{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T14:34:19Z","timestamp":1787582059013,"version":"build-2736575974"},"reference-count":27,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Region Stockholm Drug and Therapeutic Committee"},{"DOI":"10.13039\/501100008310","name":"the Lisa and Johan Gr\u00f6nberg Foundation","doi-asserted-by":"publisher","award":["2022-00220"],"award-info":[{"award-number":["2022-00220"]}],"id":[{"id":"10.13039\/501100008310","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008310","name":"the Lisa and Johan Gr\u00f6nberg Foundation","doi-asserted-by":"publisher","award":["2023-007"],"award-info":[{"award-number":["2023-007"]}],"id":[{"id":"10.13039\/501100008310","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Autoimmune hypothyroidism is a common endocrine disorder affecting 1% to 2% of the population in iodine sufficient areas. While levothyroxine is standard treatment, a substantial number of patients report persistent symptoms despite adequate treatment. The use of liothyronine as an adjunct to levothyroxine therapy has increased. The psychiatric characteristics of patients receiving liothyronine remain largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examines the association between preexisting psychiatric morbidity and subsequent liothyronine use in autoimmune hypothyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide retrospective cohort study includes all adults in Sweden with autoimmune hypothyroidism and initiated on treatment with thyroid hormones between 2006 and 2020. Data were obtained from the National Patient Register and the National Prescribed Drug Register. Psychiatric morbidity prior to diagnosis was identified using ICD-10 codes and ATC codes for psychiatric medications. Logistic models estimated associations, adjusting for sex, age, and region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 353 708 patients, 44.8% had a history of psychiatric morbidity. These patients were more likely to receive liothyronine (adjusted odds ratio [aOR] 1.90, 95% CI 1.83-1.97, P &amp;lt; .001) than those without a psychiatric history. This was most evident among individuals with affective or anxiety morbidity (aOR 1.91, 95% CI 1.84-1.98, P &amp;lt; .001). No association was found for psychotic morbidity (aOR 1.08, 95% CI 0.98-1.19, P = .11).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with a psychiatric history before autoimmune hypothyroidism were more likely to receive liothyronine, especially among those with affective or anxiety morbidity. This may reflect persistent symptoms and affect subsequent decisions in the treatment of hypothyroidism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgaf337","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T07:49:15Z","timestamp":1749196155000},"page":"e100-e105","source":"Crossref","is-referenced-by-count":2,"title":["Influence of Preexisting Psychiatric Morbidity on Liothyronine Use in Hypothyroidism: A Swedish Nationwide Cohort Study"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6706-010X","authenticated-orcid":false,"given":"Fredric","family":"Hedberg","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital L1:00 , Stockholm SE-171 76 ,","place":["Sweden"]},{"name":"Department of Endocrinology, Karolinska University Hospital , Stockholm 17176 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-7269","authenticated-orcid":false,"given":"Jonatan D","family":"Lindh","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Stockholm 14152 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5789-8470","authenticated-orcid":false,"given":"Buster","family":"Mannheimer","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education at S\u00f6dersjukhuset, Karolinska Institutet , Stockholm 11883 ,","place":["Sweden"]},{"name":"Department of Internal Medicine, Section Diabetes and Endocrinology, S\u00f6dersjukhuset , Stockholm 11883 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1398-5067","authenticated-orcid":false,"given":"Tereza","family":"Planck","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Sk\u00e5ne University Hospital , Malm\u00f6 21428 ,","place":["Sweden"]},{"name":"Department of Clinical Sciences Malm\u00f6, Lund University , Lund 22184 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Skov","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 17176 ,","place":["Sweden"]},{"name":"Department of Medicine, Karlstad Central Hospital , Karlstad 65185 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Lehtihet","sequence":"additional","affiliation":[{"name":"Department of Medicine, Huddinge, Karolinska Institutet , Stockholm 14186 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-6987","authenticated-orcid":false,"given":"Henrik","family":"Falhammar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Karolinska University Hospital , Stockholm 17176 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 17176 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Calissendorff","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Karolinska University Hospital , Stockholm 17176 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 17176 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,6,7]]},"reference":[{"issue":"5","key":"2025121807434073800_dgaf337-B1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/nrendo.2018.18","article-title":"Global epidemiology of hyperthyroidism and hypothyroidism","volume":"14","author":"Taylor","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2025121807434073800_dgaf337-B2","doi-asserted-by":"crossref","first-page":"809341","DOI":"10.4061\/2011\/809341","article-title":"Hypothyroidism and thyroid substitution: historical aspects","volume":"2011","author":"Lindholm","year":"2011","journal-title":"J Thyroid Res"},{"issue":"12","key":"2025121807434073800_dgaf337-B3","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1089\/thy.2014.0028","article-title":"Guidelines for the treatment of hypothyroidism: prepared by the American thyroid association task force on thyroid hormone replacement","volume":"24","author":"Jonklaas","year":"2014","journal-title":"Thyroid"},{"issue":"3","key":"2025121807434073800_dgaf337-B4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1038\/nrendo.2013.258","article-title":"Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism","volume":"10","author":"Wiersinga","year":"2014","journal-title":"Nat Rev Endocrinol"},{"issue":"2","key":"2025121807434073800_dgaf337-B5","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1159\/000339449","article-title":"Use of t4, t4 + t3, and t3 in the dutch population in the period 2005-2011","volume":"1","author":"de Jong","year":"2012","journal-title":"Eur Thyroid J"},{"issue":"3","key":"2025121807434073800_dgaf337-B6","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1159\/000437262","article-title":"Treating hypothyroidism with thyroxine\/triiodothyronine combination therapy in Denmark: following guidelines or following trends?","volume":"4","author":"Michaelsson","year":"2015","journal-title":"Eur Thyroid J"},{"key":"2025121807434073800_dgaf337-B7","unstructured":"The National Board of Health and Welfare . Data from: Statistical Database, Pharmaceutical. Date accessed 28 February 2025. https:\/\/sdb.socialstyrelsen.se\/if_lak\/val.aspx"},{"key":"2025121807434073800_dgaf337-B8","doi-asserted-by":"crossref","first-page":"477","DOI":"10.3389\/fendo.2019.00477","article-title":"A systematic review and meta-analysis of patient preferences for combination thyroid hormone treatment for hypothyroidism","volume":"10","author":"Akirov","year":"2019","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"11","key":"2025121807434073800_dgaf337-B9","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1089\/thy.2021.0270","article-title":"Benefits and harms of levothyroxine\/l-triiodothyronine versus levothyroxine monotherapy for adult patients with hypothyroidism: systematic review and meta-analysis","volume":"31","author":"Millan-Alanis","year":"2021","journal-title":"Thyroid"},{"issue":"1","key":"2025121807434073800_dgaf337-B10","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/s12902-024-01612-6","article-title":"Evaluating the effectiveness of combined T4 and T3 therapy or desiccated thyroid versus T4 monotherapy in hypothyroidism: a systematic review and meta-analysis","volume":"24","author":"Nassar","year":"2024","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"2025121807434073800_dgaf337-B11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1111\/cen.14742","article-title":"Combined T4 + T3 therapy versus T4 monotherapy effect on psychological health in hypothyroidism: a systematic review and meta-analysis","volume":"97","author":"Lan","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"2025121807434073800_dgaf337-B12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1159\/000339444","article-title":"2012 ETA guidelines: the use of L-T4 + L-T3 in the treatment of hypothyroidism","volume":"1","author":"Wiersinga","year":"2012","journal-title":"Eur Thyroid J"},{"issue":"11","key":"2025121807434073800_dgaf337-B13","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s10654-009-9350-y","article-title":"The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research","volume":"24","author":"Ludvigsson","year":"2009","journal-title":"Eur J Epidemiol"},{"issue":"7","key":"2025121807434073800_dgaf337-B14","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/pds.1294","article-title":"The new Swedish Prescribed Drug Register\u2013opportunities for pharmacoepidemiological research and experience from the first six months","volume":"16","author":"Wettermark","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"1","key":"2025121807434073800_dgaf337-B15","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"7","key":"2025121807434073800_dgaf337-B16","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1089\/thy.2005.15.700","article-title":"Increased risk of developing affective disorder in patients with hypothyroidism: a register-based study","volume":"15","author":"Thomsen","year":"2005","journal-title":"Thyroid"},{"issue":"1","key":"2025121807434073800_dgaf337-B17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1471-244X-4-25","article-title":"The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future","volume":"4","author":"Carta","year":"2004","journal-title":"BMC Psychiatry"},{"issue":"6","key":"2025121807434073800_dgaf337-B18","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/j.1399-5618.2010.00853.x","article-title":"Autoimmune diseases, bipolar disorder, and non-affective psychosis","volume":"12","author":"Eaton","year":"2010","journal-title":"Bipolar Disord"},{"issue":"9","key":"2025121807434073800_dgaf337-B19","first-page":"3194","article-title":"Are autoimmune thyroid dysfunction and depression related?","volume":"83","author":"Pop","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2025121807434073800_dgaf337-B20","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1089\/thy.2013.0555","article-title":"Increased psychiatric morbidity before and after the diagnosis of hypothyroidism: a nationwide register study","volume":"24","author":"Thvilum","year":"2014","journal-title":"Thyroid"},{"issue":"1","key":"2025121807434073800_dgaf337-B21","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.1210\/clinem\/dgae140","article-title":"Hypothyroidism and type D personality: results from E-MPATHY, a cross-sectional international online patient survey","volume":"110","author":"Perros","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"2025121807434073800_dgaf337-B22","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/cen.13052","article-title":"Liothyronine use in a 17 year observational population-based study\u2014the tears study","volume":"85","author":"Leese","year":"2016","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"2025121807434073800_dgaf337-B23","doi-asserted-by":"crossref","first-page":"e220149","DOI":"10.1530\/ETJ-22-0149","article-title":"Socioeconomic influence on treatment with liothyronine and desiccated thyroid extract in Denmark","volume":"11","author":"la Cour","year":"2022","journal-title":"Eur Thyroid J"},{"issue":"4","key":"2025121807434073800_dgaf337-B24","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s42000-021-00312-3","article-title":"Subclinical thyroid dysfunction and major depressive disorder","volume":"20","author":"Karakatsoulis","year":"2021","journal-title":"Hormones (Athens)"},{"issue":"3-4","key":"2025121807434073800_dgaf337-B25","first-page":"24","article-title":"Liothyronine for depression: a review and guidance for safety monitoring","volume":"14","author":"Touma","year":"2017","journal-title":"Innov Clin Neurosci"},{"issue":"9","key":"2025121807434073800_dgaf337-B26","doi-asserted-by":"crossref","first-page":"e2023301118","DOI":"10.1073\/pnas.2023301118","article-title":"The echo chamber effect on social media","volume":"118","author":"Cinelli","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"11","key":"2025121807434073800_dgaf337-B27","doi-asserted-by":"crossref","first-page":"1416","DOI":"10.1089\/thy.2018.0325","article-title":"Physician choice of hypothyroidism therapy: influence of patient characteristics","volume":"28","author":"Jonklaas","year":"2018","journal-title":"Thyroid"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgaf337\/63449969\/dgaf337.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/1\/e100\/63449969\/dgaf337.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/111\/1\/e100\/63449969\/dgaf337.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:45:16Z","timestamp":1766061916000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/111\/1\/e100\/8158266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,7]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,6,7]]},"published-print":{"date-parts":[[2025,12,18]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgaf337","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,6,7]]}}}