EFFECTS OF LONG-TERM TREATMENT WITH SERTRALINE (ZOLOFT(R)) SIMULATINGHYPOTHYROIDISM IN AN ADOLESCENT

A 16-year-old depressed adolescent, who had received sertraline treatm ent for the previous 18 months, developed insomnia, daytime somnolence and lack of energy. His thyroid function tests revealed low levels of total T4 with normal levels of free T4 and TSH, and a normal thyrotro pin-releasing hormone (TRH) stimulation test. Discontinuing sertraline resulted in improved sleep and disappearance of daytime somnolence. A lthough daytime somnolence and low levels of total T4 can mimic hypoth yroidism, in this case sertraline only displaced the bound-fraction of total T4 and was not associated with true hypothyroidism.