Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-05T02:09:53.317Z Has data issue: false hasContentIssue false

Chapter 6 - Disorders of the Thyroid and Parathyroid

Published online by Cambridge University Press:  14 October 2021

Anne M. Doherty
Affiliation:
University College Dublin
Aoife M. Egan
Affiliation:
Division of Endocrinology and Metabolism, Mayo Clinic, Minnesota, USA
Sean Dinneen
Affiliation:
School of Medicine, National University of Ireland, Galway
Get access

Summary

Psychological symptoms commonly occur as a result of both thyroid and parathyroid disorders. Epidemiological studies evaluating the association between thyroid function and mood are heterogeneous in design and report varying results. The larger studies demonstrate no effect or an increase in depression with decreasing thyroid-stimulating hormone concentrations. There is growing evidence supporting the fact that thyroid function in psychiatric patients may be affected by the mental disorder itself, as well as by the medications used to treat that illness. Biochemical assessment of thyroid function and calcium concentrations should form part of the baseline assessment in those who present with new psychological symptoms. Once an abnormality is confirmed, further workup and treatment of the underlying endocrine disorder can be expected to alleviate and even reverse the psychological symptoms.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Pankow, B, Michalak, J, McGee, MK. Adult human thyroid weight. Health Phys. 1985; 49(6): 1097–103.Google Scholar
Kopp, P, Carlos Solis-S, J. Thyroid hormone synthesis. In: Clinical Management of Thyroid Disease (eds. Wondisford, FE, Radowick, S). Elsevier, 2009, pp. 1941.CrossRefGoogle Scholar
Yen, P. Genomic and Nongenomic Actions of Thyroid Hormones. Lippincott Williams & Wilkins, 2005.Google Scholar
Fukao, A, Takamatsu, J, Arishima, T, Tanaka, M, Kawai, T, Okamoto, Y, et al. Graves’ disease and mental disorders. J Clin Transl Endocrinol. 2020; 19: 100207.Google ScholarPubMed
Bauer, M, Heinz, A, Whybrow, PC. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol Psychiatry. 2002; 7(2): 140–56.Google Scholar
Dayan, CM, Panicker, V. Hypothyroidism and depression. Eur Thyroid J. 2013; 2(3): 168–79.Google Scholar
Engum, A, Bjøro, T, Mykletun, A, Dahl, AA. An association between depression, anxiety and thyroid function – a clinical fact or an artefact? Acta Psychiatr Scand. 2002; 106(1): 2734.Google Scholar
Williams, MD, Harris, R, Dayan, CM, Evans, J, Gallacher, J, Ben-Shlomo, Y. Thyroid function and the natural history of depression: findings from the Caerphilly Prospective Study (CaPS) and a meta-analysis. Clin Endocrinol (Oxf). 2009; 70(3): 484–92.Google Scholar
Guimarães, JM, de Souza Lopes, C, Baima, J, Sichieri, R. Depression symptoms and hypothyroidism in a population-based study of middle-aged Brazilian women. J Affect Disord. 2009; 117(1–2): 120–3.Google Scholar
Sharma, A, Stan, MN. Thyrotoxicosis: diagnosis and management. Mayo Clin Proc. 2019; 94(6): 1048–64.CrossRefGoogle ScholarPubMed
Braverman, L, Utiger, R. Werner and Ingbar’s The Thyroid, 6th ed. J.B. Lippincott Company, 1991.Google Scholar
Bunevicius, R, Prange, AJ. Thyroid disease and mental disorders: cause and effect or only comorbidity? Curr Opin Psychiatry. 2010; 23(4): 363–8.Google Scholar
Wu, W, Sun, Z, Yu, J, Meng, Q, Wang, M, Miao, J, Sun, L. A clinical retrospective analysis of factors associated with apathetic hyperthyroidism. Pathobiology. 2010; 77(1): 4651.Google Scholar
McLachlan, S, Pegg, C, Atherton, M, Middleton, S, Clark, F, Rees Smith, B. TSH receptor antibody synthesis by thyroid lymphocytes. Clin Endocrinol (Oxf). 1986; 24(2): 223–30.Google Scholar
Graves, R. Newly observed affection of the thyroid gland in females. Lond Med Surg J. 1835; 7: 516–7.Google Scholar
Ritchie, M, Yeap, BB. Thyroid hormone: influences on mood and cognition in adults. Maturitas. 2015; 81(2): 266–75.Google Scholar
Hu, L-Y, Shen, C-C, Hu, Y-W, Chen, M-H, Tsai, C-F, Chiang, H-L, et al. Hyperthyroidism and risk for bipolar disorders: a nationwide population-based study. PLoS ONE. 2013; 8(8): e73057.Google Scholar
Chattopadhyay, C, Chakrabarti, N, Ghosh, S. An assessment of psychiatric disturbances in Graves disease in a medical college in eastern India. Niger J Clin Pract. 2012; 15(3): 276–9.Google Scholar
Brandt, F, Thvilum, M, Almind, D, Christensen, K, Green, A, Hegedüs, L, Brix, TH. Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study. Eur J Endocrinol. 2014; 170(2): 341–8.Google Scholar
Cooper, DS, Biondi, B. Subclinical thyroid disease. Lancet. 2012; 379(9821): 1142–54.Google Scholar
Asher, R. Myxoedematous madness. Br Med J. 1949; 2(4627): 555–62.Google Scholar
Wu, EL, Chien, IC, Lin, CH, Chou, YJ, Chou, P. Increased risk of hypothyroidism and hyperthyroidism in patients with major depressive disorder: a population-based study. J Psychosom Res. 2013; 74(3): 233–7.Google Scholar
Gulseren, S, Gulseren, L, Hekimsoy, Z, Cetinay, P, Ozen, C, Tokatlioglu, B. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res. 2006; 37(1): 133–9.Google Scholar
Khemka, D, Ali, JA, Koch, CA. Primary hypothyroidism associated with acute mania: case series and literature review. Exp Clin Endocrinol Diabetes. 2011; 119(8): 513–7.Google Scholar
Roberts, LM, Pattison, H, Roalfe, A, Franklyn, J, Wilson, S, Hobbs, FDR, Parle, JV. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med. 2006; 145(8): 573–81.Google Scholar
Chueire, VB, Romaldini, JH, Ward, LS. Subclinical hypothyroidism increases the risk for depression in the elderly. Arch Gerontol Geriatr. 2007; 44(1): 21–8.Google Scholar
Bunevicius, R, Steibliene, V, Prange, AJ. Thyroid axis function after in-patient treatment of acute psychosis with antipsychotics: a naturalistic study. BMC Psychiatry. 2014; 14: 279.Google Scholar
Roca, RP, Blackman, MR, Ackerley, MB, Harman, SM, Gregerman, RI. Thyroid hormone elevations during acute psychiatric illness: relationship to severity and distinction from hyperthyroidism. Endocr Res. 1990; 16(4): 415–47.CrossRefGoogle ScholarPubMed
Steiblienė, V, Mickuvienė, N, Prange, AJ, Bunevičius, R. Concentrations of thyroid axis hormones in psychotic patients on hospital admission: the effects of prior drug use. Medicina (Kaunas). 2012; 48(5): 229–34.Google Scholar
Fliers, E, Bianco, AC, Langouche, L, Boelen, A. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol. 2015; 3(10): 816–25.CrossRefGoogle ScholarPubMed
Lazarus, JH. The effects of lithium therapy on thyroid and thyrotropin-releasing hormone. Thyroid. 1998; 8(10): 909–13.Google Scholar
McKnight, RF, Adida, M, Budge, K, Stockton, S, Goodwin, GM, Geddes, JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012; 379(9817): 721–8.Google Scholar
Sauvage, MF, Marquet, P, Rousseau, A, Raby, C, Buxeraud, J, Lachatre, G. Relationship between psychotropic drugs and thyroid function: a review. Toxicol Appl Pharmacol. 1998; 149(2): 127–35.CrossRefGoogle ScholarPubMed
Nikolova, VL, Pattanaseri, K, Hidalgo-Mazzei, D, Taylor, D, Young, AH. Is lithium monitoring NICE? Lithium monitoring in a UK secondary care setting. J Psychopharmacol. 2018; 32(4): 408–15.Google Scholar
Taylor, DM, Paton, C, Kapur, S. The Maudsley Prescribing Guidelines in Psychiatry, 12th ed. Wiley Blackwell, 2015.Google Scholar
Bou Khalil, R, Richa, S. Thyroid adverse effects of psychotropic drugs: a review. Clin Neuropharmacol. 2011; 34(6): 248–55.Google Scholar
Li, C, Lai, J, Huang, T, Han, Y, Du, Y, Xu, Y, Hu, S. Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study. Neuropsychiatr Dis Treat. 2019; 15: 2285–90.Google Scholar
Caye, A, Pilz, LK, Maia, AL, Hidalgo, MP, Furukawa, TA, Kieling, C. The impact of selective serotonin reuptake inhibitors on the thyroid function among patients with major depressive disorder: a systematic review and meta-analysis. Eur Neuropsychopharmacol. 2020; 33: 139–45.Google Scholar
Spoov, J, Lahdelma, L. Should thyroid augmentation precede lithium augmentation – a pilot study. J Affect Disord. 1998; 49(3): 235–9.Google Scholar
Nierenberg, AA, Fava, M, Trivedi, MH, Wisniewski, SR, Thase, ME, McGrath, PJ, et al. A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry. 2006; 163(9): 1519–30; quiz 1665.Google Scholar
Parmentier, T, Sienaert, P. The use of triiodothyronine (T3) in the treatment of bipolar depression: a review of the literature. J Affect Disord. 2018; 229: 410–4.Google Scholar
National Institute for Health and Care Excellence. Depression in Adults: Recognition and Management (Clinical Guideline 90), 2009. Available from: www.nice.org.uk/guidance/cg90Google Scholar
Walshaw, PD, Gyulai, L, Bauer, M, Bauer, MS, Calimlim, B, Sugar, CA, Whybrow, PC. Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: a double-blind placebo-controlled trial of levothyroxine (L-T4) and triiodothyronine (T3). Bipolar Disord. 2018; 20(7): 594603.Google Scholar
Pilhatsch, M, J Stamm, T, Stahl, P, Lewitzka, U, Berghöfer, A, Sauer, C, et al. Treatment of bipolar depression with supraphysiologic doses of levothyroxine: a randomized, placebo-controlled study of comorbid anxiety symptoms. Int J Bipolar Disord. 2019; 7(1): 21.Google Scholar
Stamm, TJ, Lewitzka, U, Sauer, C, Pilhatsch, M, Smolka, MN, Koeberle, U, et al. Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2014; 75(2): 162–8.CrossRefGoogle ScholarPubMed
Lorentzen, R, Nørgaard Kjaer, J, Dinesen Østergaard, S, Madsen, MM. Thyroid hormone treatment in the management of treatment-resistant unipolar depression: a systematic review and meta-analysis. Acta Psychiatr Scand. 2020; 141(4): 316–26.Google Scholar
Marx, SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med. 2000; 343(25): 1863–75.Google Scholar
Rajagopal, S, Ponnusamy, M. Calcium signalling in neurological disorders. In: Calcium Signaling: From Physiology to Diseases (eds. Rajagopal, S, Ponnusamy, M). Springer, 2017, pp. 4360.Google Scholar
Park, S, Hieber, R. Acute psychosis secondary to suspected hyperparathyroidism: a case report and literature review. Ment Health Clin. 2016; 6(6): 304–7.Google Scholar
Alarcón, RD, Franceschini, JA. Hyperparathyroidism and paranoid psychosis. Case report and review of the literature. Br J Psychiatry. 1984; 145: 477–86.CrossRefGoogle ScholarPubMed
Michels, TC, Kelly, KM. Parathyroid disorders. Am Fam Physician. 2013; 88(4): 249–57.Google Scholar
Petersen, P. Psychiatric disorders in primary hyperparathyroidism. J Clin Endocrinol Metab. 1968; 28(10): 1491–5.Google Scholar
Papa, A, Bononi, F, Sciubba, S, Ursella, S, Gentiloni-Silveri, N. Primary hyperparathyroidism: acute paranoid psychosis. Am J Emerg Med. 2003; 21(3): 250–1.Google Scholar
Babar, G, Alemzadeh, R. A case of acute psychosis in an adolescent male. Case Rep Endocrinol. 2014; 2014: 937631.Google Scholar
Solomon, BL, Schaaf, M, Smallridge, RC. Psychologic symptoms before and after parathyroid surgery. Am J Med. 1994; 96(2): 101–6.Google Scholar
Szeifert, L, Adorjáni, G, Zalai, D, Novák, M. [Mood disorders in patients with chronic kidney disease: significance, etiology and prevalence of depression]. Orv Hetil. 2009; 150(13): 589–96.Google Scholar
Velasco, PJ, Manshadi, M, Breen, K, Lippmann, S. Psychiatric aspects of parathyroid disease. Psychosomatics. 1999; 40(6): 486–90.Google Scholar
Denko, JD, Kaelbling, R. The psychiatric aspects of hypoparathyroidism. Acta Psychiatr Scand Suppl. 1962; 38(164): 170.Google Scholar
Arneiro, AJ, Duarte, BCC, Kulchetscki, RM, Cury, VBS, Lopes, MP, Kliemann, BS, et al. Self-report of psychological symptoms in hypoparathyroidism patients on conventional therapy. Arch Endocrinol Metab. 2018; 62(3): 319–24.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×