Today I want to address the thyroid . The first time I encountered a thyroid disorder, represents an hyperfunction in a neighbor. The about in the 50th man in his youth, has already forged prescriptions to get close to estrogens. The fixed idea , he is a wife in a man's body is not his only psychosocial abnormality . So an antipsychotic ( Zyprexa ®) , he was , as he complained of insomnia, prescribed . When I told him about the long term effects of this medication (metabolic syndrome , brain atrophy ) , he went off the drug and the insomnia recurred . 
Now, however, good advice was expensive, even if already the devil-with-the- Beelzebub - expulsion came to an end . Close observation showed me a minimal approach goiter , which gave me, how was shown on curative success, the right track. The gift of Lycopus virginicus (we have then simply made ​​tea, it took nerve to break the poisoning paranoia ; Fintelmann / Weiss recommend the administration of medicinal products , eg Cefavale ® drops , Lycoaktin ® M tablets Thyreogutt ® mono drops / tablets, thyro - loges ® N tablets, to be creeped in up to the specified dose) showed remarkable results after just three days. When I was at the usual time at his apartment door knocking (9 clock in the morning, what I met before therapy was always a patient who complained of his sleepless night) , he just growled at me , he was tired , why I would wake him up so early and he slammed the door in my face . I have never not enjoyed so much before and until today again a closed door ! 

Now it is probably common in the clinic, initially to control the thyroid in a suspected schizophrenia. That is probably not going to happen with my neighbor. He searched a practitioner only , not even an expert physician in psychiatry and neurology . Has probably heard at an traininng event sponsored by Lilly in spring in Paris, Zyprexa ® helps quickly and cheaply with everything falls through grid 's of behavior and you can sleep so well. Preferly the whole 24- day, until then by the chronic blockade of serotonin , the brain is so corroded that of a difference between night and day anyway may be no more talk . But never mind that this realization has probably penetrate " from above " to you . I'm getting to something else. 

Even if with the first entry to psychiatry the thyroid hormones T3 and T4 are determined and are in the normal range , this does not mean that no thyroid malfunction subsists. The peculiarity of thyroxine is in deed that it is mainly present in bound form (T4 ), and only when needed as a free hormone (T3 ) is released. What can not be derived from the thyroid laboratory , is the rate of T3 that binds its receptor and is transported to the nucleus, where the receptor -ligand complex exerts its effect . This rate corresponds to the flow of thyroxine from its bound form into the free T3 active form , which also can not be represented in the laboratory. 

Let us have a look for a deeper understanding at Hashimoto disease . Among the clinical symptoms , there are all symptoms of epinephrine / norepinephrine overactivity , but the corresponding lab shows normal values ​​! The answer is found in the in Hashimoto overshooting expression of β -adrenergic receptor (see " Basic&Clinical Endocrinology ," Greenspan , Gardner, Lange Medical Books / McGraw -Hill ) . Although epinephrine / norepinephrine is increasingly produced, but also increased consumed , so that the blood levels almost unchanged ( possibly reduced with borderline values? ) appears . Especially for the heart this increased receptor expression is confirmed, but in the tibia and the face seems such a malfunction is to be assumed ( myxedema ) .

 At this point I can not resist a visit. Greenspan / Gardner / Karam specify , the β -adrenergic receptor mysterious ways sometimes leads to dilation of the blood vessel , but also to constriction of the blood vessel. This is easily explained. The lack of a second signal from the tissue to the adrenaline / norepinephrine triggerd blood vessel gives constriction , the normal case. If an additional inflammation signal is sent from the tissue, dilatation follows to allow the monocytes immigration.

With myxedema this mechanism fails by the following reason : In the blood vessels ( eg tibia) are pathologically increased in number β -adrenergic receptors, which prevent maturation of monocytes to macrophages . How so? Monocytes also have β -adrenergic receptors , which triggered, initiate the ripening of monocyte to phagocyte. However, the monocytes have to compete for the available (not increased ) epinephrine / norepinephrine with pathologically increased number of receptors of the vessel wall by the laws of thermodynamics. So there is not enough hormone left for monocytes , they can not mature and therefore not emigrate to the tissue. Requested by the inflammatory signal " cleanup " remain unsettled , the cell debris forms a colloid - myxedema !

But back to the topic . In cases of suspected schizophrenia a physiological thyroid lab is not an exclusion criterion for the differential diagnosis of hyperthyroidism. The native clinical picture without prior neuroleptic gift (!)( circadian rhythm , often shifted) decides. When in doubt (better : in general) a cost-effective test with the above Lycopus virginicus therapy should bring the decision .