Is goiter a contraindication to treatment with serotonine reuptake inhibitors?/nA patient is asking

Fråga: Is goiter a contraindication to treatment with serotonine reuptake inhibitors?

A patient is asking her general practitioner after having been told so by a homeopath.

Sammanfattning: We have found no evidence in the literature supporting the idea that serotonine reuptake inhibitors should not be used in patients with hypothyroidism.

Svar: A thorough literature search, including Medline, Drugline and common pharmacological handbooks, has been performed. We have found no information supporting the idea that treatment with serotonine reuptake inhibitors (SSRI) should be contraindicated in patients with hypothyroidism.

Treatment with lithium has been shown to cause a, most commonly transient, decrease in thyroid hormone levels (1). Decreased thyroid function has been discussed in the literature in connection with tricyclic antidepressants, but this effect has not been confirmed in any clinical trial.

The effect of antidepressant treatment on the thyroid axis has been investigated in two randomised, double-blind studies, including a total of 72 depressed patients, comparing fluvoxamine and either imipramine/placebo or desipramine (2,3). No clinically significant effects were seen on thyroid hormone levels.

Hypothyroidism in itself may be associated with depression and should be carefully treated before the need of additional antidepressive treatment is evaluated.