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Psychiatric Manifestations In Thyroid Patients: Written by Douglas Bremner MD

Post Published: 11 May 2010
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Category: Guest Bloggers, Psychiatric manifestations of thyroid disorders
This post currently has 30 responses. Leave a comment

YIKES! I’m going COMPLETELY BANANAS and I don’t know WHY??

I think that people are following me in the street… I fly off the handle and scream at my kids…

I lock myself in my house for days at a time… I feel so low I feel like someone needs to scrape me off the floor… I can’t think… My brain is in a fog…

What the hell is going ON WITH ME?

And I was doing fine. I was TOTALLY NORMAL AND HAPPY.

I went to doctor after doctor. They just thought I was NUTS. They gave me antidepressants. Then one of them did some blood tests, just to get me off their back.

They said I had a problem with my THYROID.

I mean, WTF?

(Well at least my psychiatrist will get something out of this. As in… um, fees)

A lot of people don’t know it, but Dr. Robert Graves, who was the first to describe several cases of women with bulging eyes (exopthalmos) and swelling of the thyroid gland in the neck, also described nervous dysfunction, and noticed that women with the disease named after him developed it after suffering a severe stress.

The reason WHY you are going nuts is because there are things on your brain cells called receptors that trap thyroid hormone. If you have Grave’s Disease or one of the other autoimmune thyroid disorders your body is seeing these guys as foreigners and making antibodies to them, which screws up your brain function. Or if you get too much of the thyroid hormone, similar problem. All of the endocrine systems where the hormone goes into the cell and modifies your genetic expression can make you nuts if you get too much or they get screwed up (steroids, androgens, thyroid, Vitamin A).

Now we know that almost all patients with thyroid disease will meet criteria for a psychiatric disorder at some point. And the others will probably suffer from anxiety, irritability, hypomania, and/or cognitive problems.

One third of patients with untreated Grave’s disease have depression and one half an anxiety disorder. Untreated Grave’s disease is associated with cognitive dysfunction and sometimes psychosis. With treatment, symptoms of anxiety and depression improve, although symptoms may continue, which are thought to be related to antithyroid antibodies in the circulation that are part of the disease.

So make sure to tell your family and friends. I’M not nuts. It’s my THYROID!

Read more here…

Stern RA, Robinson B, Thorner AR, Arruda JE, Prohaska ML, Prange AJ (1996). “A survey study of neuropsychiatric complaints in patients with Graves’ disease”. J Neuropsychiatry Clin Neurosci 8 (2): 181–5. PMID 9081554.

Bunevicius R, Prange AJ (2006). “Psychiatric manifestations of Graves’ hyperthyroidism: pathophysiology and treatment options”. CNS Drugs 20 (11): 897–909. PMID 17044727.

J. Douglas Bremner, MD
physician, researcher and author of
‘Before You Take That Pill: Why the Drug Industry May be Bad for Your Health: Risks and Side Effects You Won’t Find on the Label of Commonly Prescribed Drugs, Vitamins and Supplements,’
Before You Take That Pill, Douglas Bremner MD’s website and Blog. Follow Douglas on Twitter.

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30 Responses to “Psychiatric Manifestations In Thyroid Patients: Written by Douglas Bremner MD”

  1. Dear Thyroid says:

    Dear Dr. Bremner, thank you so much for this great post! Speaking for myself, I feel so validated. Knowing that a doctor is willing to speak up regarding psychiatric disturbances caused by our glands – well it’s just awesome.
    A million thank yous.

    xo

  2. Jocelyn says:

    sigh. i don’t have insurance, so i can’t get my theory tested. i believe i have subclinical hypothyroidism. and now that i have researched it and researched it, i wonder if i have had it and it has been getting steadily worse for years.

    i was diagnosed with manic-depression in 5/01. i have been stabilized since then (meaning i have only spent time in the hospital that one time) with various and sundry medications. i have found a “decent” cocktail of topamax (300mg), lamictal (225mg), seroquel (50-100 mg, prn) and wellbutrin XL (300mg).

    however, i think that maybe things could be wildly different if i could get on some armour. i’ve gained 20 pounds in the last year or so … i don’t eat particularly well and i don’t exercise … BUT …. that has been the case for at least the last 10 years. nothing about my diet or activity level has changed. i have all the other symptoms of hypothyroidism … the dry, brittle nails and hair, the constipation, the sluggishness, the cold hands and feet, the aches and pains, etc. etc. etc.

    i had my blood tested last year and it was 2.75 and now i don’t have any real way to get to an endocrinologist and i’m afraid the people at the free health clinic just don’t have the time for someone like me. when i looked it up on the mayo clinic website, they said one of the groups of people *they* treat for subclinical is people with bipolar disorder. even more reason to figure this out, right?

    any suggestions?

  3. Michelle says:

    Dr.Bremner.

    I want to give my sincere thanks and appreciation for your post.. I have been suffering with anxiety for 11 years. SSRI’s have not been successful for me. All they did was numb my brain, killing my personality, sex drive and creativity as an artist. I have been off Prozac for 6 months now and I have never felt better!! Unfortunately, I am dealing with the aftermath of what these drugs have done to my thyroid and adrenal system. More people need to listen to their bodies and get the right information regarding treatment of their symptoms!

  4. Dear Thyroid says:

    Jocelyn; so sorry that you’re going through all of this, and on top of it – no insurance. Is there any kind of local assistance or clinics that you can go to and request testing?

    I’m looking forward to Dr. Bremner’s input. Thank you so much for speaking up! I know it’s not easy, kid. You did it.

    Here’s to better health and a diagnosis with great treatment.

    xo

  5. Dear Thyroid says:

    Michelle – Thank you so much for speaking up and sharing your story with Dr. B. Again, I know it isn’t easy to do.
    Thrilled that you are off the Prozac, very sorry about the aftermath and what it must have been like to deal with while you were on it.

    I digress… looking forward to Dr. B’s thoughts.
    Hang in, doll.

    xo

  6. Joanne says:

    dear doctor, i have had my under active thyroid since i was 19 years old i am 35 now, in my 20,s i had a breakdown and was told that i had manic depression the breakdown was due to events that happened when i was a child. but when i had the breakdown my thyroid also was not well, i never linked the two together till years later i decided to come off the pills for the manic depression after a couple of years and despite me been advise not to i was successful and never had a reaccurrance. i have had periods of mild depression but nothing serious enough for tablets, the only thing that courses me a problem is my thyroid thanxs for listening jo x

  7. Dear Thyroid says:

    Joanne – very proud of you for sharing your story with Dr. B. It’s not easy to do (as mentioned). I’m so sorry that you had a breakdown. I think it’s so interesting that when you came off the medication, you started feeling better.
    DOes the mild depression occur depending on your thyroid levels or no? Just curious.

    Looking forward to Dr. B’s responses.
    xo

  8. Doug Bremner says:

    @jocelyn I wouldn’t assume that the free clinic wouldn’t have time for you. Another option is getting into a research study on bipolar, you can get your blood tested for free. Make sure you tell them about your thyroid.

  9. Melanie says:

    It took me ages to be diagnosed with Graves disease as I had post natal depression too. The doctors I saw kept telling me some of my symptoms were “normal” for a mother with 2 babies under 2. Either that or they told me my symptoms were anxiety related. I knew as someone who has worked in psychiatric settings that it sounded like I was going mad, but I knew I wasn’t. I’ve never felt so out of balance in my life and the doctors reluctance to listen to my concerns but dismiss them as “depression & anxiety” didn’t help. I feel like I missed some very precious time with my children in those 2 years. Fortunately I was eventually diagnosed and now 4 years later life is much better. Sadly, now looking back I realise my grandmother who attempted suicide many times before her death probably also had Graves but was never diagnosed. I think doctors here in the UK need greater awareness of the effects of thyroid disorders on peoples mental health.

  10. Joanne says:

    i generally feel quite unwell when my thyroid isnt well, i can get a bit down when im having to have blood test after blood test every 6 weeks and one result its sky high and the next its low and im doing only what im told to do.

  11. Doug Bremner says:

    @joanne There are probably a lot of people being misdiagnosed as bipolar when it is actually a thyroid problem, which can cause similar mood swings.

  12. Michelle says:

    Thank you Dear Thyroid Here is a little more insight into my horrible roller coaster ride with SSRI’s:(sorry about the long post, LOL)

    When I started taking Strattera with Prozac in 2006, things got ugly.. I became nauseous all the time, gained 20 pounds and had debilitating joint pain.. When I stopped taking Strattera cold turkey, my body spun out of control.. I had 30 hot flashes in a day! My periods have been scant or non existent, heart palpations that came out of nowhere ( I could be sitting on the couch watching TV and my heart would all of a sudden freak out!!) my hair started falling out, I became bloated around my midsection ( I went from 135 to 160 pounds in less than a year!.. What was really crazy is that I was eating right and working out 3 days a week!
    I swear the prozac/strattera combo sent me into a menopausal state! I had my hormones tested last fall.. ( FSH was 154 and LH was 57) My TSH was 2.24
    Since being off of all SSRI’s, I feel better but I now have reverted to my old anxious self.. I have lost all the extra weight, but now I can’t tolerate cold, hair still is falling out, I have dry skin, and the area around my eyes are puffy all the time!.. I finally have health insurance so I am now going to get the other thyroid tests to see if I have hypothyroid or an autoimmune disorder.. I hope my post helps someone who has been suffering like me!

  13. Linda says:

    Dr. B. Thank you for your letter. I wish my Dr’s. knew to test my thyroid before I lost several years of my life on anti-depressants and therapy that never did the trick. It was to the point that they were telling me I was a hypochondriac. Lucky for me before they did the “electro therapy” my OBGYN did a TSH test and found me at 7.5. She sent me to an Endo, and until the Armour reformulation last year I actually had my life back. I am still trying to get my thyroid back on track, but nobody (that I know of) wants to commit me anymore.

  14. Doug Bremner says:

    To everyone– Psychotherapy probably won’t work for thyroid related mood disorders– the treatment is to get the thyroid in control– I think some people with depression related to medical conditions or medications get a disservice having a psychologist tell them it is related to life issues or childhood etc. If you are on psych meds do not withdraw cold turkey. Sometimes it takes months to withdraw. Get the liquid form and go down a drop every few days if you need to. If your doc won’t work with you, find another one.

  15. Dear Thyroid says:

    Doug, I have a question for you — What are your thoughts on patients with balanced thyroids still experiencing psychiatric issues? Do you think that’s due to other hormonal issues? Or the thyroid? Because many patients, even with balanced numbers still endure psychiatric symptoms; symptoms they never had before their thyroids went wonky.
    Any light you can shed would be greatly appreciated.
    Thanks.

  16. Michelle says:

    Thanks for the infromative information… This might explain why I feel the same since being prescribed Cymbalta.

  17. Joanna says:

    Thanks for this great post, Dr. B. I have a question for you…I experience both irritability and cognitive issues. Nothing severe, but definitely something I notice. However, because I have thyroid cancer, neither my doctor nor I are willing to adjust my thyroid meds much–I stay on the hyper side of normal for suppression purposes. Any suggestions for controlling the irritability and cognitive issues?

  18. Lori says:

    Dr. Bremner – Can untreated Hashimoto’s disease be associated with cognitive dysfunction, depression, anxeity, intermittent fine hand tremor, hypomania, and psychosis manifested as paranoia? This is along with many of the typical hypothyroid symptoms. There is more depression than hypomania symptoms but clearly cycle back and forth. All symptoms except paranoia, which is new recently, have been unsuccesfully treated for 10 years. His mother has Hashimoto’s disease and recognizes many similar symptoms but having no luck getting anyone to listen so far in the psychiaric community or with the primary care.

    What thyroid tests do you recommend be checked? The person I am concerned about recently was tested by his doctor but the doc only did a TSH and FT4. He was told they were normal with TSH of 0.46 (n= 0.34-5.6) FT4 of .80 (n=0.61-1.12).

    Lastly, I am also interested in the answer to Dear Thyroid’s question above.

    Thank you very much for addressing this very important part of the thyroid puzzle for so many.

  19. Just Me says:

    Thank you! I suffered with recurrent hyperthyroid for years during a very stressful job (hyperthyroid that was in remission for the 13 years prior). While I’d never wish it on anyone else, it’s sure nice to know that I’m not crazy!

  20. Lolly says:

    Dr Bremner,

    Thank thank you thank you, so it’s not all in our heads then? or stems back from child hood. Or your levels are fine it’s not thyroid related. Even when thyroid levels show to be in range albeit in the right place for that particular person.

    So pleased that someone from the medical profession recognises the difference from autoimmune thyroid disease to actual Psychiatric symptoms although they can manifest themselves in the same way.

    I too would be interested in what Katie asked about why symptoms persist even though thyroid levels remain stable. Has the damage already been done to our brains or is it all in our heads or learned behaviour? I still get the odd Graves Rage not half as bad as when I was in full blown GD and TED. Still suffer from cognitive issues I’m sure it’s effected my brain or could that be my age? 21 isn’t very old to feel like your 80 going on 100 with signs of alzheimer’s

    Why do i still get a foggy brain maybes it’s because I don’t have enough Free T3 circulating in my body and with little or no chance of getting a good Dr or Endo to actually prescribe any for me, then again I’m at a disavantage I live in the UK and we are a little behind the times we still live in the victorian era.

    I want to thank you this is me being really mice for your great article, really appreciate it.

    Lolly

  21. Doug Bremner says:

    @dearthyroid you can have normal thyroid hormone levels but still have your thyroid disease affect your mood becaue of anti thyroid hormone antibodies that are affecting your brain function if you have Graves or a similar autoimmune disease like Hashimoto’s thyroiditis.

    @joanna if you have to be hyperthyroid to control your cancer, you may have to learn to live with irritability I guess? Not sure

    @Lori You should get total and free T3 and T4 checked as well? Yes Hashimoto’s can cause psych symptoms even if your thyroid hormone levels are in normal levels.

  22. Bernadette says:

    Wonderful post…too bad it isn’t on the front page news!!! This is what so many patients deal with and are told it isn’t related!!!
    I have always dealt with depression, even as a child. The doc I see now says most likely I have always had adrenal issues as well. (I am currently being treated for adrenal insufficiency plus hashi’s)
    I’ve been on anti-depressants, the last being Effexor, which ended up getting toxic in my system…I could not even make it 24 hours without having withdrawal symptoms..which I was told by my doctor were false. (there’s no such thing!!) uuuuhhhh…wrong!!!
    During this time my poor endocrine system went fully haywire..developed ovarian cysts, fibroids, diagnosed with thyroiditis, nodule found…I can’t even describe the emotional craziness going on! It took me almost a YEAR to slowly taper off Effexor. It WRECKED me..stole years of my life, time with my children, I have never been the same. Adrenal & thyroid issues…finally dealing with now.
    The mood roller coaster…the depression for me it is one of the absolute worst symptoms of this disease. Being told by every one to just “take a pill.”

    Thanks doc…great to read this from a professional…now let’s go shout this validation a little louder!!

  23. Dear Thyroid says:

    THANK YOU, DR. BREMNER. THANK YOU. THANK YOU. THANK YOU. Did I say thank you? I meant – THAAAAAAAAAAAAAAAAAAAAAAANK YOUUUUUUUUUUUUUUUUUUUU!!!

  24. Elena says:

    Thank you Dr. Bremner!! I went on anti-depressants a year and a half ago because of a major tail-spin into depression. Luckily, my mom continued to push the physiological side (she was diagnosed with post-partum hypothyroidism after she had me) and a few months later (after having to leave college early for the semester) I was in to see her endocrynologist and got on thyroid supplements for hypothyroidism.
    A question for you (long back story, sorry): My thyroid got to a good level in February, but I was still feeling tons of brain-fog and fatigue until I cut my dosage of Prozac down a bit (consulting with a phsyciatrist). In about two weeks, I was feeling so much better!! I still had some thyroid symptoms, but my brain function and concentration improved ten-fold. I’ve dosed down a bit more on my Prozac since then, but my doctor wants me to stay on it for a while longer because of the positive studies on year-long use after stabilization.
    Are there any studies out there about depression/anxiety and thyroid issues? Especially related to taking SSRI’s if not needed and that adding to symptoms? I’m wondering if any other people had a similar experience of anti-depressants or other meds making their symptoms worse or if doctor’s are really aware of that issue. It seems really important to me that more people (and health professionals) know of this because it can be hard enough to advocate for yourself in health matters anyway, let alone when you are depressed.

    Thanks for your support! Is there anything the Dear Thyroid can do to make this a better known issue among doctors (besides our own)?

    Elena

  25. Elizabeth says:

    Thank you for this article! I’m right in understanding that the anti-bodies from Hashi’s can cause psych symptoms, even when hormone levels are normal? I’m on Cymbalta (a low dose); zoloft did nothing for me. I DO have plenty of childhood issues to work through, though. Is it possible for childood trauma to cause an auto-immune disorder? I’m very interested in your response.

  26. Faith says:

    Thank you. I am trying to my therapist to understand about my thyroid and why I feel like I do.

  27. cla4sam says:

    Thank you so much doc you really said how i feel.Everythng you said equals me.I thought i was going crazy my doc already thinks i am.Thank you for you pot really has helped alot.

  28. Dr. Bremner,

    Thank you so much for writing this. It’s so comforting when a doctor agrees that it just might be your thyroid! My blog is all about my battle with the depression that has occurred since having my my completion thyroidectomy. I also recently wrote an article here (also available on my blog) about my “nervous breakdown” and my stint in a psychiatric hospital.

    Chris

  29. Trish says:

    “I’m not nuts. It’s my THYROID!” – Oh how I dread saying that. It migt be better to let them just think I’m nuts; I’m not sure they believe me anyway.
    So, your thyroid makes you fat, lazy, crazy, cold, sick, sore, forgetful, bald….. Does it make you dress funny too?
    Sure, tell people it’s your thyroid, just don’t expect them to believe you.

  30. jillautumn says:

    Dr. Bremner,

    This has to be the very best thing I think I have ever read!!!!!!!!!!! I am just another person desperately feeling the urgent need to thank you. I don’t think there is anything else to say, other than suggesting someone make a copy of this and make it mandatory reading material for all pre-med and currently licensed physicians.

    Thank you Katie for passing the link to me!

    Thanks again,

    Jill

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