Thyroid for Dummies (7 page)

ᮣ Understanding the psychology of an overactive thyroid

ᮣ Finding thyroid problems in depressed people

ᮣ Using thyroid medication to treat depression

The term
myxoedema madness
is rarely used nowadays, but the expression was popular when first introduced in 1949, and for many years after. Despite its name, myxoedema is not a disease of rabbits (that’s myxomatosis) but is an old-fashioned name referring to an underactive thyroid gland or
hypothyroidism
. Myxoedema madness is a form of dementia or psychosis – often with striking delusions – that occurs in some older people with hypothyroidism.

Strangely, myxoedema is often triggered shortly after starting thyroid hormone replacement treatment. Sadly, the term myxoedema madness brings with it the suggestion that all people with low thyroid function are somehow mad.

Thankfully, that’s not the case, and I correct this misconception in this chapter.

As Chapter 3 explains more fully, there’s no question that the abnormal production of thyroid hormones can cause changes in someone’s mood, and that these changes are sometimes severe. But rarely do you find that someone’s mood changes prove so bad they need to go into hospital. Once their over- or underactive thyroid gland is diagnosed and treated, most people suffering from mood problems related to thyroid function respond very well and go on to live perfectly normal lives – both psychologically and physically.

Interestingly, however, some people without thyroid problems also benefit from treating their depression with thyroid hormones.

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Part I: Understanding the Thyroid

This chapter looks at the current level of understanding about how changes in the production of thyroid hormones (both over- and underproduction) can affect your personality. You discover how often personality or mood disorders are associated with thyroid abnormalities and why thyroid hormones play a role in the treatment of depression, even when no thyroid problem exists.

Because the emphasis in this chapter is on the psychology of thyroid abnormalities, the physical signs and symptoms are not covered; those discussions occur later in the book, primarily in Chapters 5 and 6.

Exploring How an Underactive

Thyroid Slows Your Thoughts

Sarah is a 44-year-old woman who is not quite acting as normal, and has not seemed like herself for several months. Her husband, Milton, notices that she is much less talkative than before. She often forgets to pick up the food that they need at the supermarket or to stop at the dry cleaner’s to collect clothes that she’s dropped off.

Milton wants to discuss a holiday with Sarah, but she doesn’t seem to care.

Sarah is usually the one responsible for making plans with their friends, but she has not made any for months. Everything she does seems to take more time than it used to, like preparing dinner or getting ready to go to bed. When she finally gets in bed, she is not particularly interested in having sex anymore.

The worst thing is that Sarah, usually a happy person, seems sad a lot of the time.

Worried about all these changes, Milton encourages Sarah to see her general practitioner (GP), who examines her and sends her blood for some laboratory tests. On a return visit a few days later, the doctor tells them that Sarah has hypothyroidism. That is, her thyroid gland is not making enough thyroid hormone. He gives her a prescription for replacement thyroid hormone, and about a month later Sarah is well on her way to becoming her old self. Milton is happy because he’s once again living with the Sarah he used to know.

Sarah is an excellent example of the changes in personality that can occur when the body is not producing enough thyroid hormone. Depending upon the level of the deficiency, the changes can range from mild to severe and include:

ߜ Decreased talking

ߜ Memory loss

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ߜ General loss of interest

ߜ Withdrawal from society

ߜ General slowing of movement

ߜ Depression, generally mild but sometimes severe

ߜ Loss of interest in sex

ߜ An unusually dark sense of humour, in severe cases

Experiencing any of these mental changes on their own does not mean that you definitely have low thyroid function, but they certainly can suggest that you need a test to find out for sure.

If a lack of thyroid hormone is the cause of these symptoms, then taking the right dose of hormone replacement can reverse them. However, if the symptoms don’t improve, then you and your doctor need to look elsewhere for the cause. (See Chapter 5 for a thorough discussion of hypothyroidism.) Seeing How an Overactive Thyroid

Can Trigger Anxiety

Sarah’s sister, Margaret, who is five years younger, began showing some big personality changes a few years ago. Previously a fairly even-tempered person, she is now easily excited and loses her temper after fairly mild provocation. Her small children never know when their mother is going to yell at them next. She sometimes bursts out in tears but, if asked, cannot give a reason why.

At other times, Margaret is extremely happy, but she can’t explain the reason for that either. When she tries to do a task, she often loses interest rapidly and gets distracted. She cannot sit still for very long and is always moving around and fidgeting. Her memory of recent events is poor.

After a few months of absolute chaos in their home, Margaret and her husband, Fred, go to see their GP about her condition. During an examination, the doctor discovers a number of physical findings, including:

ߜ A rapid pulse

ߜ A large thyroid gland

ߜ A fine tremor in Margaret’s fingers

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Part I: Understanding the Thyroid

The doctor confirms his findings with lab tests (see Chapter 4). Two days later, the doctor tells the concerned pair that Margaret is suffering from
hyperthyroidism
– her body is producing too much thyroid hormone. He refers her to a specialist who begins treatment with medication, and in three weeks, a definite improvement occurs. After six weeks, Margaret is just about back to normal, so she and Fred take the kids to the circus to make up for all the yelling.

Margaret is an excellent example of the psychological changes that can occur when the body produces excessive levels of thyroid hormone. Some of these changes are:

ߜ Increased excitability

ߜ An emotional roller coaster of moods

ߜ Outbursts of anger for no reason

ߜ Crying spells

ߜ A tendency to get easily distracted

ߜ A very short attention span

Years ago, doctors often saw severe, long-standing cases of hyperthyroidism –

patients with huge thyroid glands who were visibly shaky and nervous, unable to sit still for more than a few moments. Such acute cases rarely happen nowadays, as increased awareness means that people consult their doctor much sooner, and their condition is usually diagnosed earlier. In isolated cases, however, severe, prolonged hyperthyroidism may result in hallucinations, both in vision and hearing.

Importantly, you need to be aware that when hyperthyroidism affects older people (for example someone in their 80s), the condition may actually look more like hypothyroidism. An older person with hyperthyroidism may feel sad and depressed, apathetic, and withdrawn from society, and the diagnosis is often missed at first. Chapter 20 looks more closely at how thyroid problems can affect people in later life.

The treatments for hyperthyroidism (check out Chapter 6 for more information) are very effective in reversing all the mental and physical symptoms of the condition – particularly in younger people, who are the ones most likely to get the disease.

Fighting Depression

Depression is a common symptom of a lack of thyroid hormone. And con-versely, thyroid hormone may help in the treatment of depression, even 06_031727 ch02.qxp 9/6/06 10:47 PM Page 21

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Seeing a thyroid specialist

The management of an underactive thyroid gland

the first place) your GP may decide to prescribe

is usually straightforward and, in the United

a treatment to help stabilise your symptoms until

Kingdom, all GPs are trained to treat this condi-

specialist advice is available.

tion. Your doctor may refer you to a specialist for

If you’re not happy with the management of

advice on how to manage your condition if:

your thyroid condition, you have the right to

ߜ Your blood tests suggest that you have an request a referral to another doctor for a underlying disease of the pituitary gland

second opinion. However, try to:

that is failing to kick-start your thyroid

ߜ
Work with your doctor.
When you consult a

ߜ You are pregnant or have recently had a

doctor, regard him as the expert – your

baby

trusted advisor. Unless something feels

ߜ

wrong about the advice you’re getting,

You have a complex medical history

follow it to the letter. Get behind your

ߜ You are under the age of 16 years

treatment and do all you can to make it

successful – only then can you get the best

However, the management of an overactive thy-

possible results.

roid gland is more complex, and guidelines sug-

gest that once your GP diagnoses an overactive

ߜ
Research your condition
. The more you

thyroid gland, they refer you to an endocrinolo-

know about your thyroid problem, the easier

gist (physician who specialises in treating hor-

you find talking to your doctor about it. After

mone problems) for expert care. If you have no

all, that’s why you’re reading this book.

obvious clinical features (perhaps the diagnosis

ߜ
Join the British Thyroid Foundation (www.

was made during a routine medical check-up)

btf-thyroid.org)
. The Web site has a

you don’t need any treatment while on the wait-

members’ area so that you can see if you

ing list. However, if you have clinical features of

have a specialist in your region who can

an overactive thyroid gland (which is generally

offer help. You can also write to them using

why people with the condition see their doctor in

the contact details in Appendix B.

when tests indicate that the person has enough thyroid hormone. The following sections explain the role that thyroid hormone plays in depression.

Finding out if your thyroid

is causing depression

Depression is a prominent symptom of thyroid disease, especially hypothyroidism. Therefore, when someone is diagnosed with depression, determining whether thyroid disease is the cause can be important.

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Part I: Understanding the Thyroid

Although studies show that the majority of depressed people do not have hypothyroidism, the condition is found in a mild form in as many as 20

per cent of depressed people, more often in women than in men. If hypothyroidism is diagnosed, a doctor first determines whether or not the person is already taking an antidepressant drug that could actually cause hypothyroidism as a side effect (see Chapter 10). Two such drugs are lithium and carbamazepine.

If taking an antidepressant is responsible for the hypothyroidism, two options are available. The patient can stop taking the drug, in which case its contribu-tion to the depression disappears, but the patient may still remain depressed for other reasons (mainly the reasons for which they originally needed the antidepressant now causing the antithyroid side effect). Alternatively, the patient can stay on the drug and receive treatment with thyroid hormone if the doctor feels the drug is helping the depression a great deal and no suitable substitute exists.

If you are receiving treatment for depression and have not been tested for thyroid function, ask your doctor whether you need a thyroid check-up.

Using thyroid hormone to

treat depression

Many doctors believe that replacement thyroid hormone has a role in the treatment of depression, even when someone is
euthyroid
, which is the posh way of saying that their thyroid function is normal.

Given on its own, thyroid hormone does not seem to reverse depression in someone who doesn’t have a thyroid disease. However, when the thyroid hormone triiodothyronine (see Chapter 3) is given together with an antidepressant drug, the effectiveness of the treatment is often improved. This method is especially true when a person is taking a class of drugs called tricyclic antidepressants. The thyroid hormone is particularly effective in turning people who do not respond to the tricyclic antidepressant, into responders. Thyroid hormone treatment also increases the effectiveness of those drugs when they do work.

Interestingly, in cases where the thyroid hormone is used to help treat depression in patients who do not have thyroid disease, when the treatment is stopped after a few weeks or months, the positive effect persists.

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TSH, autoantibodies, and depression

Thyroid abnormalities are often associated with

substances and depression. People may some-

other chemical changes in the blood besides

times have high autoantibodies while their thy-

too much or too little thyroid hormone. A person

roid function is normal, in which case they don’t

with hypothyroidism, for example, may have too

experience thyroid-related depression. The level