Thyroid Disease and Mental Disorders: Cause and Effect or Only comorbidity?

Robertas Bunevičius; Arthur J. Prange Jr

Disclosures

Curr Opin Psychiatry. 2010;23(4):363-368. 

In This Article

Abstract and Introduction

Abstract

Purpose of review To discuss the effects of thyroid dysfunction and thyroid autoimmunity on mental symptoms and disorders in patients with thyroid disease with reference to recent epidemiological, clinical, and genetic findings.
Recent findings During brain development, iodine deficiency, maternal thyroid dysfunction, and neonatal thyroid malformations together with genetic factors contribute to neurological deficit. Most adults with thyroid dysfunction will develop mental symptoms. In hyperthyroidism, adrenergic hyperactivity is a major cause of psychiatric symptoms, and beta-adrenergic antagonists are effective treatment. Most patients with severe hypothyroidism will also demonstrate mental symptoms; however, causality is not so evident as in hyperthyroidism. Polymorphism in deiodinase genes and in transporter genes appears to make an important contribution to the presentation of mental symptoms as well as to the outcome of treatment of hypothyroidism. A thyroid autoimmunity process may by itself contribute to mental symptoms in vulnerable patients. Data from epidemiological studies provide conflicting evidence as to associations between thyroid disorders and mental symptoms.
Summary In the adult brain, compared with the developing brain, brain–thyroid relationships are less apparent but still important. Adrenergic hyperactivity is a major cause of psychiatric symptoms in hyperthyroidism. Genetic factors contribute to the development and treatment outcome of mental disorder in hypothyroidism.

Introduction

In our last review,[1•] discussing thyroid function in mental disorders, we summarized that the majority of mental patients are euthyroid. However, recent findings in individual genetic variations of thyroid axis-related proteins have provided new opportunities for better understanding of thyroid hormone effects in mental disorders, for finding additional genetic markers, and for new targets for psychiatric treatments. In this review, we will discuss the presentation of mental symptoms and mental disorders in patients with thyroid disease as well as the impact of treatment of thyroid disorders on mental functioning. Recent epidemiological, clinical, and genetic findings will be cited.

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