rapid-cycling bipolar disorder mistaken (by me) for hashitoxicosis
Hi, everyone. This is a further update on my 21-year-old daughter. We have a lot of Graves in the family. Two years ago my daughter began having symptoms that sounded like hyperthyroidism to me (racing thoughts, pounding heart, shaking, panic, hysteria). But she was also having symptoms that sounded like hypothyroidism to me (extreme fatigue, depression). I thought she was cycling between hyper and hypo, and that she might have hashitoxicosis. I was expecting her to finish the hyper phase eventually and settle into a hypo phase that would show on the labs.
Labs have been confusing. Her symptoms would come and go. For the past year, her labs have all been in the middle of the normal range and very stable, but her symptoms have gotten worse.
We have a new diagnosis for her: rapid-cycling bipolar disorder, an unusual kind with episodes of mania and depression often in the same day. The hyper symptoms I describe often start with a euphoric mood that in retrospect seems to be what they call "hypomania." We didn't want to think her euphoria could be a symptom of something wrong (so nice to see her happy and energetic!) but they were always followed by a "crash" of crippling depression, and associated with panic attacks.
We are still following her very carefully for thyroid problems (especially because she's starting on lithium, which can cause thyroid problems). As members of this board have pointed out, her TSI (71) shows that even if she didn't have suspicious symptoms, she should be carefully watched. I am also not ruling out the possibility that thyroid problems either cause or are caused by bipolar disorder, or that both are caused by the same thing. My family is full of autoimmune diseases. I have myasthenia gravis as well as Graves.
I was so sure that her problem was her thyroid. I know how often thyroid symptoms are misdiagnosed as psychiatric. Here, I believe is an unusual case of psychiatric symptoms being mistaken for thyroid symptoms. I am posting this follow-up just to give people who are having trouble getting a diagnosis one more possibility to consider--though like I say, I think this is a rare case.
I also want to thank everyone for their help, and to assure you that even though I believe we are getting closer to a firm diagnosis for her, we won't rule out the possibility that thyroid problems are part of the whole picture.