Thyroid-induced mania in hypothyroid patients

University of Minnesota Duluth, Duluth, Minnesota, United States
The British Journal of Psychiatry (Impact Factor: 7.99). 10/1980; 137(SEP):222-8. DOI: 10.1192/bjp.137.3.222
Source: PubMed


This retrospective study, based on 18 case reports, describes an organic affective syndrome, manic type, occurring shortly after the initiation of thyroid replacement in hypothyroid patients. The symptomatology and homogeneity of the syndrome offers insight into the relationship between thyroid activity and affective disturbance. The patients experiencing mania showed concurrent psychopathology at the time of replacement therapy, frequently had a past history of personal or familial psychiatric disorder and were given dosages in the high range of normal. The potential morbidity of the manic state was considerable. These findings suggest that a group of hypothyroid patients at risk can be identified. In such a group, lower initial dosages and gradual increases in dosage may be indicated.

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    • "Underlying mechanisms are less clear; they could include dysregulation of CNS catecholamine receptor sensitivity, associated thyroditis and thyrotoxicosis, or a disruption of circadian rhythms [18]. A retrospective review based on 18 patients described an organic affective syndrome-manic type occurring shortly after the initiation of thyroid replacement in hypothyroid patients [19]. Patients experiencing mania were predominantly female, often had concurrent psychotic symptoms, frequently had a personal or familial history of psychiatric disorder, and had received more than 150 mcg/day of thyroxine. "
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    ABSTRACT: Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition.
    Journal of Thyroid Research 07/2011; 2011(3):306367. DOI:10.4061/2011/306367
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    ABSTRACT: Hypothyroidism is a common problem in clinical practice, with diverse manifestations. Neuropsychiatric problems include affective disorders, disturbances in cognition and psychosis. Mania is commonly associated with hyperthyroidism. Only a few selected case reports mention mania as a presenting feature of hypothyroidism. We report a case of mania with psychotic symptoms in a 47-year-old woman who had no previous history of psychiatric disorder. She had signs of florid hypothyroidism. She required both antipsychotic drugs and thyroxine replacement for the amelioration of her symptoms. The report is followed by a brief review of the literature on mania as a clinical presentation of hypothyroidism and its probable pathogenesis. One has to have a high index of suspicion of underlying organic causes in patients presenting with depression, psychosis or cognitive disorders.

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