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Makarow-Gronert A, Margulska A, Strzelecki D, Krajewska K, Gmitrowicz A, Gawlik-Kotelnicka O. Comparison of thyroid-stimulating hormone levels in adolescents with schizophrenia, bipolar disorder, unipolar depression, conduct disorders, and hyperkinetic disorders. Medicine (Baltimore) 2021; 100:e28160. [PMID: 34889284 PMCID: PMC8663859 DOI: 10.1097/md.0000000000028160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to retrospectively compare values of thyroid-stimulating hormone (TSH) in adolescent patients diagnosed with schizophrenia, bipolar disorder, unipolar depression (UNI-DEP), conduct disorders (CD), and hyperkinetic disorders.The research involved 1122 patients (718 women, 64%); aged 12 to 18 hospitalized in the Department of Adolescent Psychiatry, Medical University of Lodz. We analyzed TSH levels in the whole study population and compared it between the above-mentioned subgroups of diagnoses.Mean serum TSH concentration in the studied population (n = 1122) was 2.06 μIU/mL. The values of percentiles were as follows: 2.5th - 0.53 μIU/mL, 10th - 0.89 μIU/mL, 25th - 1.31 μIU/mL, 50th - 1.9 μIU/mL, 75th - 2.6 μIU/mL, 90th - 3.43 μIU/mL, 97.5th - 4.72 μIU/mL. TSH values were negatively correlated with patients' age (P = .00001). Patients with bipolar depression had higher TSH levels than patients with CD (P = .002). Also, when male and female groups were examined separately we found that female patients with UNI-DEP and bipolar disorder had higher TSH levels than female patients with CD (P = .001; P = .001).Our results confirm that there may be a higher prevalence of thyroid dysfunctions in bipolar and UNI-DEP subgroups among adolescents and that it is worthy to consider some kind of interventions regarding thyroid function in depressed individuals.
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Affiliation(s)
- Agnieszka Makarow-Gronert
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Aleksandra Margulska
- Department of Adolescent Psychiatry, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Katarzyna Krajewska
- Department of Child Psychiatry, Babinski Psychiatry Hospital in Lodz, Aleksandrowska 159, Łódź, Poland
| | - Agnieszka Gmitrowicz
- Department of Adolescent Psychiatry, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
| | - Oliwia Gawlik-Kotelnicka
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechosłowacka 8/10, Lodz, Poland
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Hirtz R, Keesen A, Hölling H, Hauffa BP, Hinney A, Grasemann C. No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study. Front Endocrinol (Lausanne) 2020; 11:454. [PMID: 32982959 PMCID: PMC7492205 DOI: 10.3389/fendo.2020.00454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous. Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study ("The German Health Interview and Examination Survey for Children and Adolescents") were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors. Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism. Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.
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Affiliation(s)
- Raphael Hirtz
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Raphael Hirtz
| | - Anne Keesen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Berthold P. Hauffa
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Department of Pediatrics and Center for Rare Diseases Ruhr CeSER, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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Li C, Lai J, Huang T, Han Y, Du Y, Xu Y, Hu S. Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study. Neuropsychiatr Dis Treat 2019; 15:2285-2290. [PMID: 31496710 PMCID: PMC6691940 DOI: 10.2147/ndt.s196661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Previous studies have demonstrated a potentially close relationship between mood disorders and thyroid abnormalities. The aims of this study are to investigate: 1) whether significant differences of thyroid profiles exist between manic and depressive episodes in patients with bipolar disorder (BD); 2) the impact of quetiapine monotherapy on thyroid functions in depressed BD patients. METHODS In this retrospective naturalistic study, we reviewed patients' information based on an electronic medical system from January 2015 to April 2019. Patients with a discharge diagnosis of BD, a current depressive or manic episode, were screened. All depressed BD patients were treated with quetiapine monotherapy for at least one month. For all patients enrolled, the demographic, clinical data and thyroid functions were recorded. The differences between thyroid profiles including total thyroxine (TT4), total triiodothyronine (TT3), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) between patients with different episodes were analyzed. In addition, the change of thyroid functions before and after one-month or three-month quetiapine treatment in depressed BD patients was also analyzed. RESULTS Totally, 28 patients with a manic episode and 58 patients with a depressive episode were enrolled. No significant differences in thyroid profiles were found in patients with different mood episodes. After one-month quetiapine treatment, serum levels of TT4, FT4 and FT3 were significantly reduced (P<0.05), TSH was increased (P=0.015), while TT3 was not significantly changed (P=0.425). After three-month quetiapine treatment, serum levels of TT4, TT3, FT4 and FT3 were significantly reduced (P<0.05), except TSH (P=0.990). CONCLUSION These findings indicate that thyroid functions were not significantly fluctuated between depressive and manic episodes in BD patients. Nonetheless, quetiapine treatment may disturb the thyroid system and needs close monitoring.
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Affiliation(s)
- Chao Li
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.,Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.,Department of Psychiatry, Ningbo Psychiatric Hospital of Zhejiang Province, Ningbo 315000, People's Republic of China
| | - Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.,The Key Laboratory of Mental Disorder's Management in Zhejiang Province , Hangzhou 310003, People's Republic of China.,Brain Research Institute of Zhejiang University , Hangzhou 310003, People's Republic of China
| | - Tingting Huang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Yuqing Han
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Yanli Du
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.,The Key Laboratory of Mental Disorder's Management in Zhejiang Province , Hangzhou 310003, People's Republic of China.,Brain Research Institute of Zhejiang University , Hangzhou 310003, People's Republic of China
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China.,The Key Laboratory of Mental Disorder's Management in Zhejiang Province , Hangzhou 310003, People's Republic of China.,Brain Research Institute of Zhejiang University , Hangzhou 310003, People's Republic of China
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid 2014; 24:1670-751. [PMID: 25266247 PMCID: PMC4267409 DOI: 10.1089/thy.2014.0028] [Citation(s) in RCA: 980] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment. METHODS Task force members identified 24 questions relevant to the treatment of hypothyroidism. The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists. Ethics reviews were provided, when relevant, by a bioethicist. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement. When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. Consensus was achieved for all recommendations by the task force. RESULTS We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non-levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones. CONCLUSIONS We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine-liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects). Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.
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Affiliation(s)
| | - Antonio C. Bianco
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Andrew J. Bauer
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kenneth D. Burman
- Endocrine Section, Medstar Washington Hospital Center, Washington, DC
| | - Anne R. Cappola
- Division of Endocrinology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Francesco S. Celi
- Division of Endocrinology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - David S. Cooper
- Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian W. Kim
- Division of Endocrinology, Rush University Medical Center, Chicago, Illinois
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M. Sara Rosenthal
- Program for Bioethics, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Ayer L, Greaves-Lord K, Althoff RR, Hudziak JJ, Dieleman GC, Verhulst FC, van der Ende J. Blunted HPA axis response to stress is related to a persistent Dysregulation Profile in youth. Biol Psychol 2013; 93:343-51. [PMID: 23603315 DOI: 10.1016/j.biopsycho.2013.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 01/23/2023]
Abstract
The Child Behavior Checklist Dysregulation Profile (DP) in youth has been shown to be a predictor of psychopathology later in life. We examined the activity of the hypothalamic pituitary adrenal (HPA) axis in youth with remitted, new, persistent, and no DP. Data from 489 youth (47% boys) participating in a Dutch longitudinal general population study were included (Wave 1 mean age=11.5, Wave 2=14.2). Wave 2 diurnal cortisol patterns and levels in response to a laboratory stress paradigm were compared in youth with DP at Wave 1 only, Wave 2 only, both Waves, and neither Wave. Youth with the DP at Wave 2 only or at both time points showed blunted cortisol responses to stress relative to the other two groups. There were no group or sex differences in diurnal cortisol activity. More research is needed to determine how the association between DP symptoms and HPA axis functioning changes over time.
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