When taking care of children with hyperthyroidism, one does not usually consider a co-occuring mental health condition. Similarly, when a patient has a mental health condition such as attention deficit hyperactivity disorder (ADHD), depression, or bipolar disorder, hyperthyroidism is not usually considered. Yet Zader et al., in a study being early released this week (10.1542/peds.2018-2874) show us that there is an association between mental health conditions and hyperthyroidism. The authors evaluated data from the Military Health System database that included 2,400 children between 10 and 18 years from 2008-2016 to explore this potential association. In addition to describing the strength of the association, the study also finds that the risk of suicidality was nearly five times higher in patients with hyperthyroidism compared to those who were euthyroid. This study cannot show if one condition leads to the other, only that they are associated.
So why would there be such an association? We asked endocrinologists Dr. Rebecca Schneider Aguirre and John Fuqua from Indiana University and Riley Hospital for Children to provide an accompanying commentary (10.1542/peds.2019-2140). They share with us multiple hypotheses for this phenomenon, many focused on an autoimmune mechanism affecting both the thyroid gland and the brain, but no studies have yet to define the definitive pathophysiology. Drs. Aguirre and Fuqua also note some limitations of this study, but at the same time share with us other studies showing a similar association in adults. The authors of this commentary remind us that we should at least consider hyperthyroidism when treating patients with mental health conditions and for monitoring our patients with hyperthyroidism for mental health conditions. Read both the study and commentary and learn more.