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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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