{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:19:29Z","timestamp":1791227969805,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T00:00:00Z","timestamp":1528070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["1P01 MH44210\u201001"],"award-info":[{"award-number":["1P01 MH44210\u201001"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2018,11]]},"abstract":"\n Objectives<\/jats:title>\n \n This report describes the first comparative double\u2010blind, placebo\u2010controlled trial of levothyroxine (L\u2010T\n 4<\/jats:sub>\n ) and triiodothyronine (T\n 3<\/jats:sub>\n ) as adjunctive treatments in rapid cycling bipolar disorder.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Thirty\u2010two treatment\u2010resistant, rapid cycling patients who had failed a trial of lithium were randomized into three treatment arms: L\u2010T\n 4<\/jats:sub>\n , T\n 3<\/jats:sub>\n , or placebo. They were followed for \u22654\u00a0months with weekly clinical and endocrine assessments.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were no statistically significant differences between the groups in age, gender, duration of illness, or thyroid status. Markov chain analyses were employed to assess treatment effects on cycling patterns among mood states (euthymia, depression, mania, and mixed).\n Within groups<\/jats:italic>\n , post\u2010treatment the L\u2010T\n 4<\/jats:sub>\n group spent significantly less time depressed or in a mixed state and greater time euthymic. The T\n 3<\/jats:sub>\n and placebo groups did not differ significantly pre\u2010 and post\u2010treatment in any mood state, although the pattern of effects was the same for the T\n 3<\/jats:sub>\n group as for the L\u2010T\n 4<\/jats:sub>\n group.\n Between groups<\/jats:italic>\n , the L\u2010T\n 4<\/jats:sub>\n group had a significantly greater increase in time euthymic and decrease in time in the mixed state than the placebo group. Other group differences were not significant, although they were in the expected direction.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The findings in this first double\u2010blind study directly comparing the effects of L\u2010T\n 4<\/jats:sub>\n and T\n 3<\/jats:sub>\n therapy against placebo provide evidence for the benefit of adjunctive L\u2010T\n 4<\/jats:sub>\n in alleviating resistant depression, reducing time in mixed states and increasing time euthymic. Adjunctive T\n 3<\/jats:sub>\n did not show statistically significant evidence of benefit over placebo in reducing the time spent in disturbed mood states.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bdi.12657","type":"journal-article","created":{"date-parts":[[2018,6,4]],"date-time":"2018-06-04T23:50:09Z","timestamp":1528156209000},"page":"594-603","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Adjunctive thyroid hormone treatment in rapid cycling bipolar disorder: A double\u2010blind placebo\u2010controlled trial of levothyroxine (L\u2010T\n 4<\/sub>\n ) and triiodothyronine (T\n 3<\/sub>\n )"],"prefix":"10.1111","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4080-595X","authenticated-orcid":false,"given":"Patricia D","family":"Walshaw","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Biobehavioral Sciences Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA) Los Angeles California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Gyulai","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Pennsylvania Philadelphia Pennsylvania, USA"},{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy University Hospital Carl Gustav Carus Technische Universit\u00e4t Dresden Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Psychiatry VA Boston Healthcare System Harvard Medical School & the Center for Healthcare Organization and Implementation Research Boston Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Calimlim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Biobehavioral Sciences Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA) Los Angeles California, USA"},{"name":"Department of 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