NEW YORK (Reuters Health) – Children with hyperthyroidism have a higher prevalence of attention-deficit/hyperactivity disorder (ADHD), adjustment disorder, anxiety, bipolar disorder, depression and suicidality, according to a new study. “Thyroid disorder should be considered in a patient presenting to their primary care provider with a positive screen result for anxiety or depression or symptoms suggestive of another mental health diagnosis,” Dr. Melissa Buryk and colleagues from Naval Medical Center Portsmouth in Virginia write in a paper online today in Pediatrics.
This study is “important in that it is the first to reveal a strong association between mental health conditions and hyperthyroidism in the pediatric population in a large sample size. The results are consistent with the adult literature,” write the authors of a linked editorial.
Dr. Buryk and colleagues determined the prevalence of hyperthyroidism and mental-health conditions (MHCs) using data from the Military Health System Data Repository on military beneficiaries between 10 and 18 years old. They identified 1,894 females and 585 males with a diagnosis of hyperthyroidism during the study period (2008-2016). Compared with children without hyperthyroidism, the prevalence ratios of MHCs in children with hyperthyroidism ranged from 1.7 (ADHD) to 4.9 (bipolar disorder), with all risk increases being statistically significant. “Strikingly, suicidality was nearly 5 times more likely in patients diagnosed with hyperthyroidism than in patients who were never diagnosed with hyperthyroidism,” the authors report. “For each of the MHCs examined, with the exception of suicidality, the MHC diagnosis was more commonly made before the diagnosis of hyperthyroidism, with the highest proportion of patients being diagnosed with ADHD before receiving a diagnosis of hyperthyroidism (68.3%),” they note.
“There are two main points that we would hope health care providers take away from these findings,” Dr. Buryk noted in email to Reuters Health. “First is to recognize that when a child presents with signs or symptoms of a mental health condition, it is important to consider whether a medical issue is the cause of the symptoms. In this case hyperthyroidism. We are not saying that every child with symptoms of the mental health conditions we describe needs to have blood testing for thyroid functions but at least that the clinician may consider this in their differential.”
“Secondly, in children with a diagnosis of hyperthyroidism, there remains a high preponderance of a mental health related condition that does not appear to be related to the elevation in thyroid levels alone,” said Dr. Buryk. “Both anecdotally and as our findings suggest, these mental health diagnosis remain present months after start of treatment when the patient would be presumed to have obtained the proper treatment for the condition. It is important for the providers caring for these children to recognize that even though their thyroid disease might be treated, they still need to be mindful that the mental health symptoms/diagnosis may still be present.”
“At present, there are only clues as to the mechanisms behind the association, and it will be interesting to see additional research in this area,” Dr. Rebecca Schneider Aguirre and Dr. John S. Fuqua from Indiana University in Indianapolis point out in their editorial. The study authors, they add, “appropriately raise the important point that the American Thyroid Association guidelines do not address the mental health aspects of the disease, in particular the apparent increased risk for suicidality. They support the need for this aspect to be addressed and for additional investigations to better understand risk factors, pathophysiology, and effective treatment modalities.”
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