Bipolar disorder thyroid hormone

Thyroid Hormone (Thyroxine, Synthroid). The most common use of thyroxine in bipolar patients is the treatment of lithium-induced hypothyroidism. Approximately 5% of patients receiving long-term lithium treatment ultimately develop hypothyroidism. When this occurs, the patient with bipolar disorder may present with symptoms of a depressive episode. Therefore, periodic thyroid axis monitoring, that is, a serum thyroid stimulating hormone (TSH) test, is required for all patients taking lithium and should always be performed when the bipolar patient experiences a depressive episode. 

Since thyroid illness is commonly associated with depression, especially in women, it has long been observed that treating the thyroid abnormalities also can reverse the depression. This is especially true for treating hypothyroidism with thyroid hormone replacement (either T3 or T4). It has even been observed that giving supplemental thyroid hormone to depressed patients unresponsive to first-line antidepressants but without overt hypothyroidism can boost the antidepressant response of the first-line antidepressant (thyroid combo in Fig. 7—30). Thyroid hormone is also commonly administered to bipolar patients resistant to mood stabilizers, particularly those with rapid cycling (see discussion of combinations for bipolar disorders below). 

Combination treatments for maintenance of bipolar disorder can include two or more mood stabilizers a mood stabilizer and an atypical antipsychotic a mood stabilizer and/or atypical antipsychotic with a benzodiazepine a mood stabilizer with thyroid hormone and even a mood stabilizer and/or atypical antipsychotic with an antidepressant (Fig. 7—35). 

Other interventions used for refractory bipolar depressed patients include atypical antipsychotics, thyroid hormones, stimulants (often used in the treatment of attention-deficit/hyperactivity disorder), and phototherapy. Repetitive transcraneal magnetic stimulation (rTMS) and vagal nerve stimulation (VNS) are techniques currently being researched. 

Endocrine Thyroid A woman with thyroid carcinoma who was taking lithium for bipolar disorder discontinued her thyroid hormone replacement in preparation for radioactive iodine ( I) treatment [59" ]. Within 3 weeks she developed severe lithium toxicity, which the authors attributed to renal insuffidenqr associated with hypothyroidism [60 ]. Lithium was not withdrawn in this patient, because of an earlier suggestion that lithium can be used as an adjunct in treatment [61 ]. In an in vitro study using follicular thyroid carcinoma cell lines, lithium 10-20 nunol/1 induced expression of NR4A1 and FOSB, genes whose underexpression is associated with mahgnancy [62 ]. 

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