propylthiouracil and Bipolar-Disorder

Topics: Adult; Bipolar Disorder; Drug Therapy, Combination; Female; Humans; Neurocognitive Disorders; Propranolol; Propylthiouracil; Thyroid Function Tests; Thyrotoxicosis

Clinicians should be on the alert for the possibility of underlying thyrotoxicosis in patients having an affective disturbance. An initial detailed medical history and complete physical examination is essential even in severely agitated, threatening patients. The danger of inappropriate diagnosis and treatment of these patients requires a high index of suspicion in detecting the underlying thyroid disturbance.

Topics: Adult; Bipolar Disorder; Commitment of Mentally Ill; Humans; Iodine Radioisotopes; Male; Propranolol; Propylthiouracil; Thyrotoxicosis

The authors describe the case of a 49-year-old woman who developed a goiter, mild symptoms of hyperthyroidism, and grossly elevated thyroid function tests after 2 years of treatment with lithium carbonate. Thyroid microsomal autoantibodies were also present. She was retreated with propylthiouracil and improved, but within 3 months she developed agranulocytosis. Propylthiouracil was discontinued, and the patient was treated with antibiotics and recovered. She was then given 131I to control her hyperthyroidism. The case is an example of the rare association of hyperthyroidism with lithium, which usually suppresses thyroid function, and demonstrates that lithium carbonate cannot prevent agranulocytosis caused by propylthiouracil.

Topics: Agranulocytosis; Bipolar Disorder; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Lithium; Lithium Carbonate; Middle Aged; Propylthiouracil; Thyroid Hormones

Topics: Adult; Affective Disorders, Psychotic; Bipolar Disorder; Drug Therapy, Combination; Female; Humans; Hyperthyroidism; Lithium; Propranolol; Propylthiouracil; Thyroidectomy