Q:  Hypothyroid and Treatment of  Bipolar Disorder

 I have hypothyroidism as a result of Graves Disease.  My thyroid was radiated.  Am I limited to certain types and kinds of medicines because of this?  If so, does this mean my medicine will never stabilize?  Joan

Dear Joan -- 
So far we don't recognize any ways in which you would need to be treated differently than anyone else with bipolar disorder.  You will probably need thyroid replacement, if not already on it; and there is some controversy about T4 or T4/T3 replacement you may have heard about.  

I say "so far" because I think we're going to learn that the thyroid system is tied pretty directly into the mood system where bipolar disorder lives.  I have one patient that tried all sorts of mood stabilizers without much sustained benefit, even many combinations, who for the moment is very solidly stabilized by the T3/T4 combination -- but that's just one patient. 

So in the long run if you're having trouble getting good symptom control, you might need to try different thyroid replacement approaches.  But for now, if your thyroid routine tests (TSH, T4) are ok, you can proceed with routine treatment of your bipolar disorder, as far as I know.  If your endocrine specialist knows otherwise, trust that more than me, as I claim no particular expertise in that area. 

Dr. Phelps

Published April, 2001