Thyroxine plus triiodothyronine and thyroxine
alone have similar efficacy in hypothyroid patients who have depressive
symptoms
(March 2004)
The background of the study. Patients with hypothyroidism
who are treated with thyroxine (T4) may continue to have symptoms,
particularly psychological symptoms. Treatment with T4 plus triiodothyronine
(T3) may be helpful. In this study the effects of T4 alone and T4
plus T3 were compared in patients with hypothyroidism who had symptoms
of depression.
How the study was done. Forty patients (36 women;
mean age, 47 years) with hypothyroidism who had been taking a constant
dose of T4 for at least six months and had symptoms of depression
were studied. They were randomly assigned to receive their usual
dose of T4 once daily plus a placebo twice daily, or half their
usual dose of T4 once daily plus T3, 12.5 µg twice daily,
for 15 weeks. The patients were evaluated using the Symptom Check-List-90
(SCL-90), the Comprehensive Epidemiological Screens for Depression
(CES-D), and a general health questionnaire before and periodically
during the study.
The results of the study. At the end of the study,
the mean daily T4 dose was 118µg in the T4 group and 67µg
in the T4-plus-T3 group, and the mean T3 dose in the latter group
was 19µg. During and at the end of the study the mean serum
thyrotropin concentrations in the two groups were similar. At base
line, the scores for the subtests (depression, anxiety, global severity
index, positive symptom total, and positive symptom distress index)
of the SCL-90 test, the score for the CES-D test, and the results
of the general health questionnaire were similar in both groups.
The scores for the tests improved during the study, but there were
no differences between the groups at any time.
The conclusions of the study. In patients with hypothyroidism and
depressive symptoms despite adequate T4 therapy, the combination
of T4 plus T3 is no more effective than T4 alone in ameliorating
these symptoms.
The original article. Sawka AM, Gerstein HC, Marriott MJ, MacQueen
GM, Joffe RT. Does a combination regimen of thyroxine (T4) and 3,5,3'-triiodothyronine
improve depressive symptoms better than T4 alone in patients with
hypothyroidism? Results of a double-blind, randomized, controlled
trial. J Clin Endocrinol Metab 2003;88:4551-5.
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