T3 augmentation for depression

[randomdoc1]

I read and hear in lectures that T3 can be a great augmenting agent when treating people for depression. But one of my colleagues said when he rotated in endocrinology that the particular attending he was with was quite concerned about doing something like that. Obviously you have to make sure there are no major contraindications medically to T3 augmentation, need to monitor TFTs and for s/s of hyperthyroidism. But can someone pitch in on potential longterm concerns abut augmenting someone with T3 from an internal medicine standpoint? Thanks!

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[rokshana]

I read and hear in lectures that T3 can be a great augmenting agent when treating people for depression. But one of my colleagues said when he rotated in endocrinology that the particular attending he was with was quite concerned about doing something like that. Obviously you have to make sure there are no major contraindications medically to T3 augmentation, need to monitor TFTs and for s/s of hyperthyroidism. But can someone pitch in on potential longterm concerns abut augmenting someone with T3 from an internal medicine standpoint? Thanks!

what naturopath told you this?

 

[gutonc]

what naturopath told you this?

That was my thought exactly.

 

[randomdoc1]

LOL! To my understanding, all kidding aside, it was an allopathic doc. But good to know so far no one has expressed any major medical concerns. I was a little shocked myself when my colleague told me about that. btw, if anyone is wondering why T3 is considered a good augmenting agent, major studies like the STAR D study supported this.

 

[Crayola227]

the posters who chimed in so far don't have a posting history c/w interest in psych related issues, so I'm not surprised it's something they would ridicule rather than discuss seriously

yes, there are allopathic/osteopathic board certified psychiatrists who use supplemental T3 in some cases of depression, even when patients otherwise test normal for thyroid function, and there have been and continue to be studies regarding this that do show some support for this practice

it would be nice if rather than ridiculing this practice out of ignorance, if the resident endocrinologist on this board could give us a serious answer

 

[ICmyFuture]

From personal experience, in the clinic and the hospital, non-endocrinologists and patients obsess over the thyroid gland. They put it on this high pedestal, like as if giving some extra amount of thyroid hormone is going to fix all these symptoms or a slightly low TSH just has to be the source of that afib.

 

[Raryn]

what naturopath told you this?

He's actually not wrong. Cytomel has a long history of being used by our colleagues in psychiatry as an adjunct therapy for treatment resistant depression in otherwise euthyroid patients. Liothyronine for Depression: A Review and Guidance for Safety Monitoring

The doses talked about are nuts to me (50mcg Cytomel/day or more), but there's ABPS board certified MD/DO psychiatrists all over the country who do this. Most reserve it for patients who fail multiple other lines of therapy (SSRI, SNRI, augmentation with atypical antipsychotic, etc).

To answer the OP, the main concerns of chronic use of T3 in such a dose end up being increased risks of cardiac arrhythmias and osteoporosis. I quickly glanced through the literature and didn't see any evidence from the psychiatrists regarding f/u of these patients longer term than ~2 years.