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Thyroxine Plus 3,5,3'-triiodothyronine Treatment for Depressed Patients with Hypothyroidism Does Not Improve Patient-Assessed Well-Being

Combinatorial thyroxine (T4) plus 3,5,3'-triiodothyronine (T3) therapy for depressed patients with hypothyroidism shows no benefit on self-reported mood and personal well-being over T4 monotherapy, say researchers.

Current thyroid replacement therapy consists of exogenous levothyroxine to increase T4 levels, as well as T3 levels through T4 deiodination. Despite the effectiveness of therapy, a number of hypothyroid patients receiving T4 experience malaise and depressive symptoms.

One strategy, the addition of T3 to T4 treatment, has been suggested as an alternate thyroid replacement therapy, as well as effective treatment for hypothyroidism without concomitant depression.

AM Sawka and colleagues at McMaster University, Hamilton, Ontario, Canada, compared the effects of combinatorial T3 and T4 therapy to T4 monotherapy on mood and well-being in primary hypothyroid patients with depressive symptoms.

The study included 40 nonthyroidectomised patients (36 women, average age 50) with primary hypothyroidism, taking stable doses of levothyroxine, and who had been diagnosed with depressive symptoms by the General Health Questionnaire (GHQ).

Patients were randomised to receive either T4 (pre-study dose) plus placebo or T4 (50% of pre-study dose) and T3 (12.5 µ twice daily) for 15 weeks. Doses were adjusted based on TSH concentrations to maintain euthyroidism.

Depression was evaluated by the Symptom Check-List-90 (SCL-90) and the Comprehensive Epidemiological Screens for Depression (CES-D). Well-being was assessed by the Medical Outcomes Study (MOS) health status questionnaire.

Overall, the addition of T3 to T4 treatment did not improve self-assessed mood or personal sense of well-being and social functioning over effects seen with T4 monotherapy.

Furthermore, similar discontinuation rates due to side effects were observed, though, further study is needed on the comparative long term safety.

The authors conclude that the "data do not support the routine use of T3 in addition to T4 to maintain euthyroidism in hypothyroid patients who are receiving stable doses of levothyroxine hormone, but who complain of depressive symptoms."

J Clin Endocrinol Metab 2003 Oct;88:10:4551-5. "Does a combination regimen of thyroxine (t(4)) and 3,5,3'-triiodothyronine improve depressive symptoms better than t(4) alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial"

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