Levothyroxine shows no benefit in elderly patients with subclinical hypothyroidism, pychiatric implications
I agree with Susan Mayor [1], that thyroid hormones have a wide range of functions, subclinical hypothyroidism may be a factor in health problems in older people. Thyroid diseases are often associated with psychiatric disorders.
A clinical study [2] showed in a gender- and age-adjusted logistic regression, the odds ratio of uni- or bipolar patients with depression for an autoimmune thyroiditis was ten times higher (95 % CI = 1.2-85.3) when compared with schizophrenia patients. The main risk patients were older women (>60 years). Custro and colleagues [3] described subclinical hypothyroidism resulting from autoimmune thyroiditis in female patients with depression. Thyroid hormones have been used adjunctively in treatment-resistant, non-bipolar major depression and bipolar disorders with inconsistent evidence of efficacy, especially for tri-iodothyroine [4]. A review evaluated effects of adding tri-iodothyronine (90.4 µg/day) to complex maintenance regimens of treatment refractory bipolar disorder patients, and found improvement in 85% of cases [5]. A new trial [6] tested effects of adding L-thyroxine in doses up to 300 µg/day to complex regimens in bipolar disorder patients (depressed). There were only minor differences from placebo controls [7]. In treatment studies in bipolar depression there were some effects of additive co-medication with tri-iodothyronine or L-thyroxine with a different benefit-risk ratio [7].
References:
1) Mayor S. Levothyroxine shows no benefit in elderly patients with subclinical hypothyroidism, trial finds. BMJ 2017;357:j1754
2) Degner D et al. Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients. Eur Arch Psychiatry Clin Neurosci. 2015 ;265(1):67-72. doi: 10.1007/s00406-014-0529-1
3) Custro N et al..Subclinical hypothyroidism resulting from autoimmune thyroiditis in female patients with endogenous depression.
Endocrinol Invest. 1994 ;17(8):641-6
4) Poon S et al. Pharmacological Approaches for Treatment-resistant Bipolar Disorder. Curr Neuropharmacol. 2015;13(5):592-604
5) Kelly T., Lieberman D.Z. The use of triiodothyronine as an augmentation agent in treatment-resistant bipolar II and bipolar disorder NOS. J. Affect. Disord. 2009;116(3):222–226. doi: 10.1016/j.jad.2008.12.010
6) Stamm T.J.et al.. Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. J. Clin. Psychiatry. 2014;75(2):162–168. doi: 10.4088/JCP.12m08305
7) Goodwin GM et al. ECNP consensus meeting. Bipolar depression. Nice, March 2007. Eur Neuropsychopharmacol. 2008 Jul;18(7):535-49. doi: 10.1016/j.euroneuro.2008.03.003. Epub 2008 May 23
Competing interests:
No competing interests
26 April 2017
Detlef Degner
senior consultant, psychiatry
Department of Psychiartry, University of Göttingen, Germany
Rapid Response:
Levothyroxine shows no benefit in elderly patients with subclinical hypothyroidism, pychiatric implications
I agree with Susan Mayor [1], that thyroid hormones have a wide range of functions, subclinical hypothyroidism may be a factor in health problems in older people. Thyroid diseases are often associated with psychiatric disorders.
A clinical study [2] showed in a gender- and age-adjusted logistic regression, the odds ratio of uni- or bipolar patients with depression for an autoimmune thyroiditis was ten times higher (95 % CI = 1.2-85.3) when compared with schizophrenia patients. The main risk patients were older women (>60 years). Custro and colleagues [3] described subclinical hypothyroidism resulting from autoimmune thyroiditis in female patients with depression. Thyroid hormones have been used adjunctively in treatment-resistant, non-bipolar major depression and bipolar disorders with inconsistent evidence of efficacy, especially for tri-iodothyroine [4]. A review evaluated effects of adding tri-iodothyronine (90.4 µg/day) to complex maintenance regimens of treatment refractory bipolar disorder patients, and found improvement in 85% of cases [5]. A new trial [6] tested effects of adding L-thyroxine in doses up to 300 µg/day to complex regimens in bipolar disorder patients (depressed). There were only minor differences from placebo controls [7]. In treatment studies in bipolar depression there were some effects of additive co-medication with tri-iodothyronine or L-thyroxine with a different benefit-risk ratio [7].
References:
1) Mayor S. Levothyroxine shows no benefit in elderly patients with subclinical hypothyroidism, trial finds. BMJ 2017;357:j1754
2) Degner D et al. Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients. Eur Arch Psychiatry Clin Neurosci. 2015 ;265(1):67-72. doi: 10.1007/s00406-014-0529-1
3) Custro N et al..Subclinical hypothyroidism resulting from autoimmune thyroiditis in female patients with endogenous depression.
Endocrinol Invest. 1994 ;17(8):641-6
4) Poon S et al. Pharmacological Approaches for Treatment-resistant Bipolar Disorder. Curr Neuropharmacol. 2015;13(5):592-604
5) Kelly T., Lieberman D.Z. The use of triiodothyronine as an augmentation agent in treatment-resistant bipolar II and bipolar disorder NOS. J. Affect. Disord. 2009;116(3):222–226. doi: 10.1016/j.jad.2008.12.010
6) Stamm T.J.et al.. Supraphysiologic doses of levothyroxine as adjunctive therapy in bipolar depression: a randomized, double-blind, placebo-controlled study. J. Clin. Psychiatry. 2014;75(2):162–168. doi: 10.4088/JCP.12m08305
7) Goodwin GM et al. ECNP consensus meeting. Bipolar depression. Nice, March 2007. Eur Neuropsychopharmacol. 2008 Jul;18(7):535-49. doi: 10.1016/j.euroneuro.2008.03.003. Epub 2008 May 23
Competing interests: No competing interests