title: Hyperthyroidism and risk for bipolar disorders: a nationwide population-based study.
abstract: BACKGROUND
  Thyroid disorders have long been associated with psychiatric illness, often with symptoms suggestive of mood disorders. The most common clinical features associated with hyperthyroidism are anxiety and depression. The risk of bipolar disorders, especially bipolar mania, among patients with thyroid disorders has not been well characterized.
  
  
  OBJECTIVE
  We explored the relationship of hyperthyroidism and the subsequent development of bipolar disorders, and examined the risk factors for bipolar disorders in patients with hyperthyroidism.
  
  
  METHODS
  We identified patients who were diagnosed with hyperthyroidism between 2000 and 2010 in the Taiwan National Health Insurance Research Database. A comparison cohort without hyperthyroidism was matched based on age, sex, and comorbidities. The occurrence of bipolar disorders was evaluated in both cohorts based on diagnosis and the use of mood stabilizer drugs.
  
  
  RESULTS
  The hyperthyroidism cohort consisted of 21, 574 patients, and the comparison cohort consisted of 21, 574 matched control patients without hyperthyroidism. The incidence of bipolar disorders (incidence rate ratio [IRR], 2.31, 95% CI 1.80-2.99, P<.001) was higher for the hyperthyroidism patients than the control patients. Multivariate, matched regression models showed that women (HR 2.02, 95% CI 1.34-3.05, P = .001), patients with alcohol use disorders (HR 3.03, 95% CI 1.58-5.79, P = .001), and those with asthma (HR 1.70, 95% CI 1.18-2.43, P = .004) were independent risk factors for the development of bipolar disorders in hyperthyroidism patients.
  
  
  CONCLUSIONS
  Although a possibility that the diagnosis of bipolar disorders in this study actually includes "bipolar disorders due to hyperthyroidism" cannot be excluded, this study suggests that hyperthyroidism may increase the risk of developing bipolar disorders.
authors.affiliation: Department of Psychiatry, Yuli Veterans Hospital, Hualien, Taiwan.
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.forename: Cheng-Che
authors.initials: CC
authors.lastname: Shen
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.forename: Chia-Fen
authors.initials: CF
authors.lastname: Tsai
authors.forename: Huey-Ling
authors.initials: HL
authors.lastname: Chiang
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.forename: Wei-Shu
authors.initials: WS
authors.lastname: Wang
authors.forename: Pan-Ming
authors.initials: PM
authors.lastname: Chen
authors.forename: Tsung-Ming
authors.initials: TM
authors.lastname: Hu
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000209:etiology*; D003710:Demography; D005260:Female; D006306:Health Surveys; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
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