Central hypothyroidism related to antipsychotic and antidepressant medications: an observational study and literature review

Abstract

Objective: To investigate the final diagnosis and clinical outcome of pati ents referred to endocrinology in our district general hospital with biochemi cal isolated central hypothyroidism (CeH), and whether there is an association between this biochemical picture and treatment with antidepressant and antipsychotic med ications. Methods: We performed a retrospective observational study of patients r eferred to endocrinology with unexplained biochemical isolated CeH over a 5-year period. Results: Of the 29 patients included in the study, 4 were found to have a partially empty or empty sella and 1 to have a bulky pituitary gland whic h was deemed to be an incidental radiological finding. No patients had any clinically significant pathology. On reviewing their medications, 18/29 (62%) were found to be on ps ychotropic medications. Conclusions: Our study suggests a relationship between patients on psychotr opic medications and biochemical isolated CeH, an association only described in a very limited amount of literature prior to this. The mechanism behind this may be suppression of TSH secretion via antagonism of the dopamine-ser otoninergic pathway. Determining a correlation between psychotropic medications and isolated CeH could lead to the avoidance of further radiological investigations an d unnecessary anxiety for patients. However, a larger observational study is needed to pr ovide further evidence to support/refute our finding.

Keywords

• central hypothyroidism
• antipsychotics
• antidepressants
• psychotropic medication