Psychiatric trouble may start in the thyroid, should we be surprised? Doctors often overlook the underlying hormonal basis of psychiatric disorders. This is particularly true in cases of mild thyroid hormone deficiencies (subclinical hypothyroidism), which can, among other things, cause symptoms associated with depression and anxiety. Untreated thyroid dysfunction, even minor cases, can lead to significant psychiatric illnesses and disability, unresponsive to medications. This oversight is tragic.

The global prevalence of spontaneous hypothyroidism is significant (between 1% and 2%), is more common in older women, and 10 times more common in women than in men. Despite the large number of people struggling with this illness, subtle cases of hypothyroidism are often under treated, particularly in the absence of physical symptoms. In these cases psychiatrist are focused on treating the mood symptoms, and endocrinologist and internists resort to yearly diagnostic "monitoring."

The American Psychiatric Association in collaboration with the American Thyroid Association can help alleviate this diagnostic and treatment disparity by increasing educational and informational outreach for both physicians and the lay public during International Thyroid Awareness Week later next year. Additionally, sanctioned algorithms that spotlight mood symptoms as an important component of treatment for mild hypothroidism will play an essential role in improving the quality of life for patients struggling with thyroid-induced psychiatric illnesses.

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