A Case of Recurrent Mania with Recurrent Hyperthyroidism

Abstract

The demonstration that an endocrine disorder can precipitate a specific mental illness would be an important step towards the development of much needed animal models of affective disorder. To this end we have sought and found evidence for a causal connection between Cushings syndrome and the apprearance of a depressive illness (Kelly et al, 1980 and 1983). Whether or not hyperthyroidism can cause a manic depressive illness is at present uncertain. Reported values for the incidence of depression in hyperthyroidism vary from 1–20 per cent (Bursten, 1961; Clower et al, 1969; Dunlap and Moersch, 1935; Johnson, 1928; Katzenelbogen and Luton, 1935; Kleinschmidt et al, 1956; Lidz and Whitehorn, 1949) and these are similar to estimates of the incidence of depression in a general population (Watts et al, 1964; Shepherd et al, 1966; Crombie, 1974; Brown and Harris, 1978). Similarly estimates of the incidence of hyperthyroidism in depressed patients are around 1 per cent (Bursten, 1961; Bluestone, 1957; Martin, 1963) which is also similar to the incidence of hyperthyroidism in the general population (Tunbridge et al, 1975). Finally in a population of patients with recurrent manic depressive illness, the eight observed episodes of hyperthyroidism striking during normal health were not apparently followed by any mental disturbance (Checkley, 1978). We now report upon a patient in whom two episodes of mania coincided with two episodes of hyperthyroidism and discuss the possibility that the two illnesses were related to each other.

Are Low Basal Serum Levels of the Thyroid Stimulating Hormone (b-TSH) a Risk Factor for Switches into States of Expansive Syndromes (Known in Germany as „Maniform Syndromes” in Bipolar I Depression?

“…Factors which may have influenced the b-TSH at the time of admission or the occurrence of switches to mania were not statistically different between either b-TSH group in patients with switches to mania (see Table 2). These findings are in line with case reports showing an association between hyperthyroidism and mania (e. g. Corn et al,1983;Lee et al, 1991) and with the finding that a high dosage of thyroid hormones can be effective in treatment of depression.…”

“…Hypothyroidism has been shown to be associated with refractory depression (Joffe and Levitt, 1992;Howland, 1993), to be more prevalent in chronic than in acute depression, and also to be related to a rapid cycling course and poor treatment response in patients with bipolar disorder (Bauer et al, 1990;Howland, 1995, Lossen, 1986, Oomen et al, 1996. On the other hand, other reports indicate that hyperthyroidism may be related to the occurrence of manic episodes (Corn et al, 1983;Lee et al, 1991;Joyce, 1991;Walter-Ryan et al, 1986). While there are no reports in the literature about a clear relationship between the type of thyroid dysfunction and the type of affective episode, clinical experience suggests that thyroid hyperfunction is more often associated with mania than with depression.…”

Organic Causes of Mania

“…Other neurologic syndromes that may produce mania include posttraumatic encephalopathy, 6,29 multiple sclerosis, 23,30 syphilitic, 31 viral, 32 " 34 and cryptococcal 35 central nervous sys tem infections, Pick's disease, 36 Kleine-Levin syn drome, 37 and Klinefelter's syndrome. 38 Mania has been reported in patients with hyperthyroidism 39,40 and has been induced by starvation in a hypothyroid patient. 41 In another case, a severely manic patient with bipolar dis order was refractory to lithium treatment until her primary hypothyroidism was diagnosed and corrected.…”