Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
Department of Psychiatry and Biobehavioral Sciences, The Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), Los Angeles, CA, USA.
J Endocrinol Invest. 2021 Nov;44(11):2341-2347. doi: 10.1007/s40618-021-01600-w. Epub 2021 Jun 15.
The close association among thyroid metabolism, mood disorders and behavior has long been known. The old and modern uses of thyroid hormones to modulate the expression of depression and bipolar disorder and to improve clinical outcome when used in conjunction with psychotropic medications.
A literature search was performed to identify studies investigating the effects of thyroid hormone treatment in patient s with mood disorders.
The successful modification of mood disorders with thyroid hormone underscores the association between endocrine and cerebral systems in these disorders. Thyroid hormones have a profound influence on behavior and appear to be capable of modulating the phenotypic expression of major mood disorders. In fact, there is evidence that triiodothyronine (LT3) may accelerate the antidepressant response to antidepressants, and studies suggest that LT3 also may augment the response to antidepressants in refractory depression. Add-on treatment with supraphysiologic doses of levothyroxine (LT4) has shown efficacy in open-label and in placebo-controlled studies, including in rapid cycling and prophylaxis-resistant bipolar disorder, and with acute refractory uni- or bipolar depression. Functional brain-imaging studies (PET) demonstrated that administration of supraphysiologic LT4 improves depressive symptoms in patients with bipolar depression by modulating cerebral activity in the anterior limbic network.
The add-on administration of supraphysiologic doses of LT4 is a promising strategy in patients with refractory bipolar and depressive mood disorders.
甲状腺代谢、情绪障碍和行为之间的密切关联早已为人所知。甲状腺激素的古老和现代用途是调节抑郁和双相情感障碍的表达，并在与精神药物联合使用时改善临床结果。
进行了文献检索，以确定研究甲状腺激素治疗对情绪障碍患者的影响的研究。
甲状腺激素成功地调节了情绪障碍，突出了这些疾病中内分泌和大脑系统之间的关联。甲状腺激素对行为有深远的影响，似乎能够调节主要情绪障碍的表型表达。事实上，有证据表明三碘甲状腺原氨酸 (LT3) 可能加速抗抑郁药对抑郁症的反应，研究表明 LT3 也可能增强难治性抑郁症对抗抑郁药的反应。超生理剂量的左甲状腺素 (LT4) 的附加治疗在开放标签和安慰剂对照研究中显示出疗效，包括在快速循环和预防耐药性双相情感障碍，以及急性难治性单相或双相抑郁症。功能脑成像研究 (PET) 表明，通过调节前边缘网络的大脑活动，超生理 LT4 的给药可改善双相情感障碍抑郁症患者的抑郁症状。
在难治性双相和抑郁情绪障碍患者中，超生理剂量 LT4 的附加给药是一种很有前途的策略。
