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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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