Q:  Hyperactive Thyroid?

My 17 yr old daughter has been seeing apsychologist and psychiatrist @ Stanford and was just diagnosed w/ bi-polar II and has rapid-cycling.  It runs in my family, my mother and sister have been diagnosed.  Just did a test for thyroid function the TSH is .06; Hematology: RDW 14.7, MPV 11.3, PLT morph is large; and blood chemistry: Amylase is 104.  Hyperactive thyroid?  She is not thin, just perfect, palpitations, anxious, etc., she has been given Depakote to treat bp and we are trying to get her into the internist.  Could this possibly be to to a over active thyroid or am I still in denial? 

Thank you, any info you could give would be wonderful

 

Dear Ms. A' -- 
Good that you're watching so closely and wondering.  Here's more, so I can wonder with you:  now that I am very interested in thyroid and bipolar, I've begun asking all the primary care doc's who refer patients to me for an evaluation to include a TSH (can't get in without one; I should have done this a long time ago, as it's nearly always necessary when a patient has mood symptoms).  Now I'm starting to see little blips of "hyperthyroid", according to the TSH anyway, when people are leaning in the direction of the manic side symptoms of BPII.  Yet they don't have other manifestations of hyperthyroidism, as you point out your daughter lacked as well.  

So, is the hypomania that becomes the basis for a bipolar diagnosis "just" a thyroid shift?  Or is it the other way around: when a person has hypomania, his/her TSH might shift down toward "hyperthyroidism" range (less than 0.5 by most labs)?  I've not read anything yet about some kind of "reactive" TSH shifts with bipolar mood states.  And a high TSH is clearly associated with causing depression, or at least a slowed-down, fatigued, listlessness that responds very well to TSH and looks like depression (and might cause depression even if it, itself, wasn't depression per se, because of the impact it would have on people's lives).  

Anyway, you see the point, which is "I don't know" as far as cause or effect on this association, nor as far as I know does anybody else.  And that's why your asking is such a good thing, because we all need to keep wondering about this.  Sorry it doesn't lead to some treatment option though (as the high TSH leads to giving thyroid hormone).  Maybe we need to wonder, in this same way, about giving propylthiouracil (used to treat hyperthyroidism) to "treat" the hypomania and see what happens.  I've never heard of that approach, though.  If the association is more an effect than a cause, i.e. low TSH is what happens from hypomania, not the reverse, then there would be no sense in giving PTU, so we really need to know the answer to your question first.  

Dr. Phelps