High dose levothyroxine combined with repetitive transcranial magnetic stimulation for bipolar disorder with DIO2 gene polymorphisms

Abstract

A 23-year-old woman with a family history of rapid cycling bipolar disorder presented with fatigue, over-eating, oversleeping , low mood & passive suicidal ideation, alternating with mixed affective episodes, namely, depression with flight of ideas complicated by agitation, irritability and anger. She also exhibited phases of hypomania (increased energy associated with marked feelings of well-being and happiness). She was taking high dose Citalopram which is contraindicated. Beck Depression Inventory Score was 38 in keeping with severe depression, Beck anxiety inventory 20 and HCL-32 questionnaire was 29 in keeping with an 80% probability of bipolar depression. A diagnosis of rapid cycling bipolar disorder (RCBPD) was made. Case Report 2 A 53-year-old woman presented with a mixed affective state characterised by profound depression and flight of ideas such as relentless racing thoughts, agitation, distress, hopelessness and intense suicidal thoughts. She was diagnosed with ADHD and bipolar disorder with the latter being poorly treated. Her mood deteriorated substantially following a trip to Australia. Quetiapine was started, and the dose escalated to 700mg daily which partially helped her mood. Levothyroxine 50mcg once daily was commenced and the dose slowly escalated to 400mcg once daily and her mood stabilised. ECG showed sinus rhythm, rate 63bpm.