CNS Drugs

, Volume 20, Issue 11, pp 897–909 | Cite as

Psychiatric Manifestations of Graves’ Hyperthyroidism

Pathophysiology and Treatment Options
  • Robertas BuneviciusEmail author
  • Arthur J. PrangeJr
Therapy In Practice


Graves’ disease is an autoimmune disorder that is the most common cause of hyperthyroidism. Other symptoms associated with the disease are goitre, ophthalmopathy, and psychiatric manifestations such as mood and anxiety disorders and, sometimes, cognitive dysfunction. Graves’ hyperthyroidism may result in these latter manifestations via the induction of hyperactivity of the adrenergic nervous system.

This review addresses the psychiatric presentations, and their pathophysiology and treatment, in patients with hyperthyroidism, based on literature identified by a PubMed/MEDLINE database search. Although the focus is on mental symptoms associated with Graves’ disease, it is not always clear from the literature whether patients had Graves’ disease: in some studies, the patients were thought to have Graves’ disease based on clinical findings such as diffuse goitre or ophthalmopathy or on measurements of thyroid antibodies in serum; however, in other studies, no distinction was made between Graves’ hyperthyroidism and hyperthyroidism from other causes.

Antithyroid drugs combined with β-adrenoceptor antagonists are the treatments of choice for hyperthyroidism, as well as for the psychiatric disorders and mental symptoms caused by hyperthyroidism. A substantial proportion of patients have an altered mental state even after successful treatment of hyperthyroidism, suggesting that mechanisms other than hyperthyroidism, including the Graves’ autoimmune process per se and ophthalmopathy, may also be involved. When psychiatric disorders remain after restoration of euthyroidism and after treatment with β-adrenoceptor antagonists, specific treatment for the psychiatric symptoms, especially psychotropic drugs, may be needed.


Bipolar Disorder Propranolol Hyperthyroidism Generalise Anxiety Disorder Antithyroid Drug 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to thank Robert D. Utiger, MD, for his assistance in the preparation of this manuscript. The work of Robertas Bunevicius was supported in part by the Ruth L. Kirchstein Award from the United States National Institute of Health. The authors have no conflicts of interest that are directly relevant to the contents of this review.


  1. 1.
    Jacobson DL, Gange SJ, Rose NR, et al. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997 Sep; 84(3): 223–43PubMedCrossRefGoogle Scholar
  2. 2.
    Aghini-Lombardi F, Antonangeli L, Martino E, et al. The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab 1999; 84(2): 561–6PubMedCrossRefGoogle Scholar
  3. 3.
    Vanderpump MPJ, Tunbridge WMGH. The epidemiology of autoimmune thyroid disease. In: Volpe R, editor. Autoimmune endocrinopathies. Vol. 15 of Contemporary endocrinology. Totowa (NJ): Humana Press, 1999: 141–62Google Scholar
  4. 4.
    Vanderpump MPJ. The epidemiology of thyroid disease. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams and Wilkins, 2005: 398–406Google Scholar
  5. 5.
    Becker DV, Bigos ST, Gaitan E, et al. Optimal use of blood tests for assessment of thyroid function. JAMA 1993 Jun 2; 269(21): 2736–7PubMedCrossRefGoogle Scholar
  6. 6.
    Weetman AP. Graves’ disease. N Engl J Med 2000; 343: 1236–48PubMedCrossRefGoogle Scholar
  7. 7.
    Busuttil BE, Frauman AG. Extrathyroidal manifestations of Graves’ disease: the thyrotropin receptor is expressed in extraocular, but not cardiac, muscle tissues. J Clin Endocrinol Metab 2001 May; 86(5): 2315–9PubMedCrossRefGoogle Scholar
  8. 8.
    Crisanti P, Omri B, Hughes E, et al. The expression of thyrotropin receptor in the brain. Endocrinology 2001 Feb; 142(2): 812–22PubMedCrossRefGoogle Scholar
  9. 9.
    Davies TF. Pathogenesis of Graves’ disease. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams and Wilkins, 2005: 457–73Google Scholar
  10. 10.
    Mizokami T, Wu Li A, El-Kaissi S, et al. Stress and thyroid autoimmunity. Thyroid 2004 Dec; 4(12): 1047–55CrossRefGoogle Scholar
  11. 11.
    Weetman AP. Autoimmune thyroid disease. Autoimmunity 2004 Jun; 37(4): 337–40PubMedCrossRefGoogle Scholar
  12. 12.
    Graves RJ. Newly observed affection of the thyroid gland in females. Lond Med Surg J 1835; 7: 516–7Google Scholar
  13. 13.
    Dunlap HF, Moersch FP. Psychic manifestations associated with hyperthyroidism. Am J Psychiatry 1935; 91: 1215–36Google Scholar
  14. 14.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. text revision (DSM-IV-TR). Washington, DC: American Psychiatric Association, 2000Google Scholar
  15. 15.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization, 1992Google Scholar
  16. 16.
    Emanuele MA, Brooks MH, Gordon DL, et al. Agoraphobia and hyperthyroidism. Am J Med 1989 Apr; 86(4): 484–6PubMedCrossRefGoogle Scholar
  17. 17.
    Matsubayashi S, Tamai H, Matsumoto Y, et al. Graves’ disease after the onset of panic disorder. Psychother Psychosom 1996; 65(5): 277–80PubMedCrossRefGoogle Scholar
  18. 18.
    Iacovides A, Fountoulakis KN, Grammaticos P, et al. Difference in symptom profile between generalized anxiety disorder and anxiety secondary to hyperthyroidism. Int J Psychiatry Med 2000; 30(1): 71–81PubMedCrossRefGoogle Scholar
  19. 19.
    Demet MM, Ozmen B, Deveci A, et al. Depression and anxiety in hyperthyroidism. Arch Med Res 2002 Nov–Dec; 33(6): 552–6PubMedCrossRefGoogle Scholar
  20. 20.
    Lee IT, Sheu WH, Liau YJ, et al. Relationship of stressful life events, anxiety and depression to hyperthyroidism in an Asian population. Horm Res 2003; 60(5): 247–51PubMedCrossRefGoogle Scholar
  21. 21.
    Gulseren S, Gulseren L, Hekimsoy Z, et al. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res 2006 Jan; 37(1): 133–9PubMedCrossRefGoogle Scholar
  22. 22.
    Rockel M, Teuber J, Schmidt R, et al. Correlation of “latent hyperthyroidism” with psychological and somatic changes [in German]. Klin Wochenschr 1987 Mar 16; 65(6): 264–73PubMedCrossRefGoogle Scholar
  23. 23.
    Biondi B, Palmieri EA, Fazio S, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab 2000 Dec; 85(12): 4701–5PubMedCrossRefGoogle Scholar
  24. 24.
    Biondi B, Palmieri EA, Klain M, et al. Subclinical hyperthyroidism: clinical features and treatment options. Eur J Endocrinol 2005 Jan; 152(1): 1–9PubMedCrossRefGoogle Scholar
  25. 25.
    Larisch R, Kley K, Nikolaus S, et al. Depression and anxiety in different thyroid function states. Horm Metab Res 2004 Sep; 36(9): 650–3PubMedCrossRefGoogle Scholar
  26. 26.
    Schlote B, Nowotny B, Schaaf L, et al. Subclinical hyperthyroidism: physical and mental state of patients. Eur Arch Psychiatry Clin Neurosci 1992; 241(6): 357–64PubMedCrossRefGoogle Scholar
  27. 27.
    Grabe HJ, Volzke H, Ludemann J, et al. Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatr Scand 2005 Oct; 112(4): 286–93PubMedCrossRefGoogle Scholar
  28. 28.
    Engum A, Bjoro T, Mykletun A, et al. An association between depression, anxiety and thyroid function: a clinical fact or an artefact? Acta Psychiatr Scand 2002 Jul; 106(1): 27–34PubMedCrossRefGoogle Scholar
  29. 29.
    Alvarez MA, Gomez A, Alavez E, et al. Attention disturbance in Graves’ disease. Psychoneuroendocrinology 1983; 8(4): 451–4PubMedCrossRefGoogle Scholar
  30. 30.
    Robbins LR, Vinson DB. Objective psychologic assessment of the thyrotoxic patient and the response to treatment: preliminary report. J Clin Endocrinol Metab 1960 Jan; 20: 120–9PubMedCrossRefGoogle Scholar
  31. 31.
    MacCrimmon DJ, Wallace JE, Goldberg WM, et al. Emotional disturbance and cognitive deficits in hyperthyroidism. Psychosom Med 1979 Jun; 41(4): 331–40PubMedGoogle Scholar
  32. 32.
    Schlote B, Schaaf L, Schmidt R, et al. Mental and physical state in subclinical hyperthyroidism: investigations in a normal working population. Biol Psychiatry 1992 Jul 1; 32(1): 48–56PubMedCrossRefGoogle Scholar
  33. 33.
    Whybrow PC, Prange Jr AJ, Treadway CR. Mental changes accompanying thyroid gland dysfunction: a reappraisal using objective psychological measurement. Arch Gen Psychiatry 1969 Jan; 20(1): 48–63PubMedCrossRefGoogle Scholar
  34. 34.
    Trzepacz PT, Klein I, Roberts M, et al. Graves’ disease: an analysis of thyroid hormone levels and hyperthyroid signs and symptoms. Am J Med 1989 Nov; 87(5): 558–61PubMedCrossRefGoogle Scholar
  35. 35.
    Kathol RG, Delahunt JW. The relationship of anxiety and depression to symptoms of hyperthyroidism using operational criteria. Gen Hosp Psychiatry 1986 Jan; 8(1): 23–8PubMedCrossRefGoogle Scholar
  36. 36.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980Google Scholar
  37. 37.
    Spitzer RL, Endicott J, Robins E. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 1978 Jun; 35(6): 773–82PubMedCrossRefGoogle Scholar
  38. 38.
    Trzepacz PT, McCue M, Klein I, et al. A psychiatric and neuropsychological study of patients with untreated Graves’ disease. Gen Hosp Psychiatry 1988 Jan; 10(1): 49–55PubMedCrossRefGoogle Scholar
  39. 39.
    Placidi GPA, Boldrni M, Patronelli A, et al. Prevalence of psychiatric disorders in thyroid diseased patients. Neuropsychobiology 1998 Nov; 38(4): 222–5PubMedCrossRefGoogle Scholar
  40. 40.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  41. 41.
    Brownlie BEW, Rae AM, Walshe JWB, et al. Psychoses associated with thyrotoxicoses. “Thyrotoxic psychoses”: a report of 18 cases, with statistical analysis of incidence. Eur J Endocrinol 2000 May; 142(5): 438–44PubMedCrossRefGoogle Scholar
  42. 42.
    Manual of the international statistical classification of diseases, injuries, and causes of death. Vol. 1. Geneva: World Health Organization, 1977Google Scholar
  43. 43.
    Bunevicius R, Velickiene D, Prange Jr AJ. Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves’ disease. Gen Hosp Psychiatry 2005 Mar–Apr; 27(2): 133–9PubMedCrossRefGoogle Scholar
  44. 44.
    Corn TH, Checkley SA. A case of recurrent mania with recurrent hypothyroidism. Br J Psychiatry 1983 Jul; 143: 74–6PubMedCrossRefGoogle Scholar
  45. 45.
    Walter-Ryan WG, Fahs JJ. The problem with parsimony: mania and hyperthyroidism. J Clin Psychiatry 1987 Jul; 48: 289–90PubMedGoogle Scholar
  46. 46.
    Irwin R, Ellis PM, Delahunt J. Psychosis following acute alteration of thyroid status. Aust N Z J Psychiatry 1997 Oct; 31(5): 762–4PubMedCrossRefGoogle Scholar
  47. 47.
    Nath J, Sagar R. Late onset bipolar disorder due to hyperthyroidism. Acta Psychiatr Scand 2001 Jul; 104(1): 72–3PubMedCrossRefGoogle Scholar
  48. 48.
    Whybrow PC, Bauer M. Behavioral and psychiatric aspects of thyrotoxicosis. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams and Wilkins, 2005: 644–50Google Scholar
  49. 49.
    Oomen HA, Schipperijn AJ, Drexhange HA. The prevalence of affective disorder and in particular of a rapid cycling of bipolar disorder in patients with abnormal thyroid function test. Clin Endocrinol 1996 Aug; 45(2): 215–23CrossRefGoogle Scholar
  50. 50.
    Thomsen AF, Kessing LV. Increased risk of hyperthyroidism among patients hospitalized with bipolar disorder. Bipolar Disord 2005 Aug; 7(4): 351–7PubMedCrossRefGoogle Scholar
  51. 51.
    Orenstein H, Peskind A, Raskind MA. Thyroid disorders in female psychiatric patients with panic disorder or agoraphobia. Am J Psychiatry 1988 Nov; 145(11): 1428–30PubMedGoogle Scholar
  52. 52.
    Simon NM, Blacker D, Korbly NB, et al. Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. J Affect Disord 2002 May; 69(1–3): 209–17PubMedCrossRefGoogle Scholar
  53. 53.
    Kalmijn S, Mehta KM, Pols HA, et al. Subclinical hyperthyroidism and the risk of dementia: the Rotterdam study. Clin Endocrinol (Oxf) 2000 Dec; 53(6): 733–7CrossRefGoogle Scholar
  54. 54.
    Peake RL. Recurrent apathetic hyperthyroidism. Arch Intern Med 1981 Feb; 141(2): 258–60PubMedCrossRefGoogle Scholar
  55. 55.
    Thomas FB, Mazzaferri EL, Skillman TG. Apathetic thyrotoxicosis: a distinctive clinical and laboratory entity. Ann Intern Med 1970 May; 72(5): 679–85PubMedGoogle Scholar
  56. 56.
    Ghobrial MW, Ruby EB. Coma and thyroid storm in apathetic thyrotoxicosis. South Med J 2002 May; 95(5): 552–4PubMedGoogle Scholar
  57. 57.
    Wagle AC, Wagle SA, Patel AG. Apathetic form of thyrotoxicosis. Can J Psychiatry 1998 Sep; 43(7): 747–8PubMedGoogle Scholar
  58. 58.
    Teelucksingh S, Pendek R, Padfield PL. Apathetic thyrotoxicosis in adolescence. J Intern Med 1991 Jun; 229(6): 543–4PubMedCrossRefGoogle Scholar
  59. 59.
    Rozendaal FP. Hyperthyroidism in the elderly: aspecific signs may cause a delay in diagnosis [in Dutch]. Tijdschr Gerontol Geriatr 2005 May; 36(2): 77–80PubMedCrossRefGoogle Scholar
  60. 60.
    Wartofsky L. Thyrotoxic storm. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams and Wilkins, 2005: 651–7Google Scholar
  61. 61.
    Barker R, Zajicek J, Wilkinson I. Thyrotoxic Hashimoto’s encephalopathy. J Neurol Neurosurg Psychiatry 1996 Feb; 60(2): 234PubMedCrossRefGoogle Scholar
  62. 62.
    Utku U, Asil T, Celik Y, et al. Reversible MR angiographic findings in a patient with autoimmune Graves’ disease. AJNR Am J Neuroradiol 2004 Oct; 25(9): 1541–3PubMedGoogle Scholar
  63. 63.
    Brain L, Jellinek EH, Ball K. Hashimoto’s disease and encephalopathy. Lancet 1966 Sep 3; II(7462): 512–4CrossRefGoogle Scholar
  64. 64.
    Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth? Arch Neurol 2003 Feb; 60(2): 164–71PubMedCrossRefGoogle Scholar
  65. 65.
    Ferracci F, Moretto G, Candeago RM, et al. Antithyroid antibodies in the CSF: their role in the pathogenesis of Hashimoto’s encephalopathy. Neurology 2003 Feb 25; 60(4): 712–4PubMedCrossRefGoogle Scholar
  66. 66.
    Kahaly GJ, Hardt J, Petrak F, et al. Psychosocial factors in subjects with thyroid-associated ophthalmopathy. Thyroid 2002 Mar; 12(3): 237–9PubMedCrossRefGoogle Scholar
  67. 67.
    Park JJ, Sullivan TJ, Mortimer RH, et al. Assessing quality of life in Australian patients with Graves’ ophthalmopathy. Br J Ophthalmol 2004 Jan; 88(1): 75–8PubMedCrossRefGoogle Scholar
  68. 68.
    Terwee CB, Dekker FW, Prummel MF, et al. Graves’ ophthalmopathy through the eyes of the patient: a state of the art on health-related quality of life assessment. Orbit 2001 Dec; 20(4): 281–90PubMedCrossRefGoogle Scholar
  69. 69.
    Egle UT, Kahaly GJ, Petrak F, et al. The relevance of physical and psychosocial factors for the quality of life in patients with thyroid-associated orbitopathy (TAO). Exp Clin Endocrinol Diabetes 1999; 107Suppl. 5: S168–71PubMedCrossRefGoogle Scholar
  70. 70.
    Farid M, Roch-Levecq AC, Levi L, et al. Psychological disturbance in Graves’ ophthalmopathy. Arch Ophthalmol 2005 Apr; 123(4): 491–6PubMedCrossRefGoogle Scholar
  71. 71.
    Franklyn JA. The management of hyperthyroidism. N Engl J Med 1994 Jun 16; 330(24): 1731–8PubMedCrossRefGoogle Scholar
  72. 72.
    Trzepacz PT, McCue M, Klein I, et al. Psychiatric and neuropsychological response to propranolol in Graves’ disease. Biol Psychiatry 1988 Apr 1; 23(7): 678–88PubMedCrossRefGoogle Scholar
  73. 73.
    Kathol RG, Turner R, Delahunt J. Depression and anxiety associated with hyperthyroidism: response to antithyroid therapy. Psychosomatics 1986 Jul; 27(7): 501–5PubMedCrossRefGoogle Scholar
  74. 74.
    Rockey PH, Griep RJ. Behavioral dysfunction in hyperthyroidism. Improvement with treatment. Arch Intern Med 1980 Sep; 140(9): 1194–7Google Scholar
  75. 75.
    Freedman M, Sala M, Faraj G, et al. Psychological changes during thyrotoxicosis. Thyroidology 1993 Apr; 5(1): 25–8PubMedGoogle Scholar
  76. 76.
    Robbins LR, Vinson DB. Objective psychologic assessment of the thyrotoxic patient and the response to treatment: preliminary report. J Clin Endocrinol Metab 1960 Jan; 20: 120–9PubMedCrossRefGoogle Scholar
  77. 77.
    MacCrimmon DJ, Wallace JE, Goldberg WM, et al. Emotional disturbance and cognitive deficits in hyperthyroidism. Psychosom Med 1979 Jun; 41(4): 331–40PubMedGoogle Scholar
  78. 78.
    Artunkal S, Togrol B. Psychological studies in hyperthyroidism. In: Cameron MP, O’Connor M, editors, Brain-thyroid relationships. Boston (MA): Little, Brown and Co, 1964: 92–113Google Scholar
  79. 79.
    Perrild H, Hansen JM, Arnung K, et al. Intellectual impairment after hyperthyroidism. Acta Endocrinol (Copenh) 1986 Jun; 112(2): 185–91Google Scholar
  80. 80.
    Bommer M, Eversmann T, Pickardt R, et al. Psychopathological and neuropsychological symptoms in patients with subclinical and remitted hyperthyroidism. Klin Wochenschr 1990 Jun 5; 68(11): 552–8PubMedCrossRefGoogle Scholar
  81. 81.
    Stern RA, Robinson B, Thorner AR, et al. A survey study of neuropsychiatric complaints in patients with Graves’ disease. J Neuropsychiatry Clin Neurosci 1996 Spring; 8(2): 181–5PubMedGoogle Scholar
  82. 82.
    Fahrenfort JJ, Wilterdink AM, van der Veen EA. Long-term residual complaints and psychosocial sequelae after remission of hyperthyroidism. Psychoneuroendocrinology 2000 Feb; 25(2): 201–11PubMedCrossRefGoogle Scholar
  83. 83.
    Scheffer C, Heckmann C, Mijic T, et al. Chronic distress syndrome in patients with Graves’ disease [in German]. Med Klin (Munich) 2004 Oct 15; 99(10): 578–84CrossRefGoogle Scholar
  84. 84.
    Fukao A, Takamatsu J, Murakami Y, et al. The relationship of psychological factors to the prognosis of hyperthyroidism in antithyroid drug-treated patients with Graves’ disease. Clin Endocrinol (Oxf) 2003 May; 58(5): 550–5CrossRefGoogle Scholar
  85. 85.
    Anaissie E, Tohme JF. Reserpine in propranolol-resistant thyroid storm. Arch Intern Med 1985 Dec; 145(12): 2248–9PubMedCrossRefGoogle Scholar
  86. 86.
    Saito H, Fujita N, Miyakoshi M, et al. A case of Hashimoto’s encephalopathy associated with Graves’ disease [in Japanese]. Rinsho Shinkeigaku 2002 Jul; 42(7): 619–22PubMedGoogle Scholar
  87. 87.
    Seo SW, Lee BI, Lee JD, et al. Thyrotoxic autoimmune encephalopathy: a repeat positron emission tomography study. J Neurol Neurosurg Psychiatry 2003 Apr; 74(4): 504–6PubMedCrossRefGoogle Scholar
  88. 88.
    Hoogendoorn EH, den Heijer M, van Dijk AP, et al. Subclinical hyperthyroidism: to treat or not to treat? Postgrad Med J 2004 Jul; 80(945): 394–8PubMedCrossRefGoogle Scholar
  89. 89.
    Sgarbi JA, Villaca FG, Garbeline B, et al. The effects of early antithyroid therapy for endogenous subclinical hyperthyroidism in clinical and heart abnormalities. Clin Endocrinol Metab 2003 Apr; 88(4): 1672–7CrossRefGoogle Scholar
  90. 90.
    Ramsay I, Greer S, Bagley C. Propranolol in neurotic and thyrotoxic anxiety. Br J Psychiatry 1973 May; 122(570): 555–60PubMedCrossRefGoogle Scholar
  91. 91.
    Fukui T, Hasegawa Y, Takenaka H. Hyperthyroid dementia: clinicoradiological findings and response to treatment. J Neurol Sci 2001 Feb 15; 184(1): 81–8PubMedCrossRefGoogle Scholar
  92. 92.
    Cooper DS. Treatment of thyrotoxicosis. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 665–94Google Scholar
  93. 93.
    Grunze H, Kasper S, Goodwin G, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders (Pt II): treatment of mania. World J Biol Psychiatry 2003 Jan; 4(1): 5–13PubMedCrossRefGoogle Scholar
  94. 94.
    Grunze H, Kasper S, Goodwin G, et al. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of bipolar disorders (Pt III): maintenance treatment. World J Biol Psychiatry 2004 Jul; 5(3): 120–35PubMedCrossRefGoogle Scholar
  95. 95.
    Kirov G, Tredget J, John R, et al. A cross-sectional and a prospective study of thyroid disorders in lithium-treated patients. J Affect Disord 2005 Aug; 87(2–3): 313–7PubMedCrossRefGoogle Scholar
  96. 96.
    Segal RL, Rosenblatt S, Eliasoph I. Endocrine exophthalmos during lithium therapy of manic-depressive disease. N Engl J Med 1973 Jul 19; 289(3): 136–8PubMedCrossRefGoogle Scholar
  97. 97.
    Carmaciu CD, Anderson CS, Lawton CA. Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder. Bipolar Disord 2003 Oct; 5(5): 381–4PubMedCrossRefGoogle Scholar
  98. 98.
    Oakley PW, Dawson AH, Whyte IM. Lithium: thyroid effects and altered renal handling. J Toxicol Clin Toxicol 2000; 38(3): 333–7PubMedCrossRefGoogle Scholar
  99. 99.
    Benvenga S. Benzodiazepine and remission of Graves’ disease. Thyroid 1996 Dec; 6(6): 659–60PubMedCrossRefGoogle Scholar
  100. 100.
    Hoffman WH, Chodoroff G, Piggott LR. Haloperidol and thyroid storm. Am J Psychiatry 1978 Apr; 135(4): 484–6PubMedGoogle Scholar
  101. 101.
    Chu H, Lin JC, Hsu YD. Potentiation of haloperidol neurotoxicity in acute hyperthyroidism: report of a case. Acta Neurol Taiwan 2004 Sep; 13(3): 126–30PubMedGoogle Scholar
  102. 102.
    Folks DG, Petrie WM. Thyrotoxicosis presenting as depression. Br J Psychiatry 1982 Apr; 140: 432–3PubMedCrossRefGoogle Scholar
  103. 103.
    Martinez Ortiz JJ. Hyperthyroidism secondary to antidepressive treatment with fluoxetine [in Spanish]. An Med Interna 1999 Nov; 16(11): 583–4PubMedGoogle Scholar
  104. 104.
    Farah A, McCall WV. ECT administration to a hyperthyroid patient. Convuls Ther 1995 Jun; 11(2): 126–8PubMedGoogle Scholar
  105. 105.
    Nibuya M, Sugiyama H, Shioda K, et al. ECT for the treatment of psychiatric symptoms in Basedow’s disease. J ECT 2002 Mar; 18(1): 54–7PubMedCrossRefGoogle Scholar
  106. 106.
    Diaz-Cabal R, Pearlman C, Kawecki A. Hyperthyroidism in a patient with agitated depression: resolution after electroconvulsive therapy. J Clin Psychiatry 1986 Jun; 47(6): 322–3PubMedGoogle Scholar
  107. 107.
    Goldman JM. Resolution of hyperthyroidism after ECT therapy. J Clin Psychiatry 1987 Jul; 48(7): 304–5PubMedGoogle Scholar
  108. 108.
    Roca RP, Blackman MR, Ackerley MB, et al. Thyroid hormone elevations during acute psychiatric illness: relationship to severity and distinction from hyperthyroidism. Endocr Res 1990; 16(4): 415–47PubMedCrossRefGoogle Scholar
  109. 109.
    Klein I, Levey GS. New perspectives on thyroid hormone, catecholamines, and the heart. Am J Med 1984 Feb; 76(2): 167–72PubMedCrossRefGoogle Scholar
  110. 110.
    Mason GA, Bondy SC, Nemeroff CB, et al. The effects of thyroid state on beta-adrenergic and serotonergic receptors in rat brain. Psychoneuroendocrinology 1987; 12(4): 261–70PubMedCrossRefGoogle Scholar
  111. 111.
    Whybrow PC, Prange Jr AJ. A hypothesis of thyroid-catecholamine-receptor interaction: its relevance to affective illness. Arch Gen Psychiatry 1981 Jan; 38(1): 106–13PubMedCrossRefGoogle Scholar
  112. 112.
    Charney DS. Neuroanatomical circuits modulating fear and anxiety behaviors. Acta Psychiatr Scand Suppl 2003; (417): 38–50Google Scholar
  113. 113.
    Haggerty Jr JJ, Prange Jr AJ. Borderline hypothyroidism and depression. Annu Rev Med 1995; 46: 37–46PubMedCrossRefGoogle Scholar
  114. 114.
    Loosen PT, Prange Jr AJ. Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: a review. Am J Psychiatry 1982 Apr; 139(4): 405–16PubMedGoogle Scholar
  115. 115.
    Bunevicius R, Lasas L, Kazanavicius G, et al. Pituitary responses to thyrotropin releasing hormone stimulation in depressed women with thyroid gland disorders. Psychoneuroendocrinology 1996 Oct; 21(7): 631–9PubMedCrossRefGoogle Scholar
  116. 116.
    Taylor EA, Jefferson D, Carroll JD, et al. Cerebrospinal fluid concentrations of propranolol, pindolol and atenolol in man: evidence for central actions of beta-adrenoceptor antagonists. Br J Clin Pharmacol 1981 Oct; 12(4): 549–59PubMedCrossRefGoogle Scholar
  117. 117.
    Ravaris CL, Friedman MJ, Hauri PJ, et al. A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. J Clin Psychopharmacol 1991 Dec; 11(6): 344–50PubMedCrossRefGoogle Scholar
  118. 118.
    Chou JC. Recent advances in treatment of acute mania. J Clin Psychopharmacol 1991 Feb; 11(1): 3–21PubMedGoogle Scholar
  119. 119.
    Steffensmeier JJ, Ernst ME, Kelly M, et al. Do randomized controlled trials always trump case reports? A second look at propranolol and depression. Pharmacotherapy 2006 Feb; 26(2): 162–7PubMedCrossRefGoogle Scholar
  120. 120.
    Sandrini M, Vitale G, Vergoni AV, et al. Effect of acute and chronic treatment with triiodothyronine on serotonin levels and serotonergic receptor subtypes in the rat brain. Life Sci 1996; 8(18): 1551–9CrossRefGoogle Scholar
  121. 121.
    Mason GA, Walker CH, Prange Jr AJ. Modulation of gamma-aminobutyric acid uptake of rat brain synaptosomes by thyroid hormones. Neuropsychopharmacology 1987 Dec; 1(1): 63–70PubMedCrossRefGoogle Scholar
  122. 122.
    Morgenthaler NG, Nagata A, Katayama S, et al. Detection of low titre TBII in patients with Graves’ disease using recombinant human TSH receptor. Clin Endocrinol (Oxf) 2002 Aug; 57(2): 193–8CrossRefGoogle Scholar
  123. 123.
    Koehrle J. Local activation and inactivation of thyroid hormones: the deiodinase family. Mol Cell Endocrinol 1999 May 25; 151(1–2): 103–19CrossRefGoogle Scholar
  124. 124.
    Bradley EA. Graves ophthalmopathy. Curr Opin Ophthalmol 2001 Oct; 12(5): 347–51PubMedCrossRefGoogle Scholar
  125. 125.
    Eckstein AK, Plicht M, Lax H, et al. Clinical results of anti-inflammatory therapy in Graves’ ophthalmopathy and association with thyroidal autoantibodies. Clin Endocrinol (Oxf) 2004 Nov; 61(5): 612–8CrossRefGoogle Scholar
  126. 126.
    Nemeroff CB, Putnam JS. β-adrenergic receptor antagonists. In: Sadock BJ, Sadock VA. Kaplan and Sadock’s comprehensive textbook of psychiatry. 8th ed. Vol. 2. Philadelphia (PA): Lippinccott Williams and Wilkins, 2004: 2722–7Google Scholar
  127. 127.
    Hoffman BD. Catecholamine sympathomimetic drugs and adrenergic receptor antagonists. In: Hardman JG, Limbird LL, Gillman AG, editors. The pharmacologic basis of therapeutics. New York (NY): McGraw Hill, 2001: 253–4Google Scholar
  128. 128.
    Silva JE. Thermogenesis and the sympathoadrenal system in thyrotoxicosis. In: Braverman LE, Utiger RD, editors. Werner & Ingbar’s the thyroid: a fundamental and clinical text. 9th ed. Philadelphia (PA): Lippincott Williams & Wilkins, 2005: 607–20Google Scholar

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© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Institute of Psychophysiology and RehabilitationKaunas University of MedicinePalangaLithuania

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