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Rex W. Cowdry, MD; Thomas A. Wehr, MD; Athanasios P. Zis, MD; Frederick K. Goodwin, MD

Arch Gen Psychiatry. 1983;40(4):414-420.

Abstract
• Bipolar patients taking lithium carbonate were classified as rapid-cycling or non—rapid-cycling based on whether they had ever experienced four or more affective episodes in a 12-month period. Overt hypothyroidism was found in 12 (50.7%) of the 24 rapid-cycling patients and in none of the 19 non—rapidcycling patients. Elevated thyroid-stimulating hormone levels were present in 92% of the rapid-cycling group v 32% of the non—rapid-cycling group. Abnormalities of the hypothalamic-pituitary-thyroid axis, some of which may become apparent only during treatment with lithium carbonate, appear to interact with a predisposition to bipolar illness to produce rapidcycling. These overt and covert abnormalities may help explain the reported efficacy of thyroid in treating "periodic catatonia" and rapid-cycling.

Author Affiliations
From the Intramural Research Program, National Institute of Mental Health, Bethesda, Md (Drs Cowdry, Wehr, and Goodwin); and the Department of Psychiatry, University of Michigan, Ann Arbor (Dr Zis).

Footnotes
Accepted for publication Sept 15, 1982.

Reprint requests to Intramural Research Program, National Institute of Mental Health, The Clinical Center, 10/4C414, Bethesda, MD 20205 (Dr Cowdry).

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