Hyperthyroidism and Mental Health Disorders

Findings have shed light on clear associations between hyperthyroidism and mental health conditions including attention-deficit/hyperactivity disorder (ADHD), adjustment disorder, anxiety, bipolar disorder, depression, and suicidality.

Researchers arrived at their conclusion after performing a study of data on beneficiaries aged 10 and 18 years with eligibility to receive at least 1 month of care during fiscal years 2008 through 2016. Data were obtained from the Military Health System Data Repository. Using prevalence ratios, mental health diagnoses were compared between patients with and without hyperthyroidism.

Ultimately, hyperthyroidism was diagnosed in 1894 female patients and 585 male patients over the course of the study. For patients with vs without hyperthyroidism, the prevalence ratios for mental health conditions ranged from 1.7 for ADHD to 4.9 for bipolar disorder. Perhaps most notably, suicidality was found to be almost 5 times more likely in patients with hyperthyroidism than in patients without hyperthyroidism.

Also of note, most mental health diagnoses (except for suicidality) were most often made before hyperthyroidism had been diagnosed. Among these patients, the highest proportion received a diagnosis of ADHD (68.3%) before receiving a diagnosis of hyperthyroidism.

Consultant360 discussed these findings further with study authors Sarah J. Zader, MD, and Melissa A. Buryk, MD, from the Naval Medical Center Portsmouth in Virginia, and the Department of Pediatrics at Uniformed Services University of the Health Sciences in Bethesda, Maryland.

Consultant360: In your study, you hypothesized that the prevalence of mental health disorders would be higher in patients with hyperthyroidism. Could you elaborate further on this and what led you to this hypothesis?

Drs Zader and Buryk: We suspected an association between thyroid disorders (in particular, hyperthyroidism) and mental health disorders based on our own personal observations, as well as knowledge of the current literature, consisting primarily of case reports. The idea for this study initially began after caring for a particular patient with suicidal ideation, who was also found to have Graves’ disease. Given the relatively limited volume of literature on this subject, we elected to further investigate this suspected association on a larger scale, using the military health system.

C360: Were there any surprising aspects to the findings of a clear association between hyperthyroidism and several mental health conditions, or did you fully anticipate these findings?

Drs Zader and Buryk: What surprised us most was that suicidality was nearly 5 times more likely in patients with a diagnosis of hyperthyroidism than in those without a diagnosis of hyperthyroidism. We were also surprised to find that diagnoses for most mental health conditions, with the exception of suicidality, were commonly made before the diagnosis of hyperthyroidism. To us, this suggests that providers should have a lower threshold to screen for hyperthyroidism when considering evaluation or diagnosis of mental health conditions such as ADHD, adjustment disorder, anxiety, bipolar disorder, depression, and suicidality.

C360: Is it yet known, or have you hypothesized, what the mechanism is between hyperthyroidism and mental health conditions?

Drs Zader and Buryk: While our research supports an association between hyperthyroidism and mental health conditions, a mechanism or causative link is not yet known or understood.

C360: How can endocrinologists and other clinicians apply the findings from your study in clinical practice?

Drs Zader and Buryk: We believe that endocrinologists and primary care physicians should have a low threshold to screen for mental health disorders and implement mental health supports in patients diagnosed with hyperthyroidism.

C360: What is the next step in terms of future research?

Drs Zader and Buryk: We believe that future research efforts should ultimately be aimed at determining a possible causal relationship between hyperthyroidism and mental health disorders. We also believe that it may be beneficial to confirm this association in different demographic groups, including civilian and adult populations.

—Christina Vogt

Reference:
Zader SJ, Williams E, Buryk MA. Mental health conditions and hyperthyroidism. Pediatrics. 2019;144(5):e 20182874. https://doi.org/10.1542/peds.2018-2874.