15 Little Known Things About Your Thyroid That Can Affect Your Mental Health

Problems with your Thyroid gland can mimic a number of psychiatric disorders ranging from depression, anxiety and even psychosis. It is thus extremely important that mental health professionals be aware of some important but little known facts.

15 SNIPPETS ABOUT THE THYROID GLAND THAT YOU NEED TO KNOW

1. The brain has amongst the highest expression of thyroid hormone receptors of any organ. Neurons are often more sensitive to thyroid abnormalities than other cells.
2. TSH levels have a circadian rhythm; the most accurate measurement is obtained in the morning before 9 am.
3. Psychiatrists may be the first professionals that hypo/hyperthyroid patients may consult due to point 1.
4. Affective spectrum disorders are the most common.
5. Panic disorder can precede Graves disease by 4-5 years in some cases.
6. Increased prolactin may be a clue to hypothyroidism and not just attributable to antipsychotics.
7. T3 is the active hormone and the conversion from T4 to T3 requires selenium.
8. Iodine deficiency and Autoimmune thyroiditis are common causes of hypothyroidism.
9. TSH > 3.0 requires follow up and clinical correlation.
10. Increased antithyroid antibody titres have been linked with psychotic and depressive syndromes in Borderline personality disorder.
11. Antithyroid antibodies are associated with increased risk of developing frank or subclinical hypothyroidism.
12. Autoimmune thyroiditis is an endophenotype of bipolar disorder (both conditions may have the same genetic origin) and can be present independent of lithium use.
13. A supraphysiological dose of thyroxine in bipolar disorder may convert a non-responder to mood stabilizer to a responder.
14. Transthyretin (TTR), a carrier protein for thyroxine and retinol in plasma and cerebrospinal fluid (CSF), has been shown to bind the amyloid-beta peptide and reduced levels of transthyretin are found in Alzheimer’s disease.
15. TSH levels on their own may not accurately describe thyroid dysfunction.  Circulating T3, Free T3 or free T4 levels near the margin of the normal range and or TSH > 3.5 -4.0 mIU/ml may be indications for prescribing thyroid replacement.

Free T3 levels in the lower 20% of the laboratory’s normal range are cause for pause in a patient with a mood or psychotic disorder and any of hypothyroidism’s clinical stigmata, even if thyroxine and TSH concentrations are normal. [Geracioti D et al., 2006]

MANGEMENT ALGORITHMS IN PRIMARY AND SUBCLINICAL HYPOTHYROIDISM

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