Strengths
depression, hypothyroid
REGRESSION, HYPOTHYROID
This is the first clinical trial done on synbiotic for quality of life and depression in the hypothyroid patients. Number of patients lost to follow up and patients with poor compliance were minimal, confirming patient reports of high acceptability and increasing the statistical power of the findings. Also, the ITT analysis allowed all participants who were randomized to be included in the statistical analysis. Random assignment of treatment groups allowed for controlling for regression to the mean as an explanation for the apparent treatment effects. Enrolling patients over a short period of time (7 months) minimized the effects of seasonal changes in depression. It also limited the effect of the ups and downs in the prevalence of COVID-19, on the results. The use of placebo and blinding lead to a clearer understanding of the mechanism of action of the intervention. This research was also designed according to the SPIRIT guideline and reported according to the CONSORT checklist.