Higher Liothyronine Use in Hypothyroidism With Psych History

Medscape

17-06-2025

Patients with a psychiatric history prior to their diagnosis of autoimmune hypothyroidism were nearly twice as likely to receive liothyronine treatment as those without such a history, with the effect being most pronounced among those with a history of affective or anxiety disorders.
METHODOLOGY:
Researchers in Sweden conducted a retrospective, population-based cohort study using national registry data to assess the association between prior psychiatric history and subsequent liothyronine use in patients with autoimmune hypothyroidism.
They analysed 353,708 adults who filled at least one prescription for thyroid hormone replacement (liothyronine or levothyroxine) between 2006 and 2020, of whom 44.8% had psychiatric morbidity before the first thyroid hormone prescription.
Among patients with a history of psychiatric morbidity, 96.7% were exposed to affective or anxiety morbidity and 8.3% had a history of psychotic disorders.
The primary endpoint was liothyronine therapy at any point during the median follow-up duration of 63.4 months for patients with prior psychiatric morbidity and 69.2 months for those without.
TAKEAWAY:
Overall, 3.6% of patients received liothyronine during the study period.
Patients with a history of psychiatric morbidity were more likely to receive liothyronine therapy than those without it (adjusted odds ratio [aOR], 1.90; P < .001).
< .001). The strongest association with liothyronine therapy was observed in patients with a history of affective and anxiety disorders (aOR, 1.91; P < .001), whereas no significant difference was found between those with a history of psychotic disorders and those without ( P = .11).
IN PRACTICE:
"This study provides empirical evidence that patients with autoimmune hypothyroidism and a history of psychiatric morbidity are more likely to receive LT3 [liothyronine]-treatment, especially among those with affective or anxiety morbidity," the authors wrote.
"This may reflect lingering symptoms that influence treatment decisions of hypothyroidism, either due to symptoms being misinterpreted as treatment-resistant hypothyroidism or actual physiological differences in thyroid disease within this group," they added.
SOURCE:
This study was led by Fredric Hedberg, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. It was published online on June 07, 2025, in The Journal of Clinical Endocrinology & Metabolism .
LIMITATIONS:
The retrospective design limited the ability to establish causal relationships. Data on thyroid hormone concentrations and treatment indications were lacking, preventing the determination of whether liothyronine prescriptions were due to laboratory abnormalities, persistent symptoms, or physician preferences. Moreover, information on interferon and immune checkpoint inhibitor therapies was unavailable.
DISCLOSURES:
This study was supported by grants from the Region Stockholm Drug and Therapeutic Committee and the Lisa and Johan Grönberg Foundation. The authors declared having no competing interests.