Case Study: Sleight of Gland

When hormones wreak havoc

By Michael J. Formica, published on November 1, 2010 - last reviewed on June 9, 2016

Aubrey, 30, had few health complaints until she began having daily panic attacks, complete with heart palpitations, breathlessness, and trembling hands. She sought help from a psychiatrist, who prescribed medications, and a therapist—me. I chalked it up to family problems and introduced her to breathing techniques. She struggled on and off until, a year after the onset of symptoms, she was struck by debilitating fatigue.

Aubrey lost interest in just about everything, from sex to her job, and began to struggle cognitively. "I would say, 'The thing, you know, the pink thing,'" she recalls. "I was talking about a hairbrush. I thought I was losing my mind."

I considered bipolar disorder, but the intensity of Aubrey's cognitive symptoms baffled me. Could it be a brain injury? Ergot poisoning? I grew perplexed—and a little afraid for Aubrey.

Gender Question Mark Image

Months later, a colleague mentioned a bipolar patient whose mononucleosis sent him into depression. I remembered some cases I'd seen involving endocrine imbalance. One blood test later, I had a diagnosis: hyperthyroidism.

The condition occurs when the thyroid gland overproduces key hormones, ramping up metabolism and producing heart palpitations, irritability, fatigue, muscle weakness, or insomnia—symptoms that mimic those of mood disorders. The first symptoms are pseudo-psychiatric in up to 12 percent of cases.

"If you only treat the affective aspects of hyperthyroidism, you fail to make a diagnosis that has lots of physical ramifications," says physician Jeff Garber, former president of the American Association of Clinical Endocrinologists. The condition afflicts about 300,000 Americans annually, and women are 5 to 10 times more likely to be affected.

Aubrey's endocrinologist put her on Tapazole to slow the overactive gland. Her symptoms vanished, and she morphed back into the woman I'd seen in glimpses. "I felt human again," she says.

Maternal Triggers

Hyperthyroidism typically occurs in those over the age of 60. But one risk factor in particular targets younger women: a recent pregnancy or birth. Thyroid hormones naturally increase during pregnancy; for most, the pseudo-hyperthyroid state corrects itself one to four months afterward, but for some, the result is an ongoing condition, often mistaken for postpartum depression.