Thyroid Problems & Bipolar Symptoms
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Q:  Thyroid Problems & Bipolar Symptoms

My 14 year old daughter has been diagnosed bipolar/schizoaffective disorder.  She also was diagnosed 2 years ago with Hashimoto thyroid disease.  Her labs have come back 
T4 Free .67
T4 Serum 5.0
Free Thyroxine (by Dialysis) Serum .8
TSH .79
Anti-TPO 140
Free T-3 3.0

Our doctor says that tests are close enough to normal to not warrant any thyroid treatment.  Do you think that Hashimoto and/or the low T4 and TSH may contribute to the mental problems?  If so, what possible treatment should be considered?

Dear Mr. B' -- 
Unknown territory.  Most psychiatrists basically wait until they're presented with "psychiatric symptoms", such as led to the BP/SA diagnoses, then treat those symptoms.  We just don't know much about treating thyroid issues, with an eye to affecting mental health symptoms.  There is clearly a relationship between thyroid problems and bipolar symptoms -- but that's about all we know. 

Of the results you report here, the low T4 does catch my eye all right.  Interesting in the face of that low TSH.  I see low T4's, i.e. officially less than the lower limit of "normal", with "normal" TSH values, quite frequently.  What does this mean?  Whoops, back to the paragraph above.  

Will treatment with thyroid do something good here?  (Note that despite the first paragraph, we can still ask this question about patients and it's quite a bit easier to answer.  Because there is relatively little risk to a trial of thyroid, as you may have read on my thyroid and bipolar page, one can consider trying it without needing (relatively) as much proof of the likelihood of something good happening.  But in a 14 year old?  No data, no experience there.  

Have I seen people with a TSH of less than 1 respond to thyroid? Yes, a time or two.  Usually it's people who start from 2.5 or higher though.  

I can't emphasize enough how many unknowns there are in this realm .  Her doctor's "close enough to normal not to treat" is entirely understandable, and you really need to work your way along with the doc'.  However, if your daughter is not doing well with the typical psychiatric "treat the symptoms" approach, and you're looking for something to try -- then yes, with great caution and great worry about heading off into the wilderness without a map, I would consider a trial of thyroid (in case that was the bottom line in your question).   

Dr. Phelps

Published May, 2003


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