Refractory depression in a patient with peripheral resistance to thyroid hormone (RTH) and the effect of triiodothyronine treatment.
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 (T(3)). 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) alpha1 and beta1 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 TRbeta1 and TRalpha1 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 T(3). Screening for RTH in refractory chronic depression may provide an alternative treatment for this psychiatric condition.
Fardella
Carlos E
CE
Departamento de Endocrinología, Pontificia Universidad Católica de Chile, Santiago, Chile. cfardella@med.puc.cl
Artigas
Rocío A
RA
Gloger
Sergio
S
Jiménez
Marcela
M
Carvajal
Cristian A
CA
Krall
Paola M
PM
Quiroz
Danilo
D
Campino
Carmen
C
Mosso
Lorena M
LM
D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy* / Q000235:genetics; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D012651:Self Medication; D037021:Thyroid Hormone Receptors alpha / Q000235:genetics; D037042:Thyroid Hormone Receptors beta / Q000235:genetics; D018382:Thyroid Hormone Resistance Syndrome / Q000150:complications*; D014284:Triiodothyronine / Q000008:administration & dosage*
D000928:Antidepressive Agents; D037021:Thyroid Hormone Receptors alpha; D037042:Thyroid Hormone Receptors beta; D014284:Triiodothyronine