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I. Association With Grade I Hypothyroidism

Mark S. Bauer, MD; Peter C. Whybrow, MD; Andrew Winokur, MD, PhD

Arch Gen Psychiatry. 1990;47(5):427-432.

Abstract
• Thirty patients with rapid cycling bipolar affective disorder were studied prospectively to assess presence and severity of thyroid hypofunction. Seven (23%) were classified as having grade I hypothyroidism, while 8 (27%) had grade II and 3 (10%) had grade III abnormalities. This prevalence of grade I hypothyroidism is significantly greater than that reported in studies of unselected bipolar patients during long-term treatment with lithium carbonate, although only 63% of this sample of rapid cycling patients was taking lithium carbonate or carbamazepine. The association of rapid cycling with grade I hypothyroidism cannot be accounted for by lithium carbonate use or by the preponderance of women among rapid cycling patients. These findings (1) indicate that hypothyroidism during bipolar illness is a risk factor for the development of rapid cycling, and (2) leads to the hypothesis that a relative central thyroid hormone deficit occurring in bipolar patients predisposes to a rapid cycling course.

Author Affiliations
From the Affective Disorders Program, Department of Psychiatry, University of Pennsylvania, Philadelphia.

Footnotes
Accepted for publication November 1, 1989.

Read in part at the annual meetings of the American Psychiatric Association, Chicago, Ill, May 14, 1987; the Society of Biological Psychiatry, Montreal, Canada, May 8, 1988; and the First International Conference on Refractory Depression, Philadelphia, Pa, October 7, 1988.

Reprint requests to Department of Psychiatry, 302 Piersol North, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (Dr Bauer).

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