TRH and Abnormality of the thyroid gland: For instance, lithium, commonly used in psychiatric conditions in adolescents, generates thyroid abnormalities by interfering with TH production and release (48); amiodarone, a potent antiarrhythmic agent, may lead to thyroid dysfunction by interfering with thyroid hormone production and metabolism, or through direct cytotoxic effects on the thyroid gland (49); and glucocorticoids may interfere with TSH production by directly affecting thyrotropin-releasing hormone (TRH) in the hypothalamus (50).