Myxedema Craziness

January 10, 2006

http://www.stopthethyroidmadness.com/?page_id=18

Myxedema Craziness

(The following has been written by thyroid patient, Cindi Straughn,

2005.)

It is well documented in the medical literature that Hashimoto's

and/or hypothyroidism can be the cause of a vast variety of

behavioral and psychiatric symptoms. So it is alarming that very

rarely is thyroid function thoroughly checked (thyroid antibodies,

and Free T4 and Free T3) before a physician or psychiatrist dispenses

potentially brain-damaging psychotropic drugs.

A review of Internet thyroid forums' posts easily reveals that many

hypothyroid patients were initially prescribed anti-depressants

and/or other psychotropic medications by their physicians when they

had complained of low thyroid psychiatric symptoms such as depression

or anxiety or mood swings. More alarming is to learn that there are

Hashimoto's patients who have even undergone electric shock therapy

before their thyroid disease was discovered and properly treated.

Dr. Ridha Arem, in his book, " The Thyroid Solution: A Mind Body

Program for Beating Depression and Regaining Your Emotional and

Physical Health " , says:

Scientists now consider thyroid hormone one of the major " players " in

brain chemistry disorders. And as with any brain chemical disorder,

until treated correctly, thyroid hormone imbalance has serious

effects on the patient's emotions and behavior.

Once the important thyroid hormones, T3 and T4, are released into

your bloodstream, they enter cells of organs and play an important

role in regulating major functions in the body. Adequate amounts of

thyroid hormone are also required throughout your life if your brain

is to function normally. Most of your cognitive abilities — such as

concentration, memory, and attention span — as well as mood and

emotions depend on normal thyroid hormone levels. Mounting evidence

suggest that T3, the most potent form of thyroid hormone, is a bona

fide brain chemical. It is found in the junction of nerve (synapse)

cells that allow these cells to communicate with one another. This

thyroid hormone also regulates the levels and actions of serotonin,

noradrenaline, and GABA (gamma-aminobutyric acid), now accepted as

the main chemical transmitters implicated in both depression and some

anxiety disorders. Maintaining normal serotonin and noradrenaline

levels in the brain depends to a great extent on whether the correct

amount of T3 is available. Extensive animal and human research has

led scientists to conclude that serotonin levels in the brain

decrease if T3 is not delivered in the right amount. Also, a deficit

of T3 in the brain is likely to result in noradrenaline's working

inefficiently as a chemical transmitter, and noradrenaline deficiency

or inefficiency is, in some people, the chemical reason for

depression.

" …Thyroid patients, particularly those with hypothyroidism, want

peace and quiet. They feel the need to withdraw from activity and

noise. They have a low tolerance for sound. In essence, they wish to

insulate themselves in a surrealistic world of tranquility. "

" Patients may become withdrawn from friends, and they do not want to

talk or go out with people. They may lose all interest in doing

things with their partners… Hypothyroid patients want to be left

alone. They just want to sleep and withdraw from those around them.

In some cases, they realize the people around them are doing the best

they can, but they still want to maintain their isolation. "

What are some of the behavioral and psychiatric symptoms of a low

thyroid condition in the brain?

Depression, anxiety, panic attacks, agoraphobia, obsessive compulsive

tendencies, ultra-sensitive to the comments of others, social phobia,

self-image concerns, unable to concentrate, lack of motivation, mood

swings, dementia, phobias, delusions, suicidal ideation, memory loss,

alterations in the accuracy of perceptions, visual and other

hallucinatory distortions and more.

Many low thyroid sufferers may tend to be on the selfish side because

they have a pervasive feeling of not having enough resources for

themselves, much less enough to make the lives of any other people

better. They sometimes tend to be cranky, abusive, stingy, critical,

judgmental, and have a whole set of other exceedingly undesirable

tendencies. They can suffer from lack of motivation or ambition and

find it difficult to accomplish even simple tasks.

These folks know their feelings and behavior are quite inappropriate.

They often feel frustrated, because in spite of their best efforts,

there doesn't seem to be much they can do to control these feelings,

especially when the symptoms worsen during times of stress or just

prior to the menstrual cycle.

It is often hard for them to find enjoyment in activities. They have

a tendency to not feel like doing anything. They frequently can no

longer find enjoyment in the things that they used to find quite

interesting and enjoyable. For them, molehills frequently seem like

mountains.

What is " brain hypothyroidism " ?

This term has been used to indicate a low level or abnormal

distribution of T3 in the brain even though the thyroid gland is

producing adequate levels of thyroid hormone. Reduced cerebral

thyroid expression could therefore, contribute to a host of

psychological symptoms. This would also explain why many patients

with psychiatric conditions respond well to thyroid support, since

there are extensive T3 receptors in the brain. The effectiveness of

SSRIs such as Prozac may be effective in some patients due to the

drugs effect of increasing the availability of T3 in the brain.

Has thyroid hormone ever been used to treat psychiatric disorders?

It is known that synthetic T3 (Cytomel) can raise brain levels of the

neurotransmitters, serotonin and norepinephrine. T3 medication has

been added when someone has not responded to an antidepressant. Of

course it is also quite probable those persons are just undiagnosed

low thyroid.

Since many doctors treat low thyroid function with only T4

medication, they sometimes remain depressed. That depression is also

sometimes treated by prescribing Cytomel, although there is evidence

that indicates Armour Thyroid is the superior product for both mental

and physical symptoms of low thyroid.

It is also noted in the Journal of Clinical Psychiatry that T3 can be

used to treat post traumatic stress disorder, commonly seen in

soldiers and people who have been through other causes of terrible

emotional trauma. It is known that trauma/stress can affect thyroid

gland functioning.

Why aren't health professionals more informed about behavioral and

psychiatric conditions resulting from a low thyroid condition?

Thyroid disease in general used to be treated by symptoms prior to

the advent of the TSH test in the 1970s. People are now realizing

this test does not detect many cases of low thyroid. It wasn't until

this lab test became the " gold standard " test for thyroid function

that diseases like chronic fatigue syndrome, fibromyalgia, Irritable

Bowel Syndrome and others came into existence. Many have surmised

that these new " invisible disease " are simply low thyroid conditions

that are not being detected by the standard TSH test. Therefore it is

quite possible that some psychiatric disorders are actually

hypothyroid conditions which are not being detected by the TSH tests.

So although a health professional may know about the link with

behavioral/psychiatric conditions, the unreliable TSH test may cause

them to rule out thyroid as an origin of the problems. Additionally,

many health professionals think the TSH is the only test that is

needed, and do not realize that thyroid antibodies alone can cause

problems or that someone could be functionally hypo (low T3, normal

TSH and Free T4).

Where can I read more about thyroid functioning and

behavioral/psychiatric disorders?

(Note that many articles/studies that say thyroid function

is " normal " are using the TSH test. So there is a real probability

that if the person has thyroid antibodies and/or their Free levels

are in the lower 1/3 of the range, they actually are hypothyroid.)

Psychiatric Manifestations

" Psychiatric Manifestations of Hashimoto's Thyroiditis " by

C.W. Hall

Mypothyroidism Presenting as Psychosis

" Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited "

by W. Heinrich, M.D. and Garth Grahm, M.D.

Thyroid hormone and depression

Thyroid hormone and depression.

Anxiety and Endocrine Disease

Article " Anxiety and Endocrine Disease " by D. Hall, M.D. and

C.W. Hall which includes sections " Anxiety Disorders in Patients

with Thyroid Hormone Disturbance " and " Panic disorder/agoraphobia and

thyroid disease " .

The Thyroid and the Mind

The Thyroid and the Mind and Emotions/Thyroid Dysfunction and Mental

Disorders.

Depression Explored

Depression Explored, With Dr. Barry Durrant-Peatfield.

The link between Thyroid Autoimmunity

Study " The link between thyroid autoimmunity (antithyroid peroxidase

autoantibodies) with anxiety and mood disorders in the community: a

field of interest for public health in the future. "

Thyroid hormone and bipolar patients

A world-renowned expert on bipolar disorder discusses the latest

research demonstrating that thyroid hormone can have a positive and

profound effect on mood in bipolar patients.

Efficacy of T3

This meta-analysis supports the efficacy of T3 in accelerating

clinical response to tricyclic antidepressants in patients with

nonrefractory depression. Furthermore, women may be more likely than

men to benefit from this intervention.

Antithyroid antibodies and depression

Antithyroid antibodies may signal difficult-to-treat depression.

Bipolar Link with Thyroid Condition

Research zeros in on bipolar link with thyroid condition.

Thyroid and bipolar disorder

Thyroid and bipolar disorder.

T3/T4 Combination

This clinician's patient was bipolar and had not had any success with

any anti-depressants or mood stabilizers but responded favorably to a

T3/T4 combination.

Hypothyroidism and suicide

Woman admitted to psychiatric hospital after suicide attempt and

found to have hypothyroidism.

Thyroid and Depression

Thyroid condition may slow depression recovery.

Teen with depression found with hypothyroidism

Teen with depression found to have hypothyroidism.

Hypothyroidism and blood tests

1/3 of borderlines have symptoms of hypothyroidism, with " low normal "

blood tests.

Thyroid hormone in brain and behavior

Role of thyroid hormone in brain and behavior.

Prevalence of Psychiatric Disorders in Thyroid Diseased Patients

Abstract " Prevalence of Psychiatric Disorders in Thyroid Diseased

Patients " .

Mermudes Thyroid

Article " Psychiatric illness or thyroid disease? Don't be misled by

false lab results " by A. Mermudes, MD.

The following is a sampling of related PubMed medical abstracts which

can be searched at www.pubmed.com:

Psychiatric presentations of hypothyroidism.

Hypothyroidism often misdiagnosed as psychiatric illness.

Thyroid screening recommended for patients presenting with

depression, psychosis or organic mental disorder.

Masked " myxedema madness " .

Hypothyroidism can present a wide range of psychiatric

manifestations, including personality disturbance, neurotic traits

and psychotic features.

Failure to recognize the endocrinopathy may not only produce recovery

difficulties but also psychiatric and endocrine repercussions if

psychotrophic medications are given in such masked cases.

Psychotic manifestations of hypothyroidism.

The case of a young woman who was treated one and one half years with

psychopharmacologic agents and psychotherapy until hypothyroidism was

diagnosed. Under administration of thyroid hormone the patient was

free of psychiatric and somatic symptoms within 3 months.

Psychiatric symptoms in endocrine diseases.

Psychiatric symptoms secondary to endocrine disturbance generally

reverse, albeit slowly, with treatment of the primary hormonal

abnormality.

Treatment with pychotrophic agents for symptomatic relief of

psychiatric complaints should be undertaken with great caution in

patients with endocrine disorders.

Psychiatric and cognitive aspects of hypothyroidism.

All symptoms improved with thyroxine treatment, although patients did

not necessarily reach premorbid functioning in 6-12.

In the literature, depression in hypothyroidism is hypothesized to be

at least partly caused by relative hypothyroidism in the central

nervous system, and local brain triiodothyronine deficiency may be a

possible explanation for affective and cognitive symptoms in

subclinical hypothyroidism.

Psychiatric manifestations as the only clinical sign of

hypothyroidism.

The presence of potentially irreversible cognitive deterioration, as

well as the inocuity and sensibility of thyroid hormones examination

justify the systematic thyroid evaluation for all new psychiatric

patients.

A case of `hallucination of solioquy' with hypothyroidism induced

Hashimoto disease.

" Hallucination of soliloquy " , the autoimatic flow of meaningless

words inside the patients's mind. Symptoms disappeared soon after

starting thyroid hormone treatment.

" Symptomless " autoimmune thyroiditis in depression.

While patients with SAT are clinically euthyroid, what might

be " symptomless " for the endocrinologist might be a syndrome

presenting with psychiatric symptoms to the psychiatrist.

Myxedematous madness without myxedema.

A young woman, whose psychiatric history covered 16 years, has been

treated several times as in-patient for psychotic depression, which

was finally cured with thyroid replacement therapy.

Hypothyroidism and depression: a therapeutic challenge.

Depressed patients should be screened for hypothyroidism. In

hypothyroid patients, depression may be more responsive to a

replacement regimen that includes T3 rather than T4 alone.

Psychotic states associated with disorders of thyroid function.

Highlights the need to consider the possibility of thyroid disorder

in all patients presenting with acute psychotic mental disorder.

The diagnostic dilemma of myxedema and madness, axis I and II.

A patient with presumed chronic paranoid schizophrenia had chronic

thyroiditis and Grade I hypothyroidism. Psychosis cleared following

treatment with thyroid replacement.

Thyroid function in clinical subtypes of major depression: an

exploratory study.

There is evidence suggesting the presence of an autoimmune process

affecting the thyroid gland in depressive patients.

Studies on thyroid therapy and thyroid function in depression

patients.

A number of cases of depressed patients have latent hypothyroidism,

possibly due to hypothalamus-pituitary dysfunction.

Experiences of fatigue and depression before and after low-dose 1-

thyroxine supplementation in essentially euthyroid individuals.

Individuals may experience thyroid-related symptoms such as fatigue

and depression before thyroid indices become abnormal.

Thyroid antibodies in depressive disorders.

Hashimoto's/hypothyroidism is a risk factor for depression.

The presence of antithyroid antibodies in patients with affective and

nonaffective psychiatric disorders.

Thyroid disorders may be particularly common in patients with bipolar

affective disorder.

Antithyroid antibodies in depressed patients.

Findings support the hypothesis of subtle thyroid dysfunction in a

sizable sample of psychiatric inpatients with prominent depressive

symptoms.

Brain perfusion abnormalities in patients with euthyroid autoimmune

thyroiditis.

Findings suggest a higher than expected involvement of central

nervous system in thyroid autoimmune disease.

Brain metabolism in hypothyroidism studied with 31P magnetic-

resonance spectroscopy.

First direct evidence of cerebral metabolic effects of hypothyroidism

on an adult brain.

Sub-laboratory hypothyroidism and the empiral use of Armour Thyroid.

In some cases, treatment with desiccated thyroid has produced better

clinical results than levothyroxine.

Psychoneuroendocinology of mood disorders. The hypothalamic-pituitary-

thyroid axis.

Abnormal thyroid functioning can affect mood and influence the course

of unipolar and bipolar disorder.

Regional cerebral blood flow in patients with mild hypothyroidism.

Decreased cerebral blood flow in mild hypothyroidism found in regions

mediating attention, motor speed, memory, and visuospatial processing.

Myxedema psychosis – insanity defense in homicide.

Man commits murder in course of hypothyroid psychosis. Later judged

to be not guilty by reason of insanity.

Another excellent resource is the book, " The Thyroid Axis in

Psychiatric Disorder " by T. Joffe, M.D. and J.

Levitt, M.D. A couple of quotes from this book:

A rich and diverse literature now exists on the relationship between

thyroid function and a variety of psychiatric disorders.

…animal studies also suggest that brain utilization of thyroid

hormones differs from that of peripheral organs. These advances

create exciting possibilities for further studies examining the role

of thyroid hormones in psychiatric illness.

…recurrent exacerbations of chronic or relapsing thyroiditis may lead

to sporadic changes in thyroid hormone availability or cyclicity

without necessarily grossly altering thyroid function tests.

Hashimoto's disease is often occult and, therefore, frequently

remains undiagnosed. It appears that, in some phases, dysregulation

of hormone production may be subtle but associated changes in brain

function may be unexpectedly prominent.

Because the diagnosis of autoimmune thyroid disease is so complex and

sometimes so elusive, its identification as the cause of thyroid-

related disorders of mental function is often delayed or even

overlooked entirely.

Long-standing changes in thyroid function lead to considerable

changes in dynamics of the cerebral circulation and these, rather

than direct effects of the hormone in the brain, may be responsible

for symptoms of brain dysfunction.

It can be speculated that the role of thyroid hormone in the brain

may be different from that in peripheral tissues.

In summary, it is important for those having behavioral and/or

psychiatric symptoms to know that T3 is found in large quantities in

the limbic system of the brain, the area that is important for

emotions such as joy, panic, anger, and fear…and that if you don't

have enough T3, or if its action is blocked, an entire cascade of

neurotransmitter abnormalities may ensue and can lead to mood and

energy changes.

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MYXEDEMA CRAZINESS

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January 10, 2006