The other day someone mention high doses of levothyroxine used for treatment resistant depression. Today, this paper appears.
Have to say, I can't help wondering if the lack of cardiovascular issues in any way implies that these people have anything unusual about their systems which makes them particularly tolerant, or even in positive need of high levels of thyroxine? Too many thoughts spinning round.
J Affect Disord. 2018 May 30;238:213-217. doi: 10.1016/j.jad.2018.05.034. [Epub ahead of print]
Long-term treatment with supraphysiologic doses of levothyroxine in treatment-refractory mood disorders - A prospective study of cardiovascular tolerability.
Pilhatsch M1, Berghöfer A2, Mayer-Pelinski R1, Berghöfer G3, Ricken R4, Möckel M5, Kühnle Y6, Sauer C1, Whybrow PC7, Bauer M8.
1 Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
2 Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
3 Herzmedizin Berlin, Berlin, Germany.
4 Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
5 Division of Emergency Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and Mitte, Berlin, Germany.
6 Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
7 Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA.
8 Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. Electronic address: email@example.com.
To investigate long-term effects of adjunctive prophylactic treatment with supraphysiologic doses of levothyroxine (L-T4) on cardiovascular tolerability in 23 patients with treatment-refractory mood disorders.
Starting point for a comprehensive cardiovascular assessment in patients was the indication for long-term maintenance treatment with L-T4 (mean dose 463 mcg/day). Prospective longitudinal assessment of the cardiovascular risk profile included in addition to a physical examination and blood pressure measurement, several technical investigations: resting electrocardiogram, transthoracic echocardiogram, cardiac stress test, and holter electrocardiogram. Statistical analysis was performed by linear mixed effects models (LMM) for evaluation of longitudinal changes in various heart measures.
During the mean observational period of 20.4 months none of the heart measures reached statistical significance in change over time. None of the assessed cardiac parameters of each single patient was in a range predictive for cardiac dysfunction.
Small sample size, no technical cardiac investigations prior to L-T4 initiation, no patient control group with mood disorders who did not receive L-T4.
Results of this study indicated no increased risk for cardiovascular disorders during treatment with supraphysiologic L-T4 doses in patients with refractory mood disorders.
Copyright © 2018. Published by Elsevier B.V.
Cardiovascular risk assessment; Levothyroxine; Thyroid; Treatment-refractory mood disorders