Graves Disease & Bipolar Disorder
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Q:  Graves Disease & Bipolar Disorder

I have Graves Disease is there does this mean I could get this bipolar disorder?  My labs are normal but I'm anxious still and my psych has me on klonapin right now.  My sister also has Bipolar but no thyroid problems.  Am I at risk or do I not have to worry about it just because I have Graves Disease this might be all I have right?  I am raging all the time and annoying people so thats not good and my labs are normal and if my labs are normal it must mean I'm normal.  Anyway I was wondering if there was any information on if Graves Disease and bipolar could be connected or not. 

I do see an Endrocronologist and a psychatrist right now just thought you might have some information to post on your board.  My psychatrist has not mentioned anything so maybe I just do have graves disease and nothing more which I hope is the case.

thanks for your reply

Dear Ms. A -- 
Hmm, that's tricky.  Let's see:  you have a psychiatrist.  She/he has you taking Klonopin.  She hasn't said you have bipolar disorder.  She's said you have uh, what?  Anxiety and rage, and for now we'll treat it with Klonopin.  That would be okay, at least for a while.  On the other hand, even on the Klonopin you're "raging all the time and annoying people".  Okay, so your labs are normal but in terms of mood and behavior, you are not.  Have I got that right so far? 

Meanwhile, your sister has bipolar disorder.  And you're worrying that you might have it; or get it; and that the thyroid issue now might be part of that question.  In fact, you're worrying that the thyroid problem is going to increase your risk of bipolar disorder beyond the "family history" level.  In fact, you're asking whether thyroid and bipolar disorder are possibly so closely connected that getting Graves' is somehow part of getting bipolar disorder.  I hope I've got that right too. 

Okay.  First off, the connection between thyroid and bipolar disorder is there all right, but what the connection is, remains unknown.  What's the risk of getting bipolar disorder if you have Graves'?  Don't know.  What's the risk of getting bipolar disorder if your sister has bipolar disorder.  Well, we know a little there.  It's summarized for parents under the title Risk to Your Kids, and you can read that. 

Finally, what's the risk of getting bipolar disorder if there's a family history and then you get Graves'?  That is, are you at greater risk?  Don't know. 

But now we come back to things that are known.  You're "raging all the time and annoying people".  In my view, with your family history, and given that apparently your thyroid labs are now "normal", but you aren't, I'd go ahead and strongly consider treating those symptoms even if I didn't -- for now at least -- call it "bipolar disorder".  And I'd start with whatever your sister had done really well on.  If she hadn't done really well on anything, I'd look for something that made sense to start with that she hadn't taken yet (e.g. if she'd had lithium and Depakote and Zyprexa and nothing worked particularly well, I'd think about starting with Trileptal, or vice versa, as long as there were no other clear basis on what you personally should start with).  

Now, fortunately you have a psychiatrist.  So, you could just wonder out loud with him/her about treating these symptoms, whether or not you want to call it "bipolar disorder" now or not.  

Finally, am I really saying "you have bipolar disorder"?  No, really, I don't intend that.  The labels may be getting in the way here, it seems.  I prefer to focus on symptoms and treatment options, not on the labels.  

For example, you should probably start with all the things someone with bipolar disorder should do, to see if that helps with your symptoms, before you start medications:  e.g. regular sleep habits; avoid late-night light exposure; no regular alcohol; and definitely regular exercise.  Then, if you're still having symptoms, talk with your psychiatrist about treating them more aggressively.   Good luck with all that. 

Dr. Phelps

Published March, 2003


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