Transient Subclinical Hypothyroidism and Acute Suicidal Ideation Following Treatment with Escitalopram

Thyroid function abnormalities after the use of selective serotonin reuptake inhibitors (SSRIs) have been reported in the extant literature, but the strength of this correlation is unclear and a commentary on its clinical significance is necessary. The one-week hospital course of a 16-year-old male presenting with worsening of major depressive disorder after the initiation of escitalopram was significant for the development of transient subclinical hypothyroidism (SCH). An analysis of the aberrant thyroid indices in the setting of escitalopram use was pursued. Data from previous studies suggesting similar events were reviewed in order to better characterize the nature of this association. The exact diagnostic criterion for SCH in the pediatric population has been undergoing reform and, based on the newer suggestions, our patient was assessed to have transient SCH. Thyroid hormone derangement following SSRI use has been reported in the past; however, the clinical implications of developing transient SCH in adolescent patients with major depression who are taking SSRIs is still unclear and not well understood at this time. The importance of having a better understanding of this potential interaction is marked by both the increased risk for suicidal ideation in the pediatric population with the use of SSRIs, as well as the confounding overlap of symptom presentation between hypothyroidism and major depressive disorder.