Thyroid Psychopharmacology: T3 Augmentation, Levothyroxine Dosing, and Lithium-Induced Hypothyroidism

<jats:p>T3 augmentation is worth considering before an atypical antipsychotic after two failed antidepressant trials. Its more favorable side-effect profile spares patients the metabolic and neurologic risks antipsychotics can carry. Lithium-induced thyroid abnormalities are common but usually transient. Most normalize over time without stopping lithium, and when hypothyroidism does develop, the approach is to add thyroid replacement and continue lithium. In refractory rapid cycling, check for a modestly elevated TSH. This subclinical hypothyroidism can feed mood instability, and T4 supplementation may remove that predisposing factor.</jats:p>