The Relationship between Thyroid Dysfunction and Bipolar Disorder

Background: Bipolar disorder (BD) is a complex psychiatric condition characterized by alternating episodes of mania and depression. Neuroendocrine factors, including thyroid function, play a crucial role in the pathogenesis of BD. Thyroid dysfunction, associated with abnormalities of the hypothalamic-pituitary-thyroid axis, disrupts the balance of key neurotransmitters such as noradrenaline, serotonin, and dopamine which contributes to the development of affective states. Genetic and immuneinfiammatory mechanisms also play a significant role in the pathophysiology of both BD and thyroid disorders. The aim of the review is to evaluate current evidence on the relationship between thyroid dysfunction and BD, focusing on neurochemical, genetic, and immune mechanisms, as well as the potential therapeutic applications of thyroid hormones in BD treatment. Materials and Methods: a literature review was conducted for the years 2000–2023, including publications available in PubMed, the Cochrane Library, and the e-Library databases. The search was performed using the keywords: bipolar disorder, thyroid dysfunction, thyroid hormones, infiammation, GWAS. Original studies, meta-analyses, randomized controlled trials, and cohort studies were included in the analysis. Discussion: Genetic studies, particularly genome-wide association studies (GWAS), have identified shared genetic loci associated with immune regulation and infiammation, which increase the risk of both BD and thyroid dysfunction. The presence of thyroid peroxidase antibodies in patients with BD and their relatives suggests a potential genetic predisposition and an autoimmune component underlying both conditions. Furthermore, clinical trials have demonstrated the efficacy of high-dose L-thyroxine in alleviating depressive symptoms in patients with BD who are resistant to standard therapy. However, further investigation is needed to determine the factors infiuencing response to hormone therapy, including genetic predisposition, coexisting thyroid disorders, and disease duration, to optimize treatment strategies. Conclusion: а deeper understanding of the relationship between BD and thyroid dysfunction, including neurochemical, genetic, and immune mechanisms, will facilitate the development of personalized therapeutic approaches. This, in turn, may improve diagnosis, prevention, and overall quality of life for affected patients.

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