Thyroid Hormone for Rapid-Cycling Bipolar Disorder? Not a good Idea.
- Making Bipolar patients thyrotoxic from an overdose of T4 with TSH <0.1 is a short term solution at best.
- Long term effects of excess T4 thyroid hormone builds over time beyond 3 months of the study.
- heart,bone and other bad effects for long term excess thyroid hormone has been well studied in thyroid cancer patients to be detremental.
- Jonathan Silver, MD please stop doing this and others Do Not Try this on their Bipolar patients.
T4, but not T3, is effective.
Rapid-cycling bipolar disorder is common and refractory to treatment. Thyroid medications, predominately levothyroxine (L-T4) for bipolar depression, have been tested but mostly in open-label studies. These researchers conducted a double-blind, randomized, placebo-controlled study of L-T4 and triiodothyronine (T3) in euthyroid patients with rapid-cycling bipolar disorder (≥4 episodes/year) who were receiving therapeutic levels of lithium.
The original study was powered for 60 patients, but only 32 patients were studied (mean age, 36; 22 women). Doses, adjusted weekly, were increased until treatment goals were met (L-T4: free T4 index, 4.5–7.5 units or thyroid-stimulating hormone, <0.1 units; T3: T3-resin uptake, 0.65–1.36 units). At baseline, eight patients had histories of hypothyroidism, and seven were on supplementation.
During a minimum follow-up of 3 months (medians across groups, 15.6–16.6 weeks), the L-T4 group spent significantly less time depressed or in mixed states and more time in euthymia than the placebo group; time in the manic phase did not differ between groups. T3 produced no significant findings, but the authors noted a pattern of effects similar to that with L-T4. Adverse effects included hot flashes/sweating with L-T4 and mild tremor with both L-T4 and T3. Response was not related to baseline thyroid status.