Subclinical hypothyroidism in recurrent mania

Abstract

Treatment of cyclic mood disorders wim thyroid extracts has been reported by Gjcssing (1938). The relationship between recurrent psychotic depression and hypothyroidism was first reported by Libow and Durell (1965b). In a longitudinal study of manic-depressive psychosis, elevated thyroid-stimulating hormone (TSH) values were observed in early phases of hypomania or depression (Dewhurst et al 1969). The resulting hypothesis of increased TSH levels in (otherwise eethyroid) bipolar patients with a rapid-cycling course of illness or affective relapse was supported by further studies (Wehr and Goodwin 1979; O'Shannick and EIlinwood 1982; Cowdry et ai 1983; Roy-Byrne et al 1984; Tollefson et al 1985), and several other investigations showed that thyroid hormones augment the efficacy of tricyclic antidepressants (Prange et el 1969; Goodwin et al 1982). After the successful treatment of rapid-cycling women with daily 500 ~g of levothyroxine (Stancer and Persad 1982), thyroid hormones were suggested to be helpful if antidepressants, lithium, carbamazepine, or neuroleptics failed (Extein et al 1982; Leibow 1983; Joffe et ai 1984; Bauer and Wbybrow 1986). This article tries to prospectively correlate variables of thyroid activity with clinical ratings in a manic-depressive patient over a period of more than 2 years.