Refractory depression in a patient with peripheral resistance to thyroid hormone (RTH) and the effect of triiodothyronine treatment
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We here described a 39-year-old woman with a severe chronic mood disorder, refractory to antidepressive therapy who showed a significant improvement after a self-prescription of high doses of liothyronine (T3). A modified Refetoff protocol was carried out to study the role of thyroid hormones on her clinical and biochemical responses. Depression severity was assessed by the HAM-D and MADRS Depression Rating Scales. Sequencing of Thyroid Receptors (TR) α1 and β1 genes was done. At the final stage of the study, plasma T3 and free T3 were >800 ng/dl (80–180) and 1409 pg/dl (230–420), respectively. No changes in the cardiovascular parameters, alkaline phosphatase isoenzymes, creatinine kinase, or ferritin were observed. However, an improvement in mood was detected by specific scores (HAM-D 24 to 8; MADRS 40 to 11). No mutations in DNA- and hormone-binding-domains of TRβ1 and TRα1 genes were found in proband, suggesting that the defect could be due to an unknown mutation in either the TR gene or a post receptor abnormality. These results support the existence of a peripheral RTH manifestation as a refractory chronic depression reverted by high doses of T3. Screening for RTH in refractory chronic depression may provide an alternative treatment for this psychiatric condition.
KeywordsThyroid hormones Refractory depression Peripheral resistance to thyroid hormone
This work was supported by the Departamento de Endocrinología, Facultad de Medicina at the Pontificia Universidad Católica de Chile and by FONDECYT Grant 1040834.
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