Suboptimal thyroid levels - even within normal range - may affect clinicial outcomes in bipolar disorder

As the instruments of laboratory science become more precise, so too does our understanding of how even slight biochemical imbalances in the body may potentially affect human health.

A new study funded by the National Institute of Mental Health reports that as many as two out of every three patients with bipolar depression may have suboptimal thyroid hormone levels. These slight
imbalances, though still within the "normal range," appear to make these patients much more resistant to standard drug treatments with anti-depressants.

Researchers measured thyroid hormone levels in 65 patients diagnosed in the depressive phase of bipolar disorder. For the next 50 months, they tracked their recovery after treatment with mood-stabilizing drug therapies, including lithium carbonate and various antidepressant medications.

While it's already well known that both overt and subclinical thyroid dysfunction are strongly linked with depression, the effect of more subtle thyroid imbalances has not yet been thoroughly studied.

The study found that patients with low normal levels of free thyroxine (T4) index or high normal levels of thyroid-stimulating hormone (TSH) levels were much less responsive to various drug treatments for depression. On average, these patients took nearly one year to respond to drug therapy - at least four months longer than patients who had an optimal thyroid profile.

Thyroid hormone imbalances in these patients could develop as the central nervous system becomes unable to self-regulate itself properly under the stress of chronic depression. The imbalances could also be a first early warning signal that thyroid failure is more likely to develop in these patients in the future.

"…it appears likely that patients with mood disorders are particularly vulnerable to even minor variations in thyroid hormone levels," researchers concluded. The imbalances that produced an effect on treatment outcomes were even milder than those falling under the subclinical definition of hypothyroidism. For this reason, a suboptimal thyroid profile - still within the "normal" range - may be an important modifiable risk factor in bipolar depression.

"These results add to the growing literature in support of the idea that thyroid measures in the low normal range may result in a less than optimal outcome in mood disorders," the study asserted.

NOTE: The Comprehensive Thyroid Assessment is a thorough functional evaluation of central and peripheral thyroid metabolism and thyroid autoimmunity, specially designed to reveal subtle, preclinical imbalances. Because the thyroid is the main regulator of human metabolism, even slight imbalances can affect a wide range of physiological and psychological conditions, including mood disorders, obesity, chronic fatigue, digestive problems, cognitive and sexual dysfunction, and cardiovascular disease.

In addition to analyzing central thyroid regulation (TSH and free T4) and thyroid autoimmunity (anti-TG and anti-TPO), this in-depth assessment evaluates peripheral thyroid function using free T3, rT3, free T3/rT3 ratio, and free T4/free T3 ratio. Each test report displays markers within their functional metabolic pathways for increased clinical relevance and insight, with professional commentary based on individual results. Find out more about the test click on the link above "The Comprehensive Thyroid Assessment.

Source: Cole DP, Thase ME, Mallinger AG, Soares JC, Luther JF, Kupfer DJ, Frank E. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry 2002;159:116-121.

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