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Differences in thyroid function between bipolar manic and mixed states

K D Chang¹, P E Keck, S P Stanton

¹Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.

Biological Psychiatry

|June 2, 1998

Summary

Thyroid axis dysfunction, including higher thyroid-stimulating hormone (TSH) and lower thyroxine (T4) levels, is more prevalent in bipolar mixed states than pure mania. This suggests a potential link between thyroid abnormalities and mixed features in bipolar disorder.

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Area of Science:

Neuroendocrinology
Psychiatry
Bipolar Disorder Research

Background:

Rapid-cycling bipolar disorder often presents with thyroid axis abnormalities.
Bipolar mixed states share features with rapid cycling but have been less studied regarding thyroid function.

Purpose of the Study:

To investigate the prevalence of thyroid axis abnormalities in bipolar mixed states compared to pure mania.
To test the hypothesis that mixed states are associated with higher hypothyroidism rates.

Main Methods:

Serum concentrations of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were measured.
37 consecutive patients with DSM-III-R bipolar disorder (manic or mixed) were analyzed at admission.

Main Results:

Patients with mixed mania showed significantly higher mean TSH levels.
Patients with mixed mania exhibited significantly lower mean T4 levels.
No significant differences were found in T3 levels or prior lithium exposure.

Conclusions:

Thyroid axis dysfunction appears more common in bipolar mixed states than in pure manic states.
These findings highlight a potential link between thyroid function and the presentation of bipolar disorder.