My 17 year old adopted son is currently being re-assessed, with bi-polar, rapid cycling, being a strong hypothesis. The history is that of a spirited friendly out-going  passionate inattentive child, diagnosed ADHD at age 9.  He did reasonably well on ritalin , but it was not a miracle drug. Things deteriorated in adolescence,  and he began to be less hyper, more withdrawn, sullen, irritable, and unfocused.  His motivation declined and his mood became low. He switched to wellbutrin at age 15.  School work deteriorated and we thought he was physically ill ( mono? ) and overly fatigued.   A physical exam at age 15.5 declared Graves' disease,  with extreme  hyperthyroid. After antithyroid hormone treatment, the thyroid has settled down, but he now fluctuates between fatigue ( long hours in bed and being unproductive ) and episodes of irritability, provokative behavior, and angry outbursts.  His memory and concentration is poor,  and his school performance, organisation, and general functioning have deteriorated.  Any thoughts ? or hypotheses? or areas of investigation you would recommmend?  His thyroid function is now registering normal.  Thanks very much.  JS


Dear JS -- 
The fact that you're reading and writing here obviously suggests that the bipolar hypothesis makes some sense to you, or that you see it as worth considering.  I would think that too, and that's about as far as I can go given that I'm not a child/adolescent psychiatrist, and also given that (as I understand it from my colleagues who are) it is routinely extremely difficult to make these kinds of calls.  

As you may have seen from my website, I'm very interested in the relationship of thyroid disorders and bipolar disorder, which would seem very relevant here.  But there's painfully little to go on about how to connect the two; on the whole they just seem to show up together far more often than one would expect.  There is no clear story on how to treat someone like your 17 year old incorporating his thyroid experience.  You should interpret my thyroid treatment data with even more than the usual grain of salt in his case, because he's not had a chance at some much more routine treatments yet.  I hope things get better, or at least clearer, for you all soon. 

Dr. Phelps