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Bipolar Disorder - New era of Treatments: High dose Levothyroxine, rTMS and genetics

Published online by Cambridge University Press:  01 September 2022

A. Zamar ,
T. Koutsomitros  and
A. Lulsegged
A. Zamar*
Affiliation:
The London Psychiatry Centre, Rtms Clinic, London, United Kingdom
T. Koutsomitros
Affiliation:
Maastricht University, Cognitive Neuroscience, Maastricht, The Netherlands, Greece Medical Psychotherapeutic Centre, Greek Rtms Clinic, Thessaloniki, Greece
A. Lulsegged
Affiliation:
Health 121, Endocrinology And Diabetes, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Rapid cycling Bipolar disorder and mixed affective states are treatment resistant conditions. Standard treatments are ineffective. Homozygous polymorphism of DIO2 gene is associated 3.75-fold risk of bipolar disorder.

Objectives

High Dose Levothyroxine combined with repetitive transcranial magnetic stimulation (rTMS) in Rapid cycling Bipolar disorder: Is it thyroid disease?

Methods

20 RCBPD with ICD-10criteria for bipolar disorder. All were severely symptomatic. TFTs and ECGs were monitored weekly with cardiology and endocrinology backup. Genetic testing was undertaken for DiO1/DiO2 status.

Results

17 were female, average age 32.4 yrs. 19/20 had Single nucleotide polymorphisms (SNP) of either DIO1, DIO2 or both. All but two patients were treated with rTMS to induce cerebral neuroplasticity. Average pre-treatment fT4 was 17.0 pmol/L , and fT3 4.5 pmol/L Average post-treatment, fT4 was 59.7 pmol/L and fT3 5.3 pmol/L. Average fT4:fT3 ratio pre-treatment was 4:1, and post-treatment was 5:1. HDL range was 200-800 mcg daily for remission. Average dose 472 mcg daily. Discontinuation rate was 0%. All patients had ECG and cardiac review One patient required a dose reduction because of minimal side effects 12 patients needed one mood stabiliser All were in remission for a minimum of 6 months.

Conclusions

We speculate that BPD may be a form of cerebral hypothyroidism and that HDL helps to overcome the deficit while robust inactivating deiodinases in the periphery protect from systemic thyrotoxicosis. This is evidenced by findings of normal clinical examination and elevated rT3. rTMS exercises its well established neuroplastic effect, helping to achieve and maintain remission as an adjunct to HDL.

Disclosure

The London Psychiatry Centre (TLPC) has pending patents for the combined protocol of rTMS and/or Thyroid hormones depending on the territory: - Pending US Patent application: (and/or) US20200384279 - Pending European patent appl

Keywords

bipolar disorderrTMSHigh Dose Levothyroxine
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S410
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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