To the Editor: Hyperthyroidism has been noted to have various effects on patients with anorexia nervosa, ranging from promotion of weight loss to binging, purging, and weight gain (1) . Moreover, both anorexia nervosa and hyperthyroidism have been associated with bipolar affective disorder (2, 3) . We present the case of an anorexia nervosa patient with hyperthyroidism who developed hypomania during re-feeding.
After an initial response to antithyroid treatment, our patient exhibited rapid weight gain, developed hypomania, and had relapsed hyperthyroidism. We postulate that a re-feeding-associated increase of thyroid hormone contributed to the development of hypomania (4) . This case report suggests a more conservative approach in dietary supplementation and rate of weight gain for anorexia nervosa patients with hyperthyroidism during the re-feeding period. The observation that hypomania subsided rapidly using low-dose antipsychotics also suggests that hyperthyroidism-related hypomania may be self-limited.
Footnotes
Dr. Tseng has served as a principal investigator for a clinical trial sponsored by Pfizer. Drs. Lin and Chang report no competing interests.
This letter (doi: 10.1176/appi.ajp.2009.09010065) was accepted for publication in April 2009
References
1.
Birmingham CL, Gritzner S, Gutierrez E:Hyperthyroidism in anorexia nervosa: case report and review of the literature. Int J Eat Disord 2006; 39:619–620
Moore R, Mills IH: Serum T3 and T4 levels in patients with anorexia nervosa showing transient hyperthyroidism during weight gain. Clin Endocrinol 1979; 10:443–449
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Birmingham CL, Gritzner S, Gutierrez E:Hyperthyroidism in anorexia nervosa: case report and review of the literature. Int J Eat Disord 2006; 39:619–620
Moore R, Mills IH: Serum T3 and T4 levels in patients with anorexia nervosa showing transient hyperthyroidism during weight gain. Clin Endocrinol 1979; 10:443–449
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