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 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. A 2009 study showed a high rate of Hashimoto’s disease in those with bipolar disorder compared to the control group. Additional studies have shown that outcomes in treatment for bipolar disorder are poor unless a thyroid condition is treated. 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. Subjects with Hashimoto’s disease show higher frequencies of lifetime depressive episode, generalized anxiety disorders and social phobias. 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.