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Research Articles and Papers on:

Thyroid Related Mental Illness


Thyroid hormones are associated with cognitive function: moderation by sex, race and depressive symptoms

M. A. Beydoun, PhD1, H. A. Beydoun, PhD2, M. H. Kitner-Triolo, PhD1, J. S. Kaufman, PhD3, M. K. Evans, MD1,† and A. B. Zonderman, PhD1,‡


Context: Recent evidence indicates that thyroid hormones may be closely linked to cognition among adults.

Objective: We investigated associations between thyroid hormones and cognitive performance, while testing effect modification by sex, race and elevated depressive symptoms (EDS).

Design: This cross-sectional study used extensive data from the HANDLS study.

Setting: Baltimore City, MD, 2004–2009.

Participants: U.S. adults aged 30–64y. Sample size ranged from 1,275 to 1,346.

Main outcome measures: Outcomes included thirteen cognitive test scores spanning domains of learning/memory, language/verbal, attention, visuo-spatial/visuo-construction, psychomotor speed, executive function, and mental status.

Results: Within reference ranges, and after Bonferroni correction, elevated free thyroxine (fT4) was associated with better performance on tests of visuo-spatial/visuo-construction ability (overall, women and African-Americans), learning/memory (women and African-Americans); whereas a higher total thyroxine (tT4) level was associated with better performance in the domain of psychomotor speed (individuals without EDS) and a higher level of both fT4 and tT4 was linked to better language/verbal test performance among men. In contrast, higher T3(%uptake) was related to better performance on tests of visuo-spatial/visuo-construction ability and psychomotor speed among Whites. When comparing above reference range to within in the overall population, and after Bonferroni correction, within reference range fT4 was linked to better performance on visuo-spatial/visuo-constrution ability and psychomotor speed, while being below the normal range thyroid stimulating hormone (TSH) level (compared to the reference range) was linked to better performance in domains of psychomotor speed and attention.

Conclusions: Thyroid hormones and cognition are closely linked, differentially by sex, race and EDS status.


(The article below from Endocrine Today website relates to the above paper)


Thyroid hormones closely related to cognition in adults

Beydoun MA. J Clin Endocrinol Metab. 2013;doi:10.1210/jc.2013-1813.
June 4, 2013

Results from a cross-sectional analysis conducted by researchers at the NIH indicate that cognition is associated with thyroid hormones in adults, but vary by sex, race and depressive status.

Using data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study, May A. Beydoun, PhD, of the National Institute on Aging, and colleagues analyzed the relationship between thyroid hormones and cognitive function. HANDLS examined the results of 13 cognitive tests given to 1,275 to 1,346 adults (aged 30 to 64 years) in Baltimore between 2004 and 2009. Beydoun and colleagues used baseline data from HANDLS.

The tests evaluated areas of learning/memory, language/verbal, attention, visuo-spatial/visuo-construction, psychomotor speed, executive function and mental status among men and women.

According to data, increased free thyroxine levels were linked to better performance on visuo-spatial/visuo-construction ability tests and learning/memory tests among women and blacks, after adjusting for reference ranges and Bonferroni corrections. Additionally, higher total T4 levels were associated with better psychomotor speed performances, and higher levels of free T4 and total T4 were associated with better language/verbal test performance in men.

Conversely, higher triiodothyronine uptake was linked to better performance on tests of visuo-spatial/visuo-construction ability and psychomotor speed among white patients.

Better performance areas of psychomotor speed and attention were attributed to levels being below the normal thyroid-stimulating hormone range (P<.004), according to data. Moreover, free T4 within the reference range was linked to better performance in the visuo-spatial/visuo-construction ability and psychomotor speed, researchers wrote.

Beydoun and colleagues wrote that these findings indicate thyroid function and cognition are related based on sex, race and depressive status.

"We also detected different associations between thyroid hormones and cognitive domains when individuals were within hormone reference ranges as opposed to when they were outside of it," the researchers wrote. "These differences should be further evaluated."




Revisiting Thyroid Hormones in Schizophrenia

Journal of Thyroid Research. 2012

Thyroid hormones are crucial during development and in the adult brain. Of interest, fluctuations in the levels of thyroid hormones at various times during development and throughout life can impact on psychiatric disease manifestation and response to treatment. Here we review research on thyroid function assessment in schizophrenia, relating interrelations between the pituitary-thyroid axis and major neurosignaling systems involved in schizophrenia's pathophysiology. These include the serotonergic, dopaminergic, glutamatergic, and GABAergic networks, as well as myelination and inflammatory processes. The available evidence supports that thyroid hormones deregulation is a common feature in schizophrenia and that the implications of thyroid hormones homeostasis in the fine-tuning of crucial brain networks warrants further research.

The full article is available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321576/


Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited

Thomas W. Heinrich, M.D. and Garth Grahm, M.D.
J Clin Psychiatry. 2003

Hypothyroidism is a medical condition commonly encountered in a variety of clinical settings. The clinical presentations of thyroid hormone deficiency are diverse, complicated, and often overlooked. Hypothyroidism is a potential etiology for multiple somatic complaints and a variety of psychological disturbances. The physical complaints are primarily related to metabolic slowing secondary to lack of thyroid hormone. Psychiatric presentations include cognitive dysfunction, affective disorders, and psychosis. The realization that hypothyroidism might be the potential etiology of an assortment of symptoms is critical in the identification and treatment of the hypothyroid patient. Once hypothyroidism is identified, symptoms usually respond to appropriate thyroid hormone supplementation. This article presents a case of clinical hypothyroidism that came to clinical attention due to psychotic symptoms consisting of auditory and visual hallucinations. The case is followed by a brief discussion of the literature describing the relationship of hypothyroidism and psychiatric symptomatology. References were identified with an English language–based MEDLINE search (1966–2003) using the terms thyroid, hypothyroid, depression, dementia, delirium, mania, bipolar disorder, psychosis, and myxedema and utilization of referenced articles.

The full article is available here:



Hypothyroidism and Depression

Colin M. Dayana,* and Vijay Panicker
Eur Thyroid J. 2013 Sep; 2(3): 168–179.
Published online 2013 Aug 27. doi:  10.1159/000353777
PMCID: PMC4017747

An association between hypothyroidism and depression has been accepted and taught in medicine for many years, although the nature of this relationship and what determines it have not been convincingly proven. Observations on which this association was first derived are the similarity of symptoms in severely depressed and hypothyroid patients, the therapeutic use of thyroid hormones in the management of depression and the apparent abnormalities in the hypothalamic-pituitary-thyroid axis of subjects with depression. However, there have been many conflicting studies in this area and this review seeks to define what our current understanding of this relationship is and where further research is required.

The full article is available here:


Psychiatric manifestations of Hashimoto's thyroiditis

Richard C.W.Hall M.D., Michael K. Popkin M.D., Richard DeVaul M.D., Anne K Hall C.R.N.A., Earl R Gardener Ph.D., Thomas P. Beresford M.D

The Journal of the Academy of Psychosomatic Medicine 1982

The mental symptoms associated with Hashimoto's thyroiditis may precede the full-blown, classic picture of hypothyroidism. The psychiatric symptoms include various mental aberrations, depression, irritability, and confusion. Indeed, patients may be mislabeled as having psychotic depression, paranoid schizophrenia, or the manic phase of a manic depressive disorder. The workup must include a thorough evaluation of thyroid function, including tests for autoantibodies. Patients usually respond favorably to thyroid replacement hormone therapy.

The full article in PDF format can be downloaded from here:


Myxoedematous Madness

Richard Asher M.D. M.R.C.P - Physician, Central Middlesex Hospital

British Medical Journal 1949

Myxoedema is one of the most important, one of the least known, and one of the most frequently missed causes of organic psychoses-important because it may respond so gratifyingly to treatment, little known because little has been written about it, often missed because the textbook description of myxoedema is not the rule but the exception.

Fourteen cases are here described, all of which had myxoedema and psychotic changes. In every one of them the diagnosis was confirmed beyond doubt. They all showed a psychosis amounting to complete "madness," ten being admitted to the mental observation wards under the Lunacy Act, one referred to the neurosurgeon for cerebral tumour, and three to general medical wards with other diagnoses. In nine of the cases there was a dramatic and complete recovery of sanity with thyroid treatment, in two there was partial improvement, one showed no change, and two patients died. The fact that in none of these cases had the diagnosis been made by the outside doctor suggests that there is need for increased awareness of myxoedema as a cause of psychoses, and, further, shows that it may be worth while discussing how myxoedema can be diagnosed so that cases may be recognized and treated early.

A scanned copy in PDF format of the original article can be downloaded from here: