Understanding The Use Of Thyroid Hormones For Treatment Of Bipolar Disorder Of all the treatments known for rapid cycling, Levothyroxine has the highest evidence base and is the most promising in addition to having few or any side effects. In fact, in this recent article review, Levothryoxine has been ranked as the top choice for treatment of rapid cycling with recommendation grade A. Here, we outline how the use of thyroid hormones for treating bipolar disorder is supported by evidence. All clinicians are required to follow evidence-based medicine in their advice and management to patients, as required by the Good Medical Practice (GMC): In providing clinical care you must: b provide effective treatments based on the best available evidence Assessing Evidence-Based Medicine Levels Evidence-based medicine requires clinicians to consider the best evidence when making decisions for an individual’s care. The Centre for Evidence-Based Medicine (CEBM) sets out an approach for appraising medical research and assessing the level of evidence: Evidence-based medicine level 1B, a Randomised Controlled Trial or RCT (recommendation grade A or B) is higher than level 2A, (Systematic Review of cohorts, e.g. 1million subjects). A panel of experts who have not appraised the literature and rely on their knowledge of physiology, first principle (thyroid is dangerous or ineffective), or bench research, rank as the lowest possible level of evidence, namely level 5 with recommendation Grade D. This level of evidence must not be followed if higher levels of evidence are present. The London Psychiatry Centre publications stand at level 2B, namely 2 consistent cohort studies with Grade B recommendation. What Is The Level Of Evidence For Thyroid Hormones In Bipolar Treatment? According to evidence-based medicine, high dose thyroid is NOT harmful in bipolar disorder patients. Supporting evidence: Efficacy and Safety of Supraphysiologic Doses of Levothyroxine for Patients With Bipolar Depression in Adults: A Systematic Review. Evidence level: 1, recommendation grade A for safety and effectiveness. Treatment of Bipolar Depression With Supraphysiologic Doses of Levothyroxine: A Randomized, Placebo-Controlled Study of Comorbid Anxiety Symptoms. Evidence level: 1B, recommendation A*. Longitudinal studies. Please read paragraph 4 in the Background section. Adjunctive Thyroid Hormone Treatment in Rapid Cycling Bipolar Disorder: A Double-Blind Placebo-Controlled Trial of Levothyroxine (L-T4) and Triiodothyronine (T3) Evidence level: 1B, recommendation A*. High-Dose Levothyroxine for Bipolar Disorder; the Potential Role of Thyroid Function and Genetic Tests. Report from Twenty Cases. Evidence level: 2B Our publication. Bipolar spectrum disorders treatment with a new protocol of High Dose Levothyroxine (HDT) and rTMS and thyroid genetic mutations: a cohort evaluation Evidence level: 2B Our poster,...
