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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Jim R on December 13, 2000, at 2:41:39
Hello, all. I have the whole gamut of irregular neurotransmitter symptoms and have for years, mostly at a sub-clinical level and all suggesting a mild bipolar condition of some kind: racing thoughts, occasional stuporous depression, sleep irregularities, anxiety, panic, dislike of bright lights, high creativity, etc. I don't really cycle, per se, but have very unstable moods, like a boat with no keel bobbing up and down through the day. The descriptions of ultra-rapid cycling seem to be the ones that fit me best. I have gotten so tired of all this that I am now trying to get some treatment.
I am now taking gabapentin/neurontin (900mg/d), which seems to have brought the racing thoughts under control, but there is still very little over all stability and depression, anxiety, panic, etc. are all still present. Have been going through trials of celexa and serzone but had too many side effects with each.
I want to investigate thyroid possibilities. I have read that hypOthyrodism is often connected with rapid cycling; but I seem clearly to have some symptoms of hypERthyrodism: including tremor, high startle response, somewhat bulging eyes, and perpetually inflamed eyelids (this is very distinctive; they are highly vascularized and red; have been for years). Once I had my thyroid checked in another context and some assistant said it was "normal" but I don't put much stock in that.
I have read the many associations between hypOthyroid and the mood instability I seem to display. Can anyone tell me if hypERthyroidism can produce similar rapid cycling mood symptoms? (I'm not an M.D., but I am a biologist so will be glad to hear technical answers and references, as well as more general ones.)
Many thanks.
Jim R
Posted by SLS on December 13, 2000, at 20:23:27
In reply to hyperthyrodism and cyclothymia, posted by Jim R on December 13, 2000, at 2:41:39
> Hello, all. I have the whole gamut of irregular neurotransmitter symptoms and have for years, mostly at a sub-clinical level and all suggesting a mild bipolar condition of some kind: racing thoughts, occasional stuporous depression, sleep irregularities, anxiety, panic, dislike of bright lights, high creativity, etc. I don't really cycle, per se, but have very unstable moods, like a boat with no keel bobbing up and down through the day. The descriptions of ultra-rapid cycling seem to be the ones that fit me best. I have gotten so tired of all this that I am now trying to get some treatment.
>
> I am now taking gabapentin/neurontin (900mg/d), which seems to have brought the racing thoughts under control, but there is still very little over all stability and depression, anxiety, panic, etc. are all still present. Have been going through trials of celexa and serzone but had too many side effects with each.
>
> I want to investigate thyroid possibilities. I have read that hypOthyrodism is often connected with rapid cycling; but I seem clearly to have some symptoms of hypERthyrodism: including tremor, high startle response, somewhat bulging eyes, and perpetually inflamed eyelids (this is very distinctive; they are highly vascularized and red; have been for years). Once I had my thyroid checked in another context and some assistant said it was "normal" but I don't put much stock in that.
>
> I have read the many associations between hypOthyroid and the mood instability I seem to display. Can anyone tell me if hypERthyroidism can produce similar rapid cycling mood symptoms? (I'm not an M.D., but I am a biologist so will be glad to hear technical answers and references, as well as more general ones.)
>
> Many thanks.
>
> Jim R
I have no technical input regarding an association between thyroid state and cyclothymia. My gut tells me that hypERthyroidism is more likely to be responsible for rapid-cyclicity and hypOthyroidism for a stable atypical-type depression. I think it would be a good idea to pursue the thyroid issue further. I feel that it takes a good endocrinologist to accurately administer testing and evaluate the results. It is more complicated than simply assaying absolute levels of T3, T4, and TSH, and comparing them to the prescribed "normal" ranges. Noa, a frequent poster here, has focused quite a bit of her research into the contributions of thyroid function to mood-illness. You might find some useful information in her Psycho-Babble tips section:http://www.egroups.com/links/psycho-babble-tips//Noa_s_thyroid_links_000963272558/
I would offer that you might look into adding Lamictal (lamotrigine), another anticonvulsant mood-stabilizer, to Neurontin. The NIMH has been reporting success with this combination as they seem to act synergistically. Currently, I believe Lamictal is generally considered to be more effective against rapid-cyclicity. It certainly possesses antidepressant properties on its own, seemingly independent of its mood-stabilizing properties. The two drugs are very compatible.Also, 900mg is far from the upper limit of Neurontin dosage. I should think that the effective range usually lies between 1200mg and 1800mg.
Good luck.
- Scott
Posted by SLS on December 13, 2000, at 21:22:00
In reply to Re: hyperthyrodism and cyclothymia, posted by SLS on December 13, 2000, at 20:23:27
Here are a couple of relevant abstracts I came across:
----------------------------------------------------
10: Psychiatry Res 1997 Aug 29;72(1):1-7Rapid cycling bipolar affective disorder: lack of relation to hypothyroidism.
Post RM, Kramlinger KG, Joffe RT, Roy-Byrne PP, Rosoff A, Frye MA, Huggins T
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892, USA.
Thyroid indices were measured after an extended period of medication-free evaluation averaging 6 weeks in 67 consecutively admitted patients with bipolar illness. Thyroid hormone levels -- thyroxine (T4), free T4 and triiodothyronine (T3) -- were not significantly different in the 31 rapid cyclers ( > or = 4 affective episodes/year) than in 36 non-rapid cyclers. Analysis of covariance indicated a non-significant trend relation between higher T4 and a greater number of affective episodes in the year prior to admission and male gender when age was covaried. Several previous reports, primarily in medicated subjects, have suggested a link between rapid cycling patients and decreased peripheral thyroid indices (low hormone levels and elevated TSH), but now the majority of studies do not support such a relation. Among those in the literature, this study includes patients studied for the longest time off medications and further suggests that the commonly-cited relation between subclinical hypothyroidism and rapid cycling bipolar illness be reevaluated.
Publication Types:
Review
Review, tutorialPMID: 9355813, UI: 98015890
--------------------------------------------------
2: Eur Psychiatry 1999 Oct;14(6):341-5Evaluation of thyroid function in lithium-naive bipolar patients.
Valle J, Ayuso-Gutierrez JL, Abril A, Ayuso-Mateos JL
Department of Psychiatry, Hospital de la Princesa, Madrid, Spain.
A high prevalence of thyroid hypofunction has been found in bipolar patients. However, the samples used in previous studies included a high percentage of patients in treatment with lithium and carbamazepine. Since the use of these drugs may explain the high prevalence of thyroid disturbances found in bipolar patients, we designed the present study to assess thyroid function in a sample of bipolar patients who had not been treated previously with lithium or carbamazepine. Patients included in the sample met Research Diagnostic Criteria for bipolar affective disorder. Assessment included determination of serum levels for total tyroxine (T4), total triiodothyronine (T3), and thyrotropin both basally and in response to infusion of 500 mg of Protilerin. The rate of thyroid hypofunction in the total sample (9.2%) was considerably lower than that reported in other studies with bipolar patients undergoing lithium therapy. Five patients (9.2%) showed some thyroid hyperfunction parameter. Our results do not show significant differences in thyroid function indices between long-term and short-term duration of illness, between outpatients and inpatients, between high and low number of episodes, and between rapid- and non-rapid-cycling cases. Comparison between bipolar I and bipolar II patients shows a statistically significant difference in the values of TSH levels, with the bipolar II group having a higher mean value. Our data suggest that thyroid dysfunction is not related to gender, duration of illness, number of episodes, or rapid-cycling course of illness. The higher TRH-stimulated TSH levels in the bipolar II group could be considered a differential biological feature.
PMID: 10572366, UI: 20048774
Posted by Lycaste on January 3, 2001, at 14:06:52
In reply to hyperthyrodism and cyclothymia, posted by Jim R on December 13, 2000, at 2:41:39
Hi Jim,
I don't know if you are still around, but if you are and haven't yet had your thyroid checked, I'd like to encourage you to do so. I actually wrote you a reply soon after your original post, but apparently had the bad luck to try to post my reply just after the Psychobabble server went down.
Anyway, yes--hyperthyroidism can cause cyclothymia. I know: been there, done that. If you want less anecdotal confirmation, I can cite Dr. Arem, an endrocrinologist who specializes in thyroid disease. In his discussion of hyPOthyroidism and cyclothymia in his book, "The Thyroid Solution", he adds "an overactive thyroid could also make the swings in mood more apparent and more severe." And a recurring theme in his discussions of the mental effects of hyperthyroidism is that of mood and emotional instability. The reason you've read more about cyclothymia and hyPOthyroidism probably has more do with the greater frequency of hypothyroidism in the general population, not that it is any more likely to cause cyclothymia than hyperthyroidism.
And as far as anxiety/panic attacks go--well, they are a specialty of hyperthyroidism. The only time in my life where I experienced full-out panic attacks was when I was hyperthyroid.
As you are aware, your eye inflammation points to hyperthyroidism as well. The same antibodies that attack the thyroid apparently attack eye tissue as well. And in many cases, the eye symptoms show up before any thyroid symptoms. (I should say any "obvious" thyroid symptoms. I personally believe thyroid imbalances usually affect mood/mental processes long before the clear-cut physical symptoms occur.)
It is also quite possible to be hyperthyroid and not have the condition show up on tests--if the wrong tests are done or interpreted incorrectly. For example, I have had clear symptoms of mild hyperthyroidism over the last several months, but my T4 levels are within normal range. It is only when you look at my TSH (thyroid stimulating hormone), do you see a confirmation of my clinical symptoms: it is almost to zero, trying to get my thyroid to slow down. Had a doctor merely tested my T4 levels (and a lot still do), I would have been told that I was "normal."
Finally, as added incentive to get this checked out as soon as possible, let me point out that not all the effects of being hyperthyroid are guaranteed to be reversible. If you are hyperthyroid, you are probably losing muscle mass, bone, and increasing the overall oxidative stress of your body--in short, you are in effect accelerating the aging process. Now, much of this can be reversed, but obviously the longer you go untreated, the bigger the hole you gotta crawl out of. And in addition, your thyroid is being destroyed in process. Although sometimes the only cure for hyperthyroidism is to destroy some or part of the thyroid, it is also possible to treat hyperthyroidism nondestructively and allow people to maintain their thyroid function afterwards. But the longer you wait to get treated, the more likely you'll be dealing with a damaged thyroid and hypothyroidism in the future.
Hope this helps.Lycaste
> Hello, all. I have the whole gamut of irregular neurotransmitter symptoms and have for years, mostly at a sub-clinical level and all suggesting a mild bipolar condition of some kind: racing thoughts, occasional stuporous depression, sleep irregularities, anxiety, panic, dislike of bright lights, high creativity, etc. I don't really cycle, per se, but have very unstable moods, like a boat with no keel bobbing up and down through the day. The descriptions of ultra-rapid cycling seem to be the ones that fit me best. I have gotten so tired of all this that I am now trying to get some treatment.
>
> I am now taking gabapentin/neurontin (900mg/d), which seems to have brought the racing thoughts under control, but there is still very little over all stability and depression, anxiety, panic, etc. are all still present. Have been going through trials of celexa and serzone but had too many side effects with each.
>
> I want to investigate thyroid possibilities. I have read that hypOthyrodism is often connected with rapid cycling; but I seem clearly to have some symptoms of hypERthyrodism: including tremor, high startle response, somewhat bulging eyes, and perpetually inflamed eyelids (this is very distinctive; they are highly vascularized and red; have been for years). Once I had my thyroid checked in another context and some assistant said it was "normal" but I don't put much stock in that.
>
> I have read the many associations between hypOthyroid and the mood instability I seem to display. Can anyone tell me if hypERthyroidism can produce similar rapid cycling mood symptoms? (I'm not an M.D., but I am a biologist so will be glad to hear technical answers and references, as well as more general ones.)
>
> Many thanks.
>
> Jim R
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