December 15, 2006

Hypothyroidism and Psychiatric Illness

Symptoms of hypothyroidism can mimic, or be intertwined with, schizophrenia, bipolar disorder, anxiety and depression. Treating an underlying thyroid problem is critical to alleviating the associated psychiatric symptoms. The first hurdle to treating underlying hypothyroidism is in its diagnosis. Stress during childhood can be a trigger for my problems related to these types of problems - see this link for more information: Child and Teen Brains Very Sensitive to Stress, Likely a Key Factor in Mental Illness

An article in Current Psychiatry Online focusing on the psychiatric presentation and diagnosis of hypothyroidism explains the hypothalamic-pituitary-thyroid endocrinology involved, psychiatric presentations, testing and treatment, including the treatment in conditions considered “sub-clinical”. Although in general practice, testing for hypothyroidism is usually limited to the testing of thyroid-stimulating hormone (TSH), the article’s author, Dr. Thomas D. Geracioti Jr, MD calls for more extensive testing in patients exhibiting psychiatric symptoms.

Patients diagnosed with mental illnesses (especially those with a mood component) are more likely to have involvement of a thyroid hormone imbalance than the general population. Patients with thyroid disturbance and psychiatric symptoms are most often diagnosed with one of the following:

  • atypical depression (which may present as dysthymia)
  • bipolar spectrum syndrome (including manic-depression, mixed mania, bipolar depression, rapid-cycling bipolar disorder, cyclothymia, and premenstrual syndromes)
  • borderline personality disorder
  • psychotic disorder (typically paranoid psychosis)

Psychiatric symptoms of hypothyroidism can include psychosis, depression, mood instability, mania, anxiety, hypersomnia, apathy, anergia, impaired memory, psychomotor slowing, and attentional problems. Other symptoms (such as hypersomnia and lethargy), as well as laboratory findings such as hypercholesterolemia, galactorrhea, hyperprolactinemia, menstrual irregularities, and sexual dysfunction could be misconstrued as resulting from the psychotropic medications being given to alleviate the psychiatric symptoms.

Because thyroid hormone levels have a circadian rhythm with a peak at night, Dr. Geracioti suggests that blood tests for hypothyroidism be done before 9AM in order to not miss subclinical hypothyroidism. Blood tests may need to be serially repeated and should include measurements of the following:

  • thyroid-stimulating hormone (TSH)
  • free triiodothyronine (T3)
  • free levothyroxine (T4)
  • total T3
  • total T4
  • antithyroid antibodies
  • serum cholesterol
  • prolactin
The endocrinology of hypothyroidism is complex. It can occur from a problem in the hypothalamus, the pituitary, in the thyroid itself, or even in the body’s own resistance to thyroid hormone, with varying levels of thyroid sensitivity in different organs of the body. When this happens in pediatric patients, symptoms additionally include short stature, learning problems, and attention-deficit/hyperactivity disorder (ADHD).

When it comes to augmenting psychiatric treatment with thyroid hormone, the author asserts,

“Psychiatric patients with subclinical hypothyroidism—especially those with incomplete responses to psychotropic therapy—should usually be treated with thyroid hormone. Free T3 levels in the lower 20% of the laboratory’s normal range are cause for pause in a patient with a mood or psychotic disorder and any of hypothyroidism’s clinical stigmata, even if thyroxine and TSH concentrations are normal.”
Also, in regards to depressive symptoms:
“In some patients with no clear evidence of a biochemical or clinical thyroid disorder, mood symptoms nevertheless respond to thyroid hormone augmentation of antidepressants.”

Read the article: Identifying hypothyroidism’s psychiatric presentations (November 2006 edition of Current Psychiatry Online)
Read the companion article on hyperthyroidism: Identifying hyperthyroidism’s psychiatric presentations (December 2006 edition of Current Psychiatry Online)
Resource: American Thyroid Association

Read more on thyroid hormone dysfunction and schizophrenia:

Child and Teen Brains Very Sensitive to Stress, Likely a Key Factor in Mental Illness

Lingering Psychiatric Symptoms May be Due to Hyperthyroidism
Protein Biomarkers for Schizophrenia Studied in Cerebrospinal Fluid
Prenatal Infection Increases Risk of Schizophrenia
Causes of Schizophrenia


My mother had her thyroid removed because of goiter/we lived in WV. I do not think the iodine in salt had any theraputic value. She later died of Multiple Myloma.
I have no doubt this is inter-related.

Posted by: Veronica at January 21, 2007 04:55 PM

great info in this article.
Anyone reading it might be really interested in the info put together at on the "thyroid, depression and mental health" page at

Posted by: Cathy at January 21, 2007 05:49 PM

I was diagnosed as being bi-polar and even hospitalized at one point with what was called psychotic. I was drugged up so much I didn't even know what day it was. I quit all meds. because I couldn't function.I was later diagnosed with Hashimotos disease and I was hypothyroid. Now I am on Armour thyroid and feel great. My mental symptoms have disappeared. Doctors need to be more educated on the thyroid and mental illness.


Posted by: Kathleen at May 7, 2007 03:44 PM

i have hashimato's ? I have been on differet doses and different meds(generic) or non. they don't work and the doc's won't do other tests even though I say they should. I am now sicker than before and can't get them to think other than judge and say it's all mental. i have been reading on thransthyretin and amyloidosis which I beleive i have. are we to all be nuts??

Posted by: sally scheidemantle at August 20, 2007 09:27 AM

of all the stuff to read on thyroid disease it's confusing.I feel that doctors aren't educated enough on this doctor just changed the dose and I got sick with the racing heart like i had too much adrenaline. somethings not right around ovulation time and why my testosterone is high and estrogen and progesterone are low. I feel strange during this time and I feel this is why my labs are off. I also get stabbing pains in my spine right before I ovulate or start my period. and I have had severe ear and throat pain for three years that get worse during that time. I am told it's allergies. I mention my symptoms and still get the same labs and repeated dosage changes.If there is something else I guess I will never know.also is it strange that my daughter has a pituitary tumor while i have thyroid disease? and that she had an ovary removed due to tumor growth? She also inherited the fv leiden gene mutation , mthfr gene mutation and has a lupis anti coagulant and is protein c resistant???? I was ill while pregnant with weight gain and loss and had severe pain in ovary for the entire pregnancy with no known cause because i went to a free clinic. she was born white as a ghost and thought it was family trait? she was sickly with bad colds and ear infections. finally at age three she had hardly any platelets to clot and was covered with hematomas. it took until age sixteen to figure it out. that was when her tumor problems started. but yet it was told to be related to depression. I watched her suffer and doctors just think every illness or complaint of one is related to anxiety or depression. I have been ill for seventeen years from the time i was first assymptomatic. ten years were wasted with anxiety and antidepressants and gruling therapy sessions. the next seven years are playing around with different dosages of thyroid meds. I just turned forty and I feel like shit. My bones are crumbling away due to the thyroid meds and when I know who I am on some days I feel right in my mind then on the days I don't have a clue who I am well..... I once went to er during a hyper state I got put in room for mental case to be watched denied thyroid tests and given a script for lorazapan. you gotta love all this educational tools we have available and it all boils down to ignorance.

Posted by: eidemansch sarah at January 11, 2008 05:25 PM

eidemansch sarah,

I read your comment and I felt your frustration and horror. So much of what you have gone through is eerily and tragically similar to so many other people's stories including friends and members of my own family.

Diagnosed with mental illnesses, their bodies deteriorated because the mental symptoms were merely manifestations of something going horribly wrong in their bodies and brain.

This article was very near and dear to me since it mentioned the low thyroid possibly being the result of a dysfunction in the part of the brain called the hypothalamus. This cannot be shown by just measuring TSH.

This is precisely what happened to my little girl who has one diagnosis of childhood-onset schizoaffective. She actually has a lot more problems resulting from the hypothalamic dysfunction than just the low thyroid.

Sarah, you may want to also look into autoimmune problems, intestinal malabsorption issues, etc. You may even want to consider going to a place like Mayo Clinic, Cleveland Clinic or Massachusetts General Hopsital for a comprehensive evaluation. It is important to regain bone strength and address all these issues going on in your body. I understand the frustration of not getting the help. It took us over 15 years before we found an M.D. doctor (endocrinologist) that finally LISTENED to us, ran the tests needed, and formulated a plan to help treat my daughter.

A book that might have some ideas about how to go about getting help is "Your Symptoms Are Real" by Benjamin Natelson, M.D.


Posted by: Jeanie at February 28, 2008 07:50 PM

I was diagnosed with severe hypothyroidism at the age of 8 years old. I wore size four toddler clothes and was three feet tall, 55lbs in the third grade. My childhood was a horror. I am now 51. When my son was born in 1990, troubles began all over again. I hemmorraghed severely and was in intensive care for eight days. I had been taking 6 grains of Armour Thyroid daily to make it through the pregnancy.
Fortunately he was born healthy.
Two years later I was hospitalized with "Psychotic Episodes"; I was also having electrolyte problems. Since then I have barely avoided all but one other hospitilization in the mental ward. I'm given drugs such as Seroquel, Geodon, Topomax, Abilify, Neuronton and Trileptal, to name a few. The side effects have been devestating. The drugs have caused further electrolyte imbalances, and when I was on Trileptal, I was hospitilized against my will for what was diagnozed as bi-polar disorder, but I feel was dementia from the medication and resulting hyponeutremia.
I've paid thousands to dentists and endodontists for bone loss and cosmetic dentistry. Now, my eyes are literally drying out.
I'm searching for a specialist not too far from where I live in Michigan who will take on my case and perform diagnostic tests over time, rather than the simple but useless TSH measurement.
Does anyone have any advise or recommendations?

When I was originally diagnosed, I was in Ann Arbor for a week of testing as a child. Without the straight week of testing I would be a dwarf to this day. As it is, my mental status is tenuous at best and I'm very very tired of the battle.



Posted by: Chris Bular at April 29, 2008 03:49 PM

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