid hormone in the right place, which by itself could help your symptoms somewhat.

3. Thyroid hormone is sometimes used as a treatment for bipolar disorder, even if your thyroid is “normal” (by lab tests, anyway).

4.  And finally, lithium commonly interferes with the thyroid system, so you’ll need to understand a bit about thyroid if you’re going to take lithium.

****

One woman’s story about how her endocrine issues were mistaken for bipolar was published at Canvas of the Minds in an essay called Miss Diagnosis.

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About Casey

“the only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn like fabulous yellow roman candles exploding like spiders across the stars and in the middle you see the blue centerlight pop and everybody goes ‘Awww!’ ~ Jack Kerouac, On The Road Again
This entry was posted in Bipolar Misdiagnosis, Hashimoto's Thyroiditis. Bookmark the permalink.

13 Responses to Why Hashimoto’s thyroiditis can be mistaken for bipolar

  1. I’m definitely wishing you luck with this!! Sometimes it’s a relief to get a “real” diagnosis. Unfortunately, I seem to be stuck with garden variety depression in a garden filled with thorns, spiders and snakes. Occasionally, I weed it out… then I feel better for a while. Hope you do, too.

  2. Casey says:

    Garden variety depression would be nice. Last night, I started having these symptoms of agitation, which made me worry I was going through another immune attack just before I laid down to sleep. It didn’t last very long and was probably just due to be up late trying to catch up on some housework I neglected while having a cold and an overactive imagination. I hope.

    Apparently, these thyroid attacks can kill me/make my heart stop. I am not sure I should wait for my thyroid to completely be killed.

    Take good care of you. Make sure you do plenty of self-care, even when you don’t think you want to. Pretend like you are dating yourself and do whatever it is that would show your love and caring and would make you feel good. Send yourself love notes in the mail. 🙂 I haven’t done that yet, but I want to. I’ve sent so many love notes out over the years, and to my daughters, and now it’s time I return the favor to myself. 🙂

    I am starting to date myself. 😉 I take myself on artist dates all the time:

    http://theartistswayblog.wordpress.com/2010/10/17/101-artists-date-ideas/

  3. thenerdyscribe says:

    Best of luck with the diet!

  4. Christine says:

    My 15 year old daughter was recently diagnosed with Hashimoto’s. Her therapist was on a mission to diagnose and medicate for bipolar. My daughter would cry and say “I dont know what’s wrong with my body…please help me.” I was on a mission to get answers and was almost relieved to finally get answers. She is now on armour and has bloodwork drawn every 3 months to monitor her levels and adjust the armour.

  5. Casey says:

    Christine, I’m so glad your daughter was able to get Amour instead of the synthroid. Much better for her.

    I have to make another appointment because I forgot to go on the one I had just recently. I ended up taking a job to sub at one of the schools and completely forgot the appointment I had. I hope I can convince my doctor to prescribe the Armour for me.

  6. ~meredith says:

    Hi, Casey;
    My wife has Hashimoto’s thyroiditis, too. So does her mother, and that is fortunate because JJ was correctly diagnosed and treated without boxing her way through a thousand other treatments and diagnosis’. This is very interesting to me, though, because depression and mental illness are part of her family profile, yet there’s never been any connection with Hashimoto’s thyroditis… it’s all just a ‘body thing.’ And.. it isn’t, as you wrote.

    Thank you for writing this post. I look forward to sharing it with my wife. Something I’d like to share with you is that my wife was diagnosed with Celiac disease about a year-and-a-half ago and we cleaned out the cupboards, by god, and we’ve been eating whole foods ever since. No crackers, no crap… well, she loves chocolate… but the change is doing something wonderful for her thyroid because her med dosages have been reduced twice in the past six months–and the outcome has been good. She also doesn’t suffer the same, high level of joint pain she once had.

    I wish you all the success in the world with your diet. My wife is a different person, and she’s happy, happy, happy to see other health improvements that continue to evolve as we continue to eat simple, seasonal, whole foods cooked right on the stove most every night… and she takes leftovers to work for lunch the next day. She’s never had this in her life, but now that she does, she said she feels like she’s got a new body. It’s wonderful to see, and I’m really, really glad I learned to cook from scratch as a way of life at a young age.

    My best to you,
    Meredith

    • Casey says:

      You are most welcome.

      Many of my immediate family members were dx with thyroid AND celiac disease, and my mother has been on a committee with the U of Chicago’s celiac research department. I’ve long been aware of the link between those two autoimmune disorders. But thank you for the reminder that I probably should go gluten-free while I limit my intake of breads and rarely eat crackers (but some of the gluten free crackers are delish).

      Thank you so much for stopping by to read and comment.

      All the best to you and yours,

      Casey

    • Casey says:

      Another thing I wanted to link to, and i’ll put it in the original article, is Jim Phelp’s information about the link between thyroid hormone regulation and bipolar conditions. I don’t know if this is useful to your wife…but in case it is…

      http://www.psycheducation.org/thyroid/introduction.htm

  7. Emilia Pop says:

    Great blog! Looks like you have the same “conditions” like me: Hashimoto, CPTSD/BPD and autoimmunity in general. What I would like to add is that after more than 3 years of searching and trying different therapies for Hashimoto I ended up following a 3 stages protocol made by an obscure ND. He’s approach was to explain Hashimoto not as an autoimmune disease generated by a faulty immune system but triggered by a lack of iodine. This lack of iodine generated spelling in thyroid and the immune system is attacking as it is similar with a foreign attack. Basically I had nothing to lose as doctors don’t understand what is going on. I made my blood tests an in 3 months all where in normal limits and the antibodies were way lower ( from 1200 to 180). I add two drops of Lugol per week in my water to keep my iodine intake up and selenium periodically. If you are interested you can contact me: gemiliap@gmail.com.

    http://www.youtube.com/user/drahaskell

    He wrote a book too ( I bought is after I recovered): http://www.amazon.ca/Hope-Hashimotos-Alexander-Haskell/dp/1452854718

    • Casey says:

      Thanks for sharing Emilia,

      I’m on the fence about iodine. Different sources say it’s good, some say it’s bad. I used to supplement with an iodine and l-tyrosine mix, only to find out the l-tryosine was probably causing adrenal fatigue.

      About the BPD…it’s really hard for me to say I’d qualify for the label (even a therapist said no), but I do believe I exhibited borderline-like behaviors as a response to some truamatic events. And…it’s funny, in alcoholics anonymous, they often say the non-drinking, codependent spouse is more insane than the alcoholic, at times. I think the reason they say that is all the myriad ways you try to cope and control the alcoholic’s behavior. BPD is a dumb label, I think. “Crazy” behaviors have a really logical reason, when you look at the impact trauma has on a person.

      It’s funny, I think I’m “cured” of any BPD traits. You know why? Because my husband stopped drinking and I stopped engaging with people who have toxic patterns with me. I’ve got better boundaries between my self and others. I don’t try to put up other people’s bad behavior and I put own self-care first.

      I’ll look up that book, thanks so much for the link…

      Casey

      • If you go the iodine route, you must go big or not at all. Hashi’s is complicated and will not do well on low doses of iodine and will likely make it worse. That said, large doses are ticket to lowering antibodies and healing the thyroid. A good starting dose is 15mg oer day and work up from there. Most people do well on twice that but some go higher, way higher, depending on how they feel. Most iodine sold in stores is in micrograms (mcg) so be careful. Lugols comes in mg and can be ordered online.

  8. I definately had symptoms back in 2005 when I was diagnosed with depression. Five years later I was diagnosed with Hashimotos. If only I knew what I know now.

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