The International Journal of Romanian Society of Endocrinology / Registered in 1938

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April - June 2020, Volume 16, Issue 2
Letter to the Editor

Trifu S, Popescu A, Dragoi AM, Trifu AI

Thyroid Hormones as a Third Line of Augmentation Medication in Treatment-Resistant Depression

Acta Endo (Buc) 2020, 16 (2): 256-261
doi: 10.4183/aeb.2020.256

Introduction. Clinical or subclinical hypothyroidism dictates the severity of depressive episodes and more frequently overlaps psychotic phenomenology. There are also major depressive episodes resistant to treatment in patients with euthyroidism, in which supplementation of antidepressant medication with thyroid hormones is beneficial. Material. Systematization of meta-analyses from perspectives: hypothyroidism and depression, autoimmune and depression pathology, gestational and puerperal pathology in association with hormonal and dispositional changes, presentation of therapeutic schemes. Results. Hypothyroidism is more commonly comorbid with major depression in women. It associates the need for hospitalizations, psychotic phenomenology, resistance to treatment, somatic comorbidities. Autoimmune pathology is associated with depression and requires thorough investigation. A possible genetic candidate for thyroid dysfunction is the DIO1 gene. FT4 may be a predictor, but the combination of FT4 + TBG measured during the prenatal period has a higher prognostic power for a future depressive episode. Conclusion. The article presents psychiatric medication schemes that combine antidepressants and antipsychotics of various classes with other enhancers, an important role going back to step three, which includes thyroid hormones, mainly T3. The doses used are smaller than the amount of endogenous production of T3 daily, with a small risk of inducing clinical hyperthyroidism.

Keywords: hypothyroidism, depression, autoimmune pathology, DIO1 gene, antidepressant, thyroid hormones.

Correspondence: Simona Trifu MD, “Carol Davila” University of Medicine and Pharmacy, Neurosciences, 37 Dionisie Lupu Str., Bucharest, 020021, Romania, E-mail: