Bauer M S, Whybrow P C
Department of Psychiatry, University of Pennsylvania, Philadelphia 19104.
Arch Gen Psychiatry. 1990 May;47(5):435-40. doi: 10.1001/archpsyc.1990.01810170035006.
Eleven patients with rapid cycling bipolar affective disorder whose symptoms were refractory to their current medication regimen were entered into an open trial of high-dose levothyroxine sodium added to a stable regimen of those medications. At baseline, all patients exhibited a rapid cycling pattern and were evaluated prospectively through at least one affective episode. Levothyroxine was added to the baseline medication regimen, and the dosage was increased until clinical response occurred or until side effects precluded further increase. While patients were taking levothyroxine, scores on both depressive and manic symptom rating scales decreased significantly compared with baseline. This improvement was due to the clear-cut response of depressive symptoms in 10 of 11 patients, with manic symptoms responding in five of the seven patients who exhibited them during baseline evaluation. Four patients then underwent single- or double-blind placebo substitution; three patients relapsed into either depression or cycling. Treatment response did not depend on previous thyroid status. In 9 of 10 responsive patients, supranormal circulating levels of free thyroxine were necessary to induce clinical response. Side effects were minimal, and there were no signs or symptoms of levothyroxine-induced hypermetabolism.
11名快速循环型双相情感障碍患者，其症状对当前药物治疗方案无效，进入一项开放试验，在其稳定的药物治疗方案基础上加用高剂量左甲状腺素钠。基线时，所有患者均表现出快速循环模式，并通过至少一次情感发作进行前瞻性评估。在基线药物治疗方案基础上加用左甲状腺素，剂量逐渐增加，直至出现临床反应或出现副作用而无法进一步增加。患者服用左甲状腺素期间，抑郁和躁狂症状评定量表得分与基线相比均显著降低。这种改善归因于11名患者中有10名患者的抑郁症状有明确反应，在基线评估时有躁狂症状的7名患者中有5名患者的躁狂症状有反应。4名患者随后接受单盲或双盲安慰剂替代；3名患者复发为抑郁或循环发作。治疗反应不取决于既往甲状腺状态。在10名有反应的患者中，有9名患者需要游离甲状腺素的超正常循环水平才能诱导临床反应。副作用轻微，没有左甲状腺素诱导的代谢亢进的体征或症状。
