Recognizing Thyroid Dysfunction in Psychiatry: What to Order and How to Interpret Tests

<jats:p>Consider checking a baseline TSH in patients diagnosed with mood disorders. An elevated TSH warrants free T4 and TPO antibodies to clarify extent and etiology. Euthyroid sick syndrome means abnormal thyroid labs without true thyroid disease. It affects up to a third of psychiatric patients, often reverses on its own, and levothyroxine can worsen symptoms. In anxious patients, check for fine tremor with arms extended and ask about weight loss despite increased appetite. These free bedside findings can unmask hyperthyroidism masquerading as anxiety.</jats:p>