Does Sertraline affect thyroid function? (3+ effects)
In this article, we will explore the potential effects of Sertraline on thyroid function. We will also delve into research studies on this topic and discuss the possible side effects and their management.
Does Sertraline affect thyroid function?
Yes, Sertraline does affect thyroid function. Thyroid dysregulation is a commonly observed phenomenon with antidepressant medications, especially selective serotonin reuptake inhibitors (SSRIs).
Nevertheless, it is important to recognize that individual responses to these medications can differ, and not everyone taking Sertraline may experience thyroid dysregulation.
While there is limited clinical evidence available regarding the effect of Sertraline on thyroid function, several studies have explored potential interactions between SSRIs and thyroid hormones.
The thyroid gland is an important organ in regulating metabolism and energy production by producing thyroxine (T4) and triiodothyronine (T3) hormones. Being an SSRI, Sertraline does influence the level of thyroid hormones, potentially leading to complications such as hypothyroidism and hyperthyroidism (1,2,4).
What does research suggest?
As previously mentioned, research studies have established a connection between SSRI medications and thyroid function.
One such study examining SSRI-induced abnormal thyroid function presented a case of a 70-year-old euthyroid (normal thyroid function) woman who experienced Thyroid Stimulating Hormone (TSH) suppression, a clinical sign of hyperthyroidism while using an SSRI medication (4).
In contrast, a separate study investigating the long-term effects of Sertraline presented a case study involving a 16-year-old undergoing treatment with Sertraline. This case indicated that prolonged use of Sertraline mimics hypothyroidism by displacing bound T4 (5).
Another study focusing on the response of peripheral thyroid hormones to SSRIs suggested that an overactive thyroid (hyperthyroidism) is associated with a more favourable response to antidepressant medications.
Additionally, a separate study exploring the relationship between thyroid function and depression proposed that thyroid hormones enhance antidepressant therapy in the management of mood disorders (3,6,7).
How does Sertraline affect thyroid function?
Sertraline’s mechanism of action involves increasing serotonin levels in the brain. Studies have argued that Sertraline’s effects on the thyroid are directly related to the action of serotonin along the hypothalamus-pituitary-thyroid (HPT) axis.
The HPT axis regulates the production of thyroid hormones T4 and T3. The hypothalamus releases thyrotropin-releasing hormone (TRH), which signals the pituitary gland to produce thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce T4 and T3 (3).
Changes in Serotonin levels, due to Sertraline, may affect the release of TRH and TSH, impacting thyroid hormone production and regulation. Additionally, serotonin receptors along the HPT axis may modulate the release of TRH and TSH affecting thyroid hormone production (1).
Additionally, serotonin influences the body’s stress response. Stress often leads to the release of cortisol, a stress hormone, that may affect the HPT axis and thyroid function. Chronic stress may contribute to thyroid dysregulation in some individuals (8).
Through these mechanisms, Sertraline-induced dysregulation may occur presenting as hypothyroidism or hyperthyroidism.
Clinical manifestations of Sertraline-induced thyroid dysregulation:
Sertraline-induced thyroid dysregulation can manifest in two ways:
Hypothyroidism indicates an underactive thyroid, marked by insufficient thyroid hormone levels, which can be induced by factors such as iodine deficiency and medications like Sertraline. Similar to the side effects of Sertraline, hypothyroidism may present as fatigue, constipation, weight gain, dry skin and more (9).
Hyperthyroidism refers to an overactive thyroid, characterized by increased thyroid hormone production and elevated thyroid radioactive iodine uptake. Just like Sertraline’s side effects, it may as anxiety, diarrhoea, insomnia, irritability, decreased libido etc. (10).
It is noteworthy to recognize that these conditions may enhance Sertraline’s side effect profiles in some individuals and conversely, this could worsen pre-existing conditions such as depression and thyrotoxicosis.
How to manage Sertraline-induced Thyroid dysregulation?
If you suspect that Sertraline is causing thyroid dysregulation, it is important to discuss it with your healthcare provider. Your healthcare provider may consider adjusting the dosage to determine if it can alleviate these concerns.
Moreover, if undesirable effects linked to thyroid dysregulation persist, your doctor may recommend discontinuing the medication under their guidance. They might also recommend transitioning to a different antidepressant medication with a lower likelihood of causing thyroid dysregulation.
Your doctor may also prescribe medications to help you manage thyroid dysregulation disorders in the following ways:
- For hyperthyroidism, the primary treatment options include Carbimazole (20mg per day) or Propylthiouracil (300-450mg per day). Beta-blockers like Propranolol can be used to alleviate hyperthyroidism symptoms such as rapid heart rate and tremors. Radioiodine therapy is also beneficial in shrinking the gland and reducing thyroid hyperactivity.
- For hypothyroidism, the primary treatment is Levothyroxine, typically administered at a daily dosage of 50-75mcg.
Lifestyle modifications, including maintaining a balanced diet, engaging in regular exercise, practising stress management and good sleep hygiene practices, can contribute to optimal thyroid health and reduce the likelihood of thyroid dysregulation.
In this article, we have discussed Sertraline-induced thyroid dysregulation. We have also discussed its clinical manifestations and helpful tips to manage them.
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