Thyroid Abnormality or Bipolar Disorder
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Q:  Thyroid Abnormality or Bipolar Disorder

My question is regarding throid function tests and the "new guidelines" set by The American Association of Clinical Endocrinologists.  The new normal range is 0.3 - 3.04 as st by AACE.  THe old as you may well know was 0.5 - 5.0.  This greatly narrows the range of normality of TSH.  My level was 3.3 which falls out of new range and my sisters first abnormal reading was the same. Hypothyroidism runs in the women in the family on my mom's side.  I also take lithium now for almost a year.  I haven't had a regular period in 3 months, and I am in the weirdest depression ever.  I am trying to figure this thyroid abnormality, or just Bipolar Disorder?  Any help would be much appreciated!  Thanks!


Dear Ms. B' -- 
In Oregon there is a superb endocrinologist, if you ever want a consultation on this issue (separate from bipolar disorder), at OHSU, named Mary Samuels.  She's really busy so you might wait a while to get in.  She just came to Corvallis and gave us a run-down on TSH values, which was excellent.  I'll be posting some of her slides from this presentation on my website under
Thyroid and Bipolar and will note that I've done so under What's New if you want to watch for that.  Should happen in a month or so.  

Meanwhile, there's one crucial study you should be aware of, given your question (besides, as confirmed by several doc's including Dr. Samuels, there is no risk in taking thyroid hormone replacement as long as you don't make yourself hyperthyroid in the process -- and are willing to buy pills, have blood tests to make sure you're stable, etc.).  The crucial study is by Cole and colleagues.  Because this is so important, I'm going to copy in here the abstract from this article, which you might find rather technical, but might find of interest.  I've emphasized the important points in bold and italics. 

Cole DP, Thase ME, Mallinger AG, Soares JC, Luther JF, Kupfer DJ, Frank E.

Department of Psychiatry, University of Pittsburgh School of Medicine, USA.

OBJECTIVE: Because treatment of the depressed phase of bipolar disorder is a clinical challenge and hypothyroidism is known to be associated with depression, the authors examined the relationship between pretreatment thyroid values and response to antidepressant treatment. It was hypothesized that subjects with lower thyroid function, even within the normal range, would have a poorer response to initial treatment. METHOD: The subjects were 65 patients in the depressed phase of bipolar I disorder who were enrolled in a larger ongoing study. A panel of thyroid measures, including thyroid-stimulating hormone (TSH), thyroxine, triiodothyronine resin uptake, and free thyroxine index (FTI), were determined before initiation of algorithm-guided treatment. The effect of each thyroid measurement on time to remission was estimated by using the Cox proportional hazards model. RESULTS: Both lower values of FTI and higher values of TSH were significantly associated with longer times to remission, i.e., slower response to treatment. Outcomes were relatively poor unless patients had FTI values above the median and TSH values below the median. Patients with this optimal profile experienced remission 4 months faster than the remainder of the study group. CONCLUSIONS: This study provides further evidence that patients with bipolar disorder are particularly sensitive to variations in thyroid function within the normal range. Our results suggest that nearly three-quarters of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response. It remains to be seen whether pharmacological enhancement of thyroid function will facilitate recovery from bipolar depression.

You might show this to your doctor and see what she thinks.  As for your menstrual cycle, is that thyroid or bipolar?  I don't know there.  It would be interesting to see what your cycle does if your mood gets better -- which I hope you find a way to bring about soon. 

Dr. Phelps

Published October, 2004


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