1 Episode 6 Years Ago - Thyroid?
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Q:  1 Episode 6 Years Ago - Thyroid?

as a result of one manic episode, my father in law's doctor diagnosed bipolar six years ago and has been on medication since.  He was recently diagnosed with hypothyroid.   The question is which came first?  (he is not on lithium as I understand that can affect the thyroid...)  Could his one and only manic episode six years ago been a result of a malfunctioning thyroid?a thyroid on the verge of going out...?  Is mis- dianosis common?(hyper/hypo vs. bipolar?)  With this recent diagnosis, he can look back through these six years and clearly see symptoms of thyroid disorder, claiming he hasn't felt the same since that one episode, lost his passion...  is it possible it has been his thyroid all along?

Dear Mark -- 
Interesting:  I just finished a long reply to a woman who wonders if after six years of lithium and only two prior episodes she can consider going off lithium. (here's that letter)  And right at the end I noted that among the many factors to be considered was thyroid status.  And now comes your question, somewhat similar, but with the emphasis on the thyroid side. 

First off there should be some acknowledgement sounding like "I don't know", especially as under these circumstances there's only the information you report here to go by.  We just don't know very much about how thyroid and bipolar are related, other than that they clearly are.  You may have read my websection on thyroid and bipolar disorder, though I should emphasize how even there -- e.g. thinking about using thyroid as a treatment -- we know so little about what we're doing. 

All that said, is there an important relationship between his thyroid status and his bipolar episode, and now his "hasn't felt the same since"?  I would think very likely so, as obviously you do.  

Was his episode of apparent "mania" years ago really a hyperthyroid phase, as in Grave's Disease? (Here's an encyclopedic thyroid source, if you need one).   Anxiety, irritability, and difficulty sleeping are on the list of symptoms (e.g. here's the Mayo clinic list), and those are symptoms of bipolar manic phases as well.  

Now for the complicated part.  Note that difficulty sleeping, such as Grave's might cause, can actually itself cause a true bipolar manic episode to emerge.  If there was a family history suggesting mood disorders run in the family, and especially if someone had a diagnosis of bipolar disorder, it seems more likely that the thyroid might have triggered something than that thyroid itself was the basis of the symptoms.  And the converse is probably also relatively true:  that if there is no family history, that perhaps this was more due to a thyroid basis alone. 

Of course all that assumes that bipolar and thyroid problems are separate.  And yet we know they are not, if only on the basis of their statistical co-occurrence far more often than one would expect on the basis of the frequency of the two illnesses alone.  So, obviously if it's tough to be certain which was the "cause" when we think of them as separate illnesses, then it's even worse when we factor in their relatedness.  And that's where we lose the thread due to our lack of understanding of how these things really work. 

Now, with a little time remaining, does all this speculation lead us to something to do about the current state of things (hopefully that's why we're doing this...)?  Well, if we knew more about how to use thyroid hormone as a treatment in bipolar disorder, it sounds like your father-in-law would be a great candidate for that approach.  Since we don't, it's hard to push that approach very hard -- though tempting; as you'll see is roughly the tone I've tried to strike in my websection on this topic.  

And finally, just to give you a bit more of a straight answer, "is it possible it has been his thyroid all along?"  I think on the basis of how little we know, I'd have to say yes it's possible; and that my overall sense it that it's more complicated than that.  Good luck trying to continue to understand, and to help, from here. 

Dr. Phelps

Published March, 2003


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