Thyrotoxicosis factitia: This is a condition of false hyperthyroidism brought on by secret ingestion of thyroid hormone, usually by nurses. This is a psychiatric disorder. Mania: Characterized by extreme excitability and excessive activity. When hyperthyroidism affects elderly people (who I define as anyone older than I am), the condition may actually look like hypothyroidism. An elderly patient with hyperthyroidism may feel sad and depressed, apathetic, and withdrawn from society. I explain how thyroid problems affect the elderly in Chapter 19. The treatments for hyperthyroidism, which I describe in Chapter 6, are very effective in reversing all the mental and physical symptoms, particularly in younger people who often get the disease. If the mental symptoms are present long enough, however, curing the hyperthyroidism may not cure the manic state. Stress is sometimes blamed for bringing on hyperthyroidism, but little objective evidence supports this claim. Hyperthyroidism may precede stress. Most people who live through severe stress don’t develop hyperthyroidism. However, some evidence suggests that patients with established hyperthyroidism may do better if they’re able to handle stresses that come along while they’re receiving treatment and afterward. If they’re able to handle the stress, then relapse is less likely.
Fighting Depression Depression may be a symptom of a lack of thyroid hormone. On the other hand, thyroid hormone may help in the treatment of depression, even when tests indicate that the patient has enough thyroid hormone. The following sections explain the role that thyroid hormone plays in depression.
Determining if the thyroid is the cause Depression is a prominent symptom of thyroid disease, especially hypothyroidism. Therefore, when someone receives a diagnosis of depression, determining whether a thyroid disease is the cause is important. Studies show that most depressed people don’t have hypothyroidism. How- ever, the condition may be present in a mild form in as many as 20 percent of depressed people, more often in women than in men. If a person receives a diagnosis of hypothyroidism, a doctor should determine whether the patient is taking a drug for treatment of depression that may actually be causing hypothyroidism (see Chapter 10). Two such drugs are lithium and carbamazepine.