About 10 years ago, when my body “crashed,” I suffered from severe fatigue, sleep deprivation, and depression, I didn’t realize I was suffering from a sleep disorder and sleep deprivation, but I knew that my fatigue was more than just depression.
The doctor I saw for the fatigue sent me to an endocrinologist. They tested my blood and urine for the “normal” range of various disorders and diseases, including TSH (thyroid stimulating hormone). Everything – except an urine cortisol test that came out abnormal the first time – was normal (I suspect now that cortisol is also involved since I feel like I get a shot of cortisol which is like adrenaline at night).
In 99% of cases, doctors only test the THS level because low or high levels can indicate either hypothyroidism (not enough thyroid, as “hypo” means “low”) or hyperthyroidism (too much, “hyper” meaning “high” like hyperactive). Unfortunately, in many cases, thyroid disease cannot be determined by testing just THS alone.
When I was trying to figure out what was wrong with me – why I had such severe fatigue – I ran across a website that discussed all the problems with how doctors don’t properly test for thyroid disease.
The website encouraged patients to demand that their doctors test for other thyroid related levels such as T3, T4, reverse T3 and T4, and thyroid antibodies. Without getting into the complexities of those tests, just understand that there are two different kinds of thyroid hormones labeled T3 and T4.
The other valuable thing I learned in my thyroid research was that the medical industry has changed what they consider the “normal range” of THS six times in the past 25 years!
Simply put, they don’t know exactly what “normal” is when it comes to hypothyroidism. What used to be considered the normal range for it has decreased over the years as researchers realize that their idea of Normal has been too restrictive.
Since low thyroid or hyperthyroidism is now diagnosed within a broader range than in subsequent years, the number of people with hypothyroidism keeps expanding. This means that someone who is diagnosed with low thyroid today would not have been diagnosed several years ago or previously. Another reason to get your thyroid tested every year (and also because it can easily change).
But what’s more important, is that this suggests that people whose range of THS is still in the “normal” area still may still suffer from symptoms of low thyroid and thyroid disease.
It turns out that I am one of these people.
I didn’t ask my doctors until several years later to test for more than just THS, but I saw a homeopathic doctor in between my crash and when I suspected a thyroid-BPAD connection.
Since I showed symptoms of hypothyroidism, she put me on a low-dose of T4. It definitely helped my fatigue. It didn’t completely relieve all of my symptoms of depression and fatigue, but it was definitely a huge improvement. I had a lot more energy and my depression was not as severe. I felt hopeful the first time in three years.
Unfortunately, due to this doctor later adding T3 – which should never be done – I ended up suffering from hyperthyroidism or too much thyroid in my body and serious consequences (I dropped 30 pounds, could barely walk due to lack of muscle on my bones, and nearly had a heart attack). This is my doctors are very careful about adding or raising thyroid to treatment. They have a good reason!
Though a very frightening time, the T4 demonstrated that it could help treat some of my symptoms.
Due to the hyperthyroidism, my ER-referred cardiologist took me off the T4/T3 ASAP. Going off the thyroid, my severe fatigue and depression returned. I was also suspecting I had bipolar disorder due to my mood and energy swings.
One evening, I decided to look up both symptoms on Google Scholar, and, to my surprise, I found a medical journal article that supported Thyroid helping some patients with bipolar disorder, especially rapid cyclers.
I told the physician assistants I saw under Medi-Cal about this correlation, and how I suspected that I had bipolar disorder, and could I go on Thyroid again, but they were not convinced. Even the counselor I saw at the time kept telling me that I wasn’t bipolar because I wanted to sleep unlike most hypomanic patients who have too much energy to sleep and would much rather stay up late and be active. Argh.
What was interesting is that, when I demand it they test my T3 and T4, my T3 came out as lower than normal. They stamped “Abnormal” on the results. I know this because I asked for a copy of them. Even though my T3 was lower than normal, the providers did nothing. Why? Because the medical industry has no idea what low T3 means – except “illness.” I learned that from another journal article. I suspect it means subclinical hypothyroidism. As I understand it, it means the thyroid is not producing enough T3. Logic would have it that that means lowered thyroid levels and thus hyperthyroidism, don’t you think? Apparently, many providers don’t…! (Think)
Here’s another article that explains it more thoroughly than I do at offers even more helpful information on Thyroid: https://trmorrisnd.com/2017/08/17/functional-approach-to-thyroid-health/
Thyroid instead of an Anti-depressant
Recently, I went on thyroid again. It made me hypomanic. To me, this was more validation that there is a Thyroid-bipolar connection. I realized that I needed to lower my Prozac but it took a few times to finally realize I needed to go off the Prozac altogether. Still on a low dose of thyroid, I had heart palpitations – a common side effect of too much thyroid; but, since I hadn’t experienced palpitations the last time I was on thyroid, I realized I needed to try going off the anti-depressant completely.
That’s where I am now. I took two weeks to do the medication change, staying at my parents’ house so my mom could essentially take care of me and having company helped distract my depression. medication changes, especially going off and antidepressant, are very difficult but I got through it.
I’m happy to say that the Thyroid is working as well as the anti-depressant – actually even better because I’m not as mixed hypomanic as the Prozac made me (though I was for a duration probably as the Prozac was still living in my body).
Unfortunately, I am still a bit mixed hypomanic, but this time, there’s less agitated depression at night; and I have energy that’s allowing me to get things accomplished during the day, rather than my usual low motivation.
But the hypomania is still a problem. I’m hoping that as the Thyroid settles and my body adjusts, so will the hypomania settle down. Although I am getting things done, the problem is I can’t stop. I keep moving, doing things nonstop for several hours during the day and skip eating because I keep thinking I’ll eat after I finish something and then get distracted and start another project; and this happens over and over again. I’m waiting for the crash and feeling sick or getting it all. I’m getting close.
It’s horrible because I know I’m doing it and I know I’m bad, but I can’t stop! I recognize that it’s a problem. I have a problem because I’m not eating and wearing myself out.
I recognize that this has been a pattern in my life, but usually these times would only last a few days, during my period. It’s now been several days, and I’m still waiting for it to stop.
But I digress because this blog is really about the connection between Thyroid and bipolar disorder.
Doing some more research, I happened to run across this article below. I’ve summarized part of the Conclusion for you.
The key takeaway here are the two words “suboptimal thyroid.” What this means is that, even if your THS is showing as normal, you could still suffer from thyroid dysregulation. This is not new. Many people who suffer from low thyroid have experienced this. Many have even fought their doctors to put them on Thyroid when their TSH test showed within the “normal range.”
So get your thyroid checked. Demand a full thyroid panel, including T3 and T4 counts. Ask to see an endocrinologist if you still don’t feel current provider is accepting the results compared to your symptoms.
But also remember that not all endocrinologists are the same. Luckily, I found one who is very smart and not only listens to me, but respects my knowledge. When I first saw him, he tested for everything. He understood that a low T3 level signified some kind of thyroid problem
Read the excerpt from the article below and let me know what your thoughts are. Have you experienced low thyroid with your bipolar disorder??
Conclusions and Future Directions
Conclusions and Future Directions
There is now more or less incontrovertible evidence that, apart from their developmental effects on the CNS, thyroid hormones have major effects on the metabolic activity of the mature brain. Mood disorders are intimately associated with suboptimal thyroid function. Although comparatively less investigated, increasing evidence has shown that HPT axis dysfunction is relevant to the aetiopathogenesis, course, treatment, and outcome of bipolar disorder. Hypothyroidism either overt or more commonly subclinical appears to the commonest abnormality found among patients with bipolar disorder. It is also likely that the prevalence of thyroid dysfunction is greater in patients with rapid cycling and more refractory forms of the disorder. Lithium has potent anti-thyroid effects and can induce hypothyroidism among patients on this treatment; alternatively, it can exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis in the normal range have the potential to affect the outcome of bipolar disorder. Awareness of this fact is required among clinicians, and patients should be carefully monitored and managed for HPT axis dysfunction. Supplementation with high dose T4 can be considered in some patients, refractory to standard measures of treatment. Genetic, neuroimaging, and neurotransmitter studies are providing newer insights into the complex interactions between HPT function and bipolar disorder.