When Hashimoto’s is misdiagnosed as bipolar disorder: A patient’s story

When Hashimoto’s is misdiagnosed as bipolar disorder: A patient’s story

November 10th, 2010 | Author:

After a bipolar diagnosis, this patient was prescribed eight different psychotropic medications and received a dozen electroconvulsive treatments.

After six months of support for Hashimoto’s, her symptoms resolved and she is now drug-free, with the exception of thyroid hormone medication. Was her bipolar disorder simply misdiagnosed Hashimoto’s?

I receive many amazing stories from people around the country whose lives were turned around by proper care for their Hashimoto’s. However this story of a young woman who spent most of her thirties on psychotropic drugs and underwent more than a dozen electroconvulsive treatments while under anesthesia really struck a chord. Her story, as told by her naturopath, follows.

Could Hashimoto’s flare-ups have started her down a path of psych meds and electroshock treatments?

“My patient Jeanette, 42, had been diagnosed seven years earlier by her family physician with bipolar disorder. She had manic episodes of staying up late at night, buzzing with energy and working on various projects, and shopping to excess, spending money she and her husband didn’t have. After these energy surges she then would crash and fall into fatigue and depression. A friend suggested she might have bipolar disorder and she brought this up with her family doctor, who prescribed her two psychiatric drugs and referred her to a psychiatrist. However her diagnosis was never re-evaluated and she eventually ended up on eight different medications, including lithium and drugs for depression, anxiety, panic attacks, and insomnia.

During her seven years of treatment she had also been hospitalized six times for complications due to her medications or for manic episodes. During the last hospitalization she had her gallbladder removed and was diagnosed with high blood sugar and Hashimoto’s, an autoimmune thyroid disease, and placed on thyroid hormone medication. Prior to seeing me she received twelve or thirteen electroconvulsive treatments under anesthesia during a six-month period, as prescribed by her psychiatrist.

Uncontrollable tremors and flat affect

When Jeanette came to my office her hands and legs shook uncontrollably, the result of a tremor that had developed recently. She also had a flat affect, meaning she showed no emotion and her overall mood was dull and low. She also said she struggled with extreme fatigue.

Given the precarious nature of her mental health and that fact that she had had so many hospitalizations, I thought it prudent to start very slowly with her case management.

Going gluten-free and dietary changes

Because of her Hashimoto’s diagnosis, the first thing I did was put her on an autoimmune diet and remove gluten from her diet. I also asked her to remove dairy and sugar and add in healthy fats, lots of vegetables, and to eat more frequently to keep her blood sugar stable. I supported her nutritionally with essential fatty acids (including emulsified fish oil), emulsified vitamin D, nutrients for insulin resistance (since her blood sugar was high her last time in the hospital), and gallbladder support to give her the digestive support she needed since her gallbladder had been removed.

Gut detox and adrenal support

Immediately she started to notice improvement in how she felt. After following the diet for several months, I put her on a gut detoxification program with a hypoallergenic detox protein powder. I started her on adrenal adaptogen herbs and nutrients as her salivary adrenal panel showed an increase in cortisol and night. This means she was more awake and night when she should be tired, which indicates a dysfunction in the brain’s sleep-wake cycle. Adrenal adaptogens address this.

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Affective psychosis, Hashimoto’s thyroiditis, and brain perfusion abnormalities: case report

Background

It has recently become evident that circulating thyroid antibodies are found in excess among patients suffering from mood disorders. Moreover, a manic episode associated with Hashimoto’s thyroiditis has recently been reported as the first case of bipolar disorder due to Hashimoto’s encephalopathy. We report a case in which Hashimoto’s thyroiditis was suspected to be involved in the deteriorating course of mood disorder and discuss potential pathogenic mechanisms linking thyroid autoimmunity with psychopathology.

Case presentation

A 43-year-old woman, with a history of recurrent depression since the age of 31, developed manic, psychotic, and soft neurological symptoms across the last three years in concomitance with her first diagnosis of Hashimoto’s thyroiditis. The patient underwent a thorough medical and neurological workup. Circulating thyroperoxidase antibodies were highly elevated but thyroid function was adequately maintained with L-thyroxine substitution. EEG was normal and no other signs of current CNS inflammation were evidenced. However, brain magnetic resonance imaging evidenced several non-active lesions in the white matter from both hemispheres, suggestive of a non-specific past vasculitis. Brain single-photon emission computed tomography showed cortical perfusion asymmetry particularly between frontal lobes.

Conclusion

We hypothesize that abnormalities in cortical perfusion might represent a pathogenic link between thyroid autoimmunity and mood disorders, and that the rare cases of severe Hashimoto’s encephalopathy presenting with mood disorder might be only the tip of an iceberg.

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