In the evaluation of patients presenting with altered mental function searching for
underlying medical conditions is necessary. Abnormal thyroid function has long been
implicated in mood changes with the classic associations of depression occurring together
with hypothyroidism and of mania along with hyperthyroidism. We here report 3 patients
who presented with symptoms consistent with acute manic episode diagnosed using DSM
IV-TR criteria and who were found to have primary hypothyroidism biochemically. This
led to a review of the literature on this phenomenon resulting in the identification
of 10 reports of mania and associated thyroid profiles consistent with primary hypothyroidism.
All 3 of our patients improved clinically after use of levothyroxine and psychotropic
medications, consistent with the literature reports. This illustrates that thyroid
function abnormalities including primary hypothyroidism should be considered and screened
for when evaluating patients with acute manic episodes.
hypothyroidism - psychiatric disorders - manic episodes - HPT axis - cognitive changes
