Sunday, January 9, 2011

Brain Health: Thyroid Hormones

There is good reason the book, It's not mental, talks so much about thyroid hormones, dedicating an appendix to that topic. Not only were those hormone levels intertwined with both my daughters’ cases of ultradian cycling “bipolar” and “schizoaffective” (schizophrenia with a mood disorder), but the topic has been in psychiatric textbooks, and involved in the research on these brain symptoms, for going on half a century.

Many doctors only measure TSH – Thyroid stimulating hormone - from the pituitary. If the level lies within a broad range of statistical “normalcy” for the population, they say “the thyroid is fine” without ever measuring the levels of actual thyroid hormone (from the thyroid gland). Not only can this be misleading, even when measuring actual thyroid hormone levels, what is optimal for one person may be in the upper range of “normal,” whereas another may do well with levels in the bottom range. For some, bottom range of “normal” may still lead to pathology – symptoms – due to additional factors such as genetics, antibodies, ability to convert one form of thyroid hormone (T4) to the form cells require (T3), levels of nutrients and other hormones, and ability to transport the hormone across the blood-brain barrier.

So much has been written about this topic that I will not reference an article here for each statement above (see my book for references). Instead I will send you to some major informational sources (see BELOW) about hypothyroidism (low thyroid hormone levels) and hyperthyroidism (high thyroid levels) in relation to the brain (i.e. “mental” illness).

Here is Hypothyroidism: Is It Contributing to Your Child's Symptoms?  from a CABF (Child and Adolescent Bipolar Foundation) newsletter quoting the medical doctor who contributed information on the topic in “It's not mental.” Or for those who are more scientific-minded, go straight to these wonderful articles referenced from Current Psychiatry Online (login required), but hopefully you can go straight to these cached versions:
Identifying hypothyroidism’s psychiatric presentations
Identifying hyperthyroidism’s psychiatric presentations

In a nutshell for hypothyroidism (low thyroid level):

➢ Patients diagnosed with mental illnesses, especially those with a mood component, are more likely to have the biochemical involvement of a thyroid hormone imbalance than the general population.

➢ Patients with thyroid disturbance and psychiatric symptoms are most often diagnosed with one of the following:
  • atypical depression (which may present as dysthymia)
  • bipolar spectrum syndrome (including manic-depression, mixed mania, bipolar depression, rapid-cycling bipolar disorder, cyclothymia, and premenstrual syndromes)
  • borderline personality disorder
  • psychotic disorder (typically, paranoid psychosis)
➢ Psychiatric symptoms of hypothyroidism can include:
  • psychosis
  • depression
  • mood instability
  • mania 
  • anxiety
  • hypersomnia
  • apathy
  • lack of energy
  • impaired memory
  • psychomotor slowing
  • attentional problems
➢ Timing of blood draws for testing matters and should include so much more than TSH, such as
  • free triiodothyronine (T3)
  • free levothyroxine (T4)
  • total T3
  • total T4
  • antithyroid antibodies
  • serum cholesterol
  • prolactin
  • and even nutrients such as omega-3 fatty acids and Vitamin D.

(A list of tests for possible problems with thyroid functioning or hormone utilization suggested by Dr. Thomas Geracioti is included in the book and a longer list of possible tests are included in an appendix.)

Interestingly, when a regular family GP finally switched my older daughter’s prescription T4 thyroid hormone to a prescription natural dessicated  type, and increased her thyroid hormone levels to the upper range (they had been on the bottom-most number), we got the first glimmer of real hope for her in over a decade.

Although we had a psychiatric textbook writer inform us this technique (increasing thyroid hormone level) has been in psychiatric textbooks for decades, and even though she had symptoms of low thyroid such as the dry cracking skin, mood problems and more, her psychiatrist’s response, was “But, I don’t understand! Why increase it when it was normal?”

Fine. He is not an endocrinologist, but the endocrinologists don’t seem to be informed about psychiatric care (see Psychiatrist vs Endocrinologist: Who is Responsible?)

Note that my older daughter had hypothyroidism before this, and was already on hormone, but the endocrinologist had brought her level up to the rock-bottom number of “normal” and rather than re-test and readjust, even though she still had symptoms – had just left it there, feeling her job was done.

Dr. John Lowe explains that thyroid hormone resistance began being investigated in the 1950s, yet many endocrinologists still have never heard of it, or believe it’s a rare condition.
“The difference between hypothyroidism where there is a deficiency of thyroid hormone, and thyroid hormone resistance, is that the same amount of thyroid hormone—within the laboratories’ reference range—that would maintain normal metabolism in cells don’t do so adequately.
Those people [with thyroid hormone resistance] need a much higher dosage of hormones—a dosage that would cause most endocrinologists to scream, “You’re going to die of heart attack if you don’t get off that,”

Now that my older daughter is doing so well (see Bipolar and Off Her Meds), the psychiatrist asked her for articles on these medical treatments that have worked to stabilize her when he never could. After all, there are so many more like her with intractable ultra-ultra-rapid cycling bipolar (ultradian cycling bipolar). Well, I have just shared some of the articles with everyone. But this information is supposed to be right in the psychiatric textbooks – unless it has been removed in the newer textbooks, so influenced by a massive pharmaceutical industry which is making billions of dollars on people using psychiatric medications for life.

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27 February 2011

1 comment:

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