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Zhang X, Lu Q, Luo Y, Wang L, Tian Y, Luo X. The causal relationship between major depression disorder and thyroid diseases: A Mendelian randomization study and mediation analysis. J Affect Disord 2024; 359:287-299. [PMID: 38788859 DOI: 10.1016/j.jad.2024.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/23/2024] [Accepted: 05/19/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Studies have been conducted on the relationship between depression and thyroid diseases and function, its causal relationship remains unclear. METHODS Using summary statistics of genome-wide association studies of European and East Asian ancestry, we conducted 2-sample bidirectional Mendelian randomization to estimate the association between MDD and thyroid function (European: normal range TSH, T4, T3, fT4, TPOAb levels and TPOAb-positives; East Asian: T4) and thyroid diseases (hypothyroidism, hyperthyroidism, and Hashimoto's thyroiditis), and used Mediation analysis to evaluate potential mediators (alcohol intake, antidepressant) of the association and calculate the mediated proportions. RESULTS It was observed a significant causal association between MDD on hypothyroidism (P = 8.94 × 10-5), hyperthyroidism (P = 8.68 × 10-3), and hashimoto's thyroiditis (P = 3.97 × 10-5) among European ancestry, which was mediated by Alcohol intake (alcohol intake versus 10 years previously for hypothyroidism (P = 0.026), hashimoto's thyroiditis (P = 0.042), and alcohol intake frequency for hypothyroidism (P = 0.015)) and antidepressant (for hypothyroidism (P = 0.008), hashimoto's thyroiditis (P = 0.010)), but not among East Asian ancestry (PMDD-hypothyroidism = 0.016, but β direction was different; PMDD-hyperthyroidism = 0.438; PMDD-hashimoto's thyroiditis = 0.496). There was no evidence for bidirectional causal association between thyroid function mentioned above and MDD among both ancestry (all P > 0.05). CONCLUSION We importantly observed a significant causal association between MDD on risk of hypothyroidism, hyperthyroidism, and hashimoto's thyroiditis among European ancestry, and Alcohol intake and antidepressant as mediators for prevention of hypothyroidism, hashimoto's thyroiditis attributable to MDD.
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Affiliation(s)
- Xu Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China.
| | - Qiao Lu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Yiping Luo
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Luyao Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Yuan Tian
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China
| | - Xuemei Luo
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China
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Yu ZW, Shan ZY. Thyroid function variations within the reference range and cognitive function: A two-sample Mendelian randomization study. J Affect Disord 2024; 357:156-162. [PMID: 38703900 DOI: 10.1016/j.jad.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The causal relationship between thyroid function variations within the reference range and cognitive function remains unknown. We aimed to explore this causal relationship using a Mendelian randomization (MR) approach. METHODS Summary statistics of a thyroid function genome-wide association study (GWAS) were obtained from the ThyroidOmics consortium, including reference range thyroid stimulating hormone (TSH) (N = 54,288) and reference range free thyroxine (FT4) (N = 49,269). GWAS summary statistics on cognitive function were obtained from the Social Science Genetic Association Consortium (SSGAC) and the UK Biobank, including cognitive performance (N = 257,841), prospective memory (N = 152,605), reaction time (N = 459,523), and fluid intelligence (N = 149,051). The primary method used was inverse-variance weighted (IVW), supplemented with weighted median, Mr-Egger regression, and MR-Pleiotropy Residual Sum and Outlier. Several sensitivity analyses were conducted to identify heterogeneity and pleiotropy. RESULTS An increase in genetically associated TSH within the reference range was suggestively associated with a decline in cognitive performance (β = -0.019; 95%CI: -0.034 to -0.003; P = 0.017) and significantly associated with longer reaction time (β = 0.016; 95 % CI: 0.005 to 0.027; P = 0.004). Genetically associated FT4 levels within the reference range had a significant negative relationship with reaction time (β = -0.030; 95%CI:-0.044 to -0.015; P = 4.85 × 10-5). These findings remained robust in the sensitivity analyses. CONCLUSIONS Low thyroid function within the reference range may have a negative effect on cognitive function, but further research is needed to fully understand the nature of this relationship. LIMITATIONS This study only used GWAS data from individuals of European descent, so the findings may not apply to other ethnic groups.
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Affiliation(s)
- Zi-Wei Yu
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang 110001, China
| | - Zhong-Yan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang 110001, China.
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Roa Dueñas OH, Hofman A, Luik AI, Medici M, Peeters RP, Chaker L. The Cross-sectional and Longitudinal Association Between Thyroid Function and Depression: A Population-Based Study. J Clin Endocrinol Metab 2024; 109:e1389-e1399. [PMID: 37855318 PMCID: PMC11031221 DOI: 10.1210/clinem/dgad620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
CONTEXT An association of thyroid function with mood disorders has been widely suggested, but very few studies have examined this association longitudinally. OBJECTIVE We assessed the cross-sectional and longitudinal association between thyroid function and depression in a population-based cohort. METHODS A total of 9471 individuals were included in cross-sectional analyses, of whom 8366 had longitudinal data. At baseline, we assessed thyroid function using serum samples (thyrotropin [TSH], free thyroxine (FT4), and thyroid peroxidase antibodies) and depressive symptoms using the Centre for Epidemiologic Studies Depression (CES-D) scale. Incident depressive events (n = 1366) were continuously followed up with the CES-D and clinical interviews. We analyzed the cross-sectional association of thyroid function and thyroid disease with depressive symptoms using linear and logistic regression, and the longitudinal association with Cox proportional hazard models for depressive events. RESULTS Lower TSH levels and lower and higher FT4 levels were cross-sectionally associated with more depressive symptoms with a B value of -0.07 per 1 unit increase of natural log-transformed TSH (95% CI -0.11; -0.04). Furthermore, hypothyroidism was cross-sectionally associated with less depressive symptoms and hyperthyroidism with more depressive symptoms. Longitudinally, there was a U-shaped association between FT4 and incident depressive events but only in euthyroid participants. CONCLUSION We show a cross-sectional association between thyroid (dys)function with depressive symptoms, and a U-shaped association between FT4 and incident depressive events in euthyroid individuals. Our findings suggest an association of thyroid function with the risk of developing depression, albeit small. Reverse causation and additional underlying factors may also contribute to the association.
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Affiliation(s)
| | - Amy Hofman
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Trimbos Institute—The Netherlands Institute of Mental Health and Addiction, 3521 VS Utrecht, The Netherlands
| | - Marco Medici
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Epidemiology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands
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Babajide O, Kjaergaard AD, Deng W, Kuś A, Sterenborg RBTM, Åsvold BO, Burgess S, Teumer A, Medici M, Ellervik C, Nick B, Deloukas P, Marouli E. The role of thyroid function in borderline personality disorder and schizophrenia: a Mendelian Randomisation study. Borderline Personal Disord Emot Dysregul 2024; 11:2. [PMID: 38355654 PMCID: PMC10868101 DOI: 10.1186/s40479-024-00246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Genome-wide association studies have reported a genetic overlap between borderline personality disorder (BPD) and schizophrenia (SCZ). Epidemiologically, the direction and causality of the association between thyroid function and risk of BPD and SCZ are unclear. We aim to test whether genetically predicted variations in TSH and FT4 levels or hypothyroidism are associated with the risk of BPD and SCZ. METHODS We employed Mendelian Randomisation (MR) analyses using genetic instruments associated with TSH and FT4 levels as well as hypothyroidism to examine the effects of genetically predicted thyroid function on BPD and SCZ risk. Bidirectional MR analyses were employed to investigate a potential reverse causal association. RESULTS Genetically predicted higher FT4 was not associated with the risk of BPD (OR: 1.18; P = 0.60, IVW) or the risk of SCZ (OR: 0.93; P = 0.19, IVW). Genetically predicted higher TSH was not associated with the risk of BPD (OR: 1.11; P = 0.51, IVW) or SCZ (OR: 0.98, P = 0.55, IVW). Genetically predicted hypothyroidism was not associated with BPD or SCZ. We found no evidence for a reverse causal effect between BPD or SCZ on thyroid function. CONCLUSIONS We report evidence for a null association between genetically predicted FT4, TSH or hypothyroidism with BPD or SCZ risk. There was no evidence for reverse causality.
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Affiliation(s)
- Oladapo Babajide
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Alisa D Kjaergaard
- Aarhus University Hospital, Steno Diabetes Center, Hedeager Aarhus, Denmark
| | - Weichen Deng
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Aleksander Kuś
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Rosalie B T M Sterenborg
- Erasmus Medical Center, Academic Center for Thyroid Diseases, Department of Internal Medicine, Rotterdam, Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Department of Endocrinology, Clinic of Medicine, NTNU, Norwegian University of Science and Technology &, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Burgess
- University of Cambridge, MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alexander Teumer
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK German Center for Cardiovascular Research, Berlin, Germany
| | - Marco Medici
- Erasmus Medical Center, Academic Center for Thyroid Diseases, Department of Internal Medicine, Rotterdam, Netherlands
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bass Nick
- Division of Psychiatry, University College London, Mental Health Neuroscience, London, UK
| | - Panos Deloukas
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Eirini Marouli
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK.
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Liu S, Sun Q, Gu Q, Bao Y, Wang W, Qin X, Yuan X. Hypothyroidism is a causal determinant of age-related cataract risk in European population: a Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1254793. [PMID: 38375193 PMCID: PMC10874999 DOI: 10.3389/fendo.2024.1254793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024] Open
Abstract
Objective To determine whether there is a causal relationship between thyroid dysfunction and the risk of age-related cataract (ARC) in the European population. Design A two-sample Mendelian randomization (MR) study. Methods Hypothyroidism, hyperthyroidism, free thyroxine (fT4), and thyrotropin (TSH) were selected as exposures. The single nucleotide polymorphisms (SNP) of hypothyroidism and hyperthyroidism were obtained from the genome-wide association studies (GWAS) of the IEU database, including 337,159 subjects. Data for fT4 and TSH (72,167 subjects) were extracted from the ThyroidOmics Consortium. ARC was used as the outcome. The SNPs associated with ARC were selected from a GWAS of 216,362 individuals in the FinnGen database. The main method used was the inverse variance-weighted method, together with four complementary methods. Sensitivity analyses were performed using Cochran's Q test, MR-PRESSO, MR-Egger regression and leave-one-out test. MR pleiotropy was used to test for pleiotropy. MR Steiger test was used to test for the directionality. Results Two-sample MR analysis revealed a positive association between genetically predicted hypothyroidism and risk of ARC (OR = 2.501, 95% CI: 1.325-4.720; P = 0.004). Hyperthyroidism, circulating fT4 and TSH levels did not have a significant causal effect on ARC (P > 0.05). The results were robust and reliable, and no horizontal pleiotropy was found after sensitivity analyses. In the MR Steiger test, we found no reverse causal effects of hypothyroidism on the ARC (P <0.001). Conclusions Our study provides strong evidence that hypothyroidism is a causal determinant of ARC risk.
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Affiliation(s)
- Shu Liu
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qi Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qingwei Gu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yujie Bao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wei Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaodong Qin
- Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinran Yuan
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Kong L, Shen Y, Hu S, Lai J. The impact of quetiapine monotherapy or in combination with lithium on the thyroid function in patients with bipolar depression: A retrospective study. CNS Neurosci Ther 2024; 30:e14342. [PMID: 37424160 PMCID: PMC10848093 DOI: 10.1111/cns.14342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/09/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE This study aims to investigate whether quetiapine monotherapy or in combination with lithium significantly disturbs thyroid function in depressed patients with bipolar disorder (BD), and whether difference exists in the post-treatment thyroid function between the two therapies. METHODS Based on the electric medical records, outpatients and inpatients with a current depressive episode of BD from January 2016 to December 2022 were screened. All patients were treated with quetiapine monotherapy or in combination with lithium. In addition to the demographic data and depression scale, thyroid profiles including total thyroxine (TT4), total triiodothyronine (TT3), free thyroxine (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and antithyroglobulin antibody (TGAb) were recorded, analyzed, and compared before and after the treatment. RESULTS Totally, 73 eligible patients were enrolled, including 53 in the monotherapy group (MG) and 20 in the combined therapy group (CG). No significant differences in thyroid profiles were detected between the two groups at the baseline (p > 0.05). After one-month treatment, in the MG, serum levels of TT4, TT3, FT4, and FT3 reduced significantly (p < 0.05), while TSH, TPOAb, and TGAb increased significantly (p < 0.05). In the CG, serum levels of TT4, TT3, and FT4 reduced and TSH increased following one-month treatment (p < 0.05), with no significant change in FT3, TPOAb, or TGAb (p > 0.05). After one-month treatment, no difference of TT4, TT3, FT4, FT3, and TSH was found between the two groups (p > 0.05). CONCLUSION Both quetiapine monotherapy and a combined therapy with lithium significantly disturbed thyroid function in patients with bipolar depression, while quetiapine monotherapy seems to be associated with immune dysregulation in the thyroid.
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Affiliation(s)
- Lingzhuo Kong
- Department of Psychiatry, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yuting Shen
- School of PsychiatryWenzhou Medical UniversityWenzhouChina
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- The Key Laboratory of Mental Disorder's Management in Zhejiang ProvinceHangzhouChina
- Brain Research Institute of Zhejiang UniversityHangzhouChina
- Zhejiang Engineering Center for Mathematical Mental HealthHangzhouChina
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brian Medicine, and MOE Frontier Science Center for Brain Science and Brain‐Machine IntegrationZhejiang University School of MedicineHangzhouChina
| | - Jianbo Lai
- Department of Psychiatry, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
- The Key Laboratory of Mental Disorder's Management in Zhejiang ProvinceHangzhouChina
- Brain Research Institute of Zhejiang UniversityHangzhouChina
- Zhejiang Engineering Center for Mathematical Mental HealthHangzhouChina
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brian Medicine, and MOE Frontier Science Center for Brain Science and Brain‐Machine IntegrationZhejiang University School of MedicineHangzhouChina
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7
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Li M, Wang XW, Wang XQ, Zhang JJ, Zhang XY. Prevalence and risk factors for subclinical hypothyroidism in older patients with major depressive disorder. BMC Geriatr 2024; 24:15. [PMID: 38177993 PMCID: PMC10768208 DOI: 10.1186/s12877-023-04584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is highly correlated with major depressive disorder (MDD). However, the prevalence and risk factors for SCH in older patients with MDD have rarely been reported in China. METHODS This cross-sectional study included 266 older MDD patients with SCH was performed. Clinical and anthropometric, biochemical, and thyroid function data were collected. Depression, anxiety, and psychotic symptoms were assessed using the Hamilton Depression Scale, the Hamilton Anxiety Scale, and the Positive and Negative Syndrome Scale positive subscale, respectively. RESULTS Among older patients with MDD, the prevalence of SCH was 64.7% (172/266). Compared to patients without SCH, older MDD patients with SCH had a longer disease course and higher TSH, A-TG, A-TPO, HDL-C, LDL-C, TC, FPG, and systolic pressure levels (all P ≤ 0.002). Furthermore, disease progression (OR 1.082, 95% CI 1.020-1.147, P = 0.009), A-TG (OR 1.005, 95% CI 1.001-1.009, P = 0.017), TC (OR 2.024, 95% CI 1.213-3.377, P = 0.007), FPG (OR 2.916, 95% CI 1.637-5.194, P < 0.001), systolic pressure (OR 1.053, 95% CI 1.008-1.100, P = 0.022) were independently associated with SCH, in older patients with MDD. CONCLUSIONS Our findings suggest a high prevalence of SCH in older patients with MDD. Several demographic and clinical variables were independently associated with SCH in older patients with MDD.
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Affiliation(s)
- Min Li
- Department of Pharmaceutical and Food Engineering, Shanxi University of Chinese Medicine, Jinzhong, China
| | - Xiu-Wen Wang
- Department of Pharmaceutical and Food Engineering, Shanxi University of Chinese Medicine, Jinzhong, China
| | - Xiao-Qian Wang
- Shanxi key laboratory of Chinese medicine encephalopathy, National international joint research center for molecular Chinese medicine, Shanxi University of Chinese Medicine, Shanxi Jinzhong, 030619, China
| | - Jian-Jun Zhang
- Shanxi key laboratory of Chinese medicine encephalopathy, National international joint research center for molecular Chinese medicine, Shanxi University of Chinese Medicine, Shanxi Jinzhong, 030619, China.
- Experimental Management Center, Shanxi University of Chinese Medicine, Jinzhong, China.
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Rd, Beijing, 100101, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Rd, Beijing, 100101, China.
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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8
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Liang H, Wang JM, Wei XQ, Su XQ, Zhang BX. Thyroid function, renal function, and depression: an association study. Front Psychiatry 2023; 14:1182657. [PMID: 38179254 PMCID: PMC10765600 DOI: 10.3389/fpsyt.2023.1182657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/15/2023] [Indexed: 01/06/2024] Open
Abstract
Objective To investigate the correlations between thyroid function, renal function, and depression. Methods Clinical data of 67 patients with Major depressive disorder (MDD) and 36 healthy control subjects between 2018 and 2021 were collected to compare thyroid and renal function. Thyroid and renal functions of depressed patients were then correlated with the Hamilton Depression Rating Scale (HAMD) and the Hamilton Anxiety Rating Scale (HAMA).Spearman correlation analysis was used to find the correlation between renal function, thyroid function, and depression. A logistic regression was performed to find significant predictors of depression. Results Triiodothyronine protamine (T3), thyroxine (T4), free triiodothyronine protamine (FT3), uric acid, sodium, and anion gap were lower in the MDD group than in the control group (p < 0.05). Correlation analysis of thyroid function, renal function, and factor terms of HAMD in the MDD group suggested that diurnal variation, hopelessness, and depression level were positively correlated with thyrotropin (TSH) (p < 0.05). Cognitive disturbance, retardation, and depression level were negatively correlated with creatinine (p < 0.05). Diurnal variation was negatively correlated with sodium ion (p < 0.01); hopelessness and depression level were positively correlated with chloride ion (p < 0.05); diurnal variation, retardation, and depression level were negatively correlated with anion gap (p < 0.05). Diurnal variation (p < 0.01) and retardation (p < 0.05) were negatively correlated with osmolality. Cognitive disturbance and depression level were positively correlated with estimated glomerular filtration rate (eGFR) (p < 0.05). In the MDD group, correlation analysis of thyroid function, renal function, and HAMA factor terms suggested that the total HAMA score and anxiety level were positively correlated with chloride ion (p < 0.05); psychic anxiety, total HAMA score, and anxiety level were negatively correlated with anion gap (p < 0.05). Furthermore, a low level of anion gap was an independent risk factor for depression and anxiety levels (p < 0.05). Conclusion Low thyroid function and reduced waste metabolized by the kidneys in patients with MDD suggest a low intake and low metabolism in depressed patients. In addition, subtle fluctuations in the anion gap in depressed patients were strongly correlated with the degree of depression and anxiety.
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Affiliation(s)
- Hai Liang
- Department of Neurology, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Department of Neurology, The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jin-min Wang
- Department of Neurology, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiao-qian Wei
- Department of Integrative Medicine and Psychiatry, Xiamen Xianyue Hospital, Xiamen, China
| | - Xiao-qin Su
- Department of Neurology, The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Bi-xia Zhang
- Department of Neurology, Minhou Country Hospital, Fuzhou, China
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Yazdaan HE, Jaya F, Sanjna F, Junaid M, Rasool S, Baig A, Natt MZ, Maurya N, Iqbal S, Yeldo BA, Khan AS, Varrassi G, Kumar S, Khatri M, Awan SK. Advances in Thyroid Function Tests: Precision Diagnostics and Clinical Implications. Cureus 2023; 15:e48961. [PMID: 38111456 PMCID: PMC10726078 DOI: 10.7759/cureus.48961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
This narrative review explores the evolving field of thyroid function testing, explicitly highlighting the significance of precision diagnostics and their substantial impact on clinical practice. Commencing with a comprehensive examination of the historical progression of thyroid diagnostics, the discourse proceeds to explore recent developments, highlighting the paramount importance of accuracy in testing methods. The primary issue under consideration is the crucial requirement for accuracy in the field of therapeutic practice. The review critically examines the problems related to the interpretation, standardization, and ethical considerations in examining advanced laboratory techniques, novel biomarkers, and state-of-the-art technologies like immunoassays, molecular testing, and automation. The focus on the paradigm shift towards precision diagnostics brings attention to the complex connection between test results and their direct influence on patient care. This investigation expands upon the incorporation of imaging and molecular diagnostics, highlighting the rising significance of precision in customizing treatment strategies. In summary, the study provides a prospective viewpoint, recognizing the persistent obstacles and highlighting the want for dependable, uniform methodologies in thyroid diagnostics. This narrative's primary objective is to guide physicians, researchers, and stakeholders in effectively navigating the intricate nature of contemporary thyroid function tests, with a particular emphasis on resolving the fundamental issue of precision.
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Affiliation(s)
- Hamd E Yazdaan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Fnu Jaya
- Medicine, Ziauddin University, Karachi, PAK
| | - Fnu Sanjna
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Maha Junaid
- Medicine, Shifa College of Medicine, Islamabad, PAK
| | - Sohaib Rasool
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Ahmadullah Baig
- Internal Medicine, Allama Iqbal Medical College/ Jinnah Hospital, Lahore, PAK
| | | | - Nikhil Maurya
- Medicine, Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, IND
| | - Subhan Iqbal
- Diagnostic Radiology, Dr. Ziauddin Hospital North Nazimabad, Karachi, PAK
| | | | - Alina S Khan
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
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10
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Sun QM, Zhang S, Xu YH, Ma J, Zhang YT, Zhang XY. Depression severity partially mediates the association between thyroid function and psychotic symptoms in first-episode, drug-naive major depressive disorder patients with comorbid anxiety at different ages of onset. J Affect Disord 2023; 339:342-347. [PMID: 37437726 DOI: 10.1016/j.jad.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/06/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Anxiety and psychotic symptoms are common in patients with major depressive disorder (MDD), with a strong association with thyroid function. Age of onset contributes to the heterogeneity of MDD patients. This study aimed to assess the prevalence of psychotic symptoms in MDD patients with comorbid anxiety and to explore the relationship between thyroid function and psychotic symptoms by ages of onset. METHODS A total of 894 first-episode, drug-naïve Chinese Han MDD patients with comorbid anxiety were recruited. Thyroid function and psychometric measures including Hamilton Anxiety Scale, Hamilton Depression Scale, and Positive and Negative Syndrome Scale were evaluated. Patients were divided into early adulthood onset (EAO, < 45 years old) and mid-adulthood onset (MAO, ≥ 45 years old) groups. RESULTS The MAO subgroup had a higher prevalence of psychotic symptoms compared to EAO subgroup. TSH and TPOAb levels were positively correlated with psychotic symptoms severity, with a more pronounced effect in MAO subgroup. Furthermore, MDD severity partially mediated the effects of TPOAb and TSH levels on psychotic symptoms in both subgroups. LIMITATIONS A causal relationship could not be demonstrated with this cross-sectional study, and the results should be limited to first-episode, drug-naïve MDD patients without considering more potential confounders. Moreover, the male-to-female ratio imbalance is present. CONCLUSIONS Our results indicated that age of onset moderated the association between thyroid function and psychotic symptom, and depression severity partially mediated the effects of thyroid function on psychotic symptoms, suggesting thyroid function may serve as a biomarker of psychotic symptoms in MDD patients with anxiety.
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Affiliation(s)
- Qi-Meng Sun
- The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, China
| | - Sen Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, China
| | - Ya-Hui Xu
- The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, China
| | - Jun Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | | | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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11
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Odawara S, Shimbo T, Yamauchi T, Kobayashi D. Association of Low-Normal Free T4 Levels With Future Major Depression Development. J Endocr Soc 2023; 7:bvad096. [PMID: 37528949 PMCID: PMC10387582 DOI: 10.1210/jendso/bvad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 08/03/2023] Open
Abstract
Context Hyperthyroidism and overt and subclinical hypothyroidism are associated with major depression; however, the association of major depression across the spectrum of thyroid function within the normal range is unknown. Objective We investigated whether higher or lower levels of free thyroxine (T4) and thyrotropin (TSH) within the normal range are associated with major depression. Methods This was a retrospective cohort study of 66 960 participants with normal thyroid function who visited for health checkups (St. Luke's International Hospital, 2005-2018). The primary outcome was the development of major depression during the follow-up period. Participants were divided into 3 equal groups based on baseline free T4 or TSH values (low-, middle-, or high-normal), and the incidence of major depression was compared using the Cox proportional hazard model after adjusting for potential covariates. Results During the median follow-up of 1883 days, 1363 (2.0%) patients developed major depression. The low-normal free T4 group had a significantly higher risk of major depression (adjusted HR 1.15; 95% CI, 1.01-1.31), but not the high-normal free T4 group or TSH groups. The association between low-normal free T4 and the development of major depression was maintained, rather more obvious, upon exclusion of participants whose thyroid hormone levels became abnormal during follow-up compared with data from all participants (adjusted HR 1.24; 95% CI, 1.07-1.43). Conclusion In this cohort, low-normal free T4 was associated with an increased risk of future major depression, even if subsequent hormone levels were maintained within the normal range. The magnitude of the impact of low-normal free T4 was relatively mild.
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Affiliation(s)
- Sara Odawara
- Correspondence: Sara Odawara, MD, PhD, Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Takuro Shimbo
- Department of Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0332, Japan
- Department of Medicine, Fujita Health University, Aichi 470-1192, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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12
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Wu J, Wang Z, Xu H, Yang L, Liu J, Zheng Y, Kang C, Wang X, Shi J, Zhao N, Zhang XY. Thyroid dysfunction in young, first-episode and drug-naïve patients with major depressive disorder: prevalence and associated clinical factors. Front Psychiatry 2023; 14:1156481. [PMID: 37457778 PMCID: PMC10348838 DOI: 10.3389/fpsyt.2023.1156481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The incidence of thyroid dysfunction (TD) and major depressive disorder (MDD) is increasing year by year in the general population. However, the prevalence and correlates of TD in first-episode drug-naive (FEDN) MDD patients have not been explored. This study sought to fill this gap and examine the association between TD and MDD. Methods We recruited 1,289 FEDN MDD patients aged 18 ~ 45 years. A total of 1,289 FEDN MDD outpatients were recruited. Demographical and suicide data were collected for each patient, and lipid profiles, thyroid function, and fasting blood glucose (FBG) levels were measured. The Hamilton Depression Scale 17 (HAMD-17) was assessed for depression. Results The prevalence of TD in young FEDN MDD patients was 64.86%. Compared with those without TD, patients with TD had longer duration of illness, greater HAMD score, higher BMI, TG, TC, and LDL-C levels, and higher suicide attempt rates, but lower HDL-C and FBG levels. Further logistic regression indicated that duration of illness, HAMD score, TC, HDL-C, BMI, and FBG levels were significantly associated with TD. Limitations No causal relationship can be drawn due to the cross-sectional design. Conclusion TD is common in young FEDN MDD patients. So clinicians should monitor thyroid function in patients with MDD.
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Affiliation(s)
- Jinbo Wu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | | | - Hongjiao Xu
- Qingdao Mental Health Center, Qingdao, China
| | - Liying Yang
- Dalian No.7 People's Hospital, Dalian, Liaoning Province, China
| | - Jiacheng Liu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yue Zheng
- Peking University Sixth Hospital, Beijing, China
| | - Chuanyi Kang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaohong Wang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingjing Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Na Zhao
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Dai W, Liu J, Xie H, Teng Z, Luo W, Yuan H, Chen J, Liu M, Zhang X. Association between subclinical hypothyroidism and psychotic features in Chinese young adults with first-episode and untreated major depressive disorder. J Affect Disord 2023; 333:209-215. [PMID: 37086799 DOI: 10.1016/j.jad.2023.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Thyroid dysfunction is often reported in patients with major depressive disorder (MDD) and may be associated with depression severity and psychotic symptoms. We included young adults with first-episode and untreated MDD to avoid the effect of age and disease duration on thyroid dysfunction and psychotic symptoms. METHODS 481 young patients with MDD (aged 18-24 years) were recruited. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale and Global Impression of Severity Scale (CGIS) were used to assess depression, anxiety, psychotic symptoms and disease severity, respectively. RESULTS The prevalence rate of subclinical hypothyroidism (SCH) and thyroid antibody positivity was 56.76 % (273/481) and 26.61 % (128/481) in young MDD, respectively. A higher proportion of MDD patients with SCH displayed psychotic features (14.3 % vs. 5.3 %, OR = 2.985, p = 0.001). TSH was a risk factor for psychotic symptoms in MDD patient with SCH (B = 0.136, p = 0.017, OR = 1.384), with an AUC of 0.709, indicating acceptable discrimination. Multivariate regression analysis also showed that TSH was also independently associated with PANSS positive score (B = 0.339, t = 2.019, p = 0.045). LIMITATION This cross-sectional study design did not demonstrate a causal relationship. Relying solely on the PANSS positive subscale as psychotic symptoms may cause bias. CONCLUSIONS Our findings suggest that SCH is common in young patients with first-episode and untreated MDD. MDD patients with higher TSH levels may suffer from more psychotic symptoms. Regular screening of serum thyroid hormones is necessary in patients with MDD.
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Affiliation(s)
- Wenyu Dai
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jieyu Liu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Haiqing Xie
- Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ziwei Teng
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Wenbo Luo
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Hui Yuan
- Department of Stomatology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jindong Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Minghui Liu
- Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Santos LR, Vasconcelos Bessa I, Gaspar da Rocha A, Neves C, Freitas C, Soares P. Survey on selenium clinical supplementation in autoimmune thyroid disease. Eur Thyroid J 2023; 12:e220090. [PMID: 36622057 PMCID: PMC9986388 DOI: 10.1530/etj-22-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/10/2023] Open
Abstract
Objective Previous trials show that selenium could be a very useful tool in the control and treatment of autoimmune thyroid diseases. In this cross-sectional study, through a survey, we aim to evaluate Portuguese endocrinologists' perception and pattern of prescription of selenium supplements in these diseases and verify its agreement with current guidelines. Methods The endocrinologists registered in the Portuguese Medical Association were sent an email with a web-based questionnaire, regarding their knowledge and use of selenium supplements in thyroid autoimmune pathology. Results A total of 105 physicians (33% of the total) submitted the survey. The selenium serum concentration in the general population was unknown to 80% of respondents. Over a third of respondents have never prescribed selenium for autoimmune thyroid disease. However, 89% are not afraid of recommending it, and 61% indicate Graves' orbitopathy as the pathology they would supplement. In Hashimoto's thyroiditis, 36% of respondents use selenium occasionally or frequently, and this percentage rises to 60% in Graves' disease. Conclusions Although recommendations only encompass mild Graves' orbitopathy, selenium is prescribed across the spectrum of autoimmune thyroid diseases, probably due to recent studies that consistently show improvement of biochemical hallmarks in these patients. Further investigation is required on the impact of selenium supplements on primarily clinical outcomes and to identify disorders and/or patients who will benefit the most. Also, there is still insufficient knowledge of this field in the medical community, and evidence-based practice should continue to be promoted by endocrinology societies.
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Affiliation(s)
- Liliana Ribeiro Santos
- Internal Medicine Department, Hospital of Santa Maria, Lisbon, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Inês Vasconcelos Bessa
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal
| | - Adriana Gaspar da Rocha
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal
- Public Health Unit, ACES Baixo Mondego, Coimbra, Portugal
| | - Celestino Neves
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Department of Endocrinology, Hospital University Centre of São João, Porto, Portugal
| | - Cláudia Freitas
- Department of Endocrinology, Hospital University Centre of Porto, Porto, Portugal
| | - Paula Soares
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal
- Department of Pathology, Faculty of Medicine of the University of Porto, Porto, Portugal
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15
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Luo G, Li Y, Yao C, Li M, Li J, Zhang X. Duration of untreated illness and clinical correlates in first-episode and drug-naïve patients with major depressive disorder. Psychiatry Res 2023; 320:115056. [PMID: 36680911 DOI: 10.1016/j.psychres.2023.115056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUNDS The notion that a prolonged duration of untreated illness (DUI) leads to poorer outcomes has contributed to extensive changes in mental health services worldwide. However, most studies on DUI have focused on schizophrenia and related psychosis. This study aimed to assess the possible relationship between DUI and certain clinical correlates in first-episode and drug-naïve patients with major depressive disorder (MDD). METHODS This cross-sectional study recruited 1718 first-episode and drug-naïve MDD outpatients. All participants were scored on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, and thyroid hormone and metabolic parameters were measured. We used the Structure Clinical Interview for DSM-IV for clinical diagnosis and investigated suicide attempts through face-to-face interviews. RESULTS A total of 171 (10%) of MDD patients had co-morbid psychiatric symptoms. Participants who were older, with lower education level, and married were less likely to seek a timely treatment compared to the counterparts. One-month longer untreated duration was associated with 2% to 9% higher odds of being with most of the investigated clinical conditions. For those with the longest DUI, the risk was increased for most of the investigated clinical conditions, with absolute risk differences ranging from 5.19% to 29.48%. CONCLUSIONS These findings suggest that longer DUI may be negatively associated with clinical correlates in MDD. Further long-term follow-up studies are warranted to confirm these preliminary results.
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Affiliation(s)
- Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Yaxi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 3210 Humin Rd, Shanghai 201108, China
| | - Cong Yao
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Meijuan Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin 300222, China.
| | - Xiangyang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China.
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16
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Jensen CZ, la Cour JL, Watt T, Kanters JK, Poulsen HE, Faber J, Ellervik C, Nygaard B. Association of Levothyroxine Treatment and Thyroid Peroxidase Antibodies with Antidepressant Use: A Danish Population-Based Longitudinal Study. Thyroid 2022; 32:1477-1487. [PMID: 36222609 DOI: 10.1089/thy.2022.0335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Subjects receiving levothyroxine (LT4) treatment have increased prevalence of depression, anxiety, and antidepressant use, but whether the underlying mechanism relates to thyroid autoimmunity is still unclarified. Methods: This is a population-based longitudinal study. Baseline biochemical and questionnaire data from the Danish General Suburban Population Study (GESUS) in 2010-2013 were linked with individual-level longitudinal data in national health registries. The aim was to investigate the associations between thyroid peroxidase antibodies (TPOAbs) and LT4 treatment, separately and through interaction, and at least one redeemed prescription for antidepressants. Logistic and Cox regression were used to evaluate initiation of antidepressant use before and after the baseline examination in GESUS, respectively. All exposures and covariates were fixed at the date of baseline examination. Thyroid autoimmunity was defined as serum TPOAbs >60 U/mL. Adjustments included sex, age, education, income, Charlson comorbidity index, smoking, and alcohol. Sensitivity analyses were performed for missing variables, exclusion of lithium use, exclusion of thyroid surgery, and conservative definitions for LT4 treatment and antidepressant use requiring at least two prescriptions. Results: We included 12,894 individuals, of whom 2353 (18%) had "past or current" antidepressant use at baseline, leaving 10,541 individuals at risk for incident antidepressant use after baseline. The median follow-up was 7.8 years during which 783 individuals (7.4% of 10,541 individuals) had incident antidepressant use. TPOAb positivity was not associated with "past or current" (odds ratio [OR] 0.90 [confidence interval, CI 0.78-1.03], p = 0.13) nor incident antidepressant use (hazard ratio [HR] 1.02 [CI 0.83-1.25], p = 0.88). LT4 treatment was associated with increased "past or current" antidepressant use (OR 1.33 [CI 1.10-1.62], p = 0.004) and increased incident antidepressant use (HR 1.38 [CI 1.03-1.85], p = 0.03). There were no interactions between the effects of TPOAb positivity and LT4 treatment on the use of antidepressants in logistic (p = 0.87) or Cox regression models (p = 0.82). Sensitivity analyses were robust, except that incident use of at least two redeemed antidepressant prescriptions was not statistically significant. Conclusions: LT4 treatment, but not TPOAb positivity, was associated with increased prevalent or incident antidepressant use with at least one prescription. Our findings do not support that thyroid autoimmunity is an important factor for antidepressant use in patients receiving LT4 treatment.
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Affiliation(s)
- Christian Zinck Jensen
- Center for Endocrinology and Metabolism, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Jeppe Lerche la Cour
- Center for Endocrinology and Metabolism, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
| | - Torquil Watt
- Center for Endocrinology and Metabolism, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Kim Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Derpartment of Cardiology, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Jens Faber
- Center for Endocrinology and Metabolism, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Data Support, Region Zealand, Sorø, Denmark
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hirtz R, Hölling H, Grasemann C. Subclinical Hypothyroidism and Incident Depression in Adolescents and Young Adults: Results from a Nationwide Representative Prospective Study. Thyroid 2022; 32:1169-1177. [PMID: 35946076 DOI: 10.1089/thy.2022.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Although the relationship between subclinical hypothyroidism and major depressive disorder (MDD) has been studied in adults in cross-sectional and prospective population-based studies, this has not yet been done in adolescents. However, since thyroid function and MDD risk are subjected to maturational processes and ramifications of illness duration over the life span, these findings may not readily transfer to adolescents. Methods: The relationship between subclinical hypothyroidism and MDD was studied in a representative subsample of the nationwide KIGGS ("The German Health Interview and Examination Survey for Children and Adolescents") survey. A total of 4118 adolescents were examined over a median period of 6 years, and data were analyzed by a logistic regression approach accounting for important covariates related to thyroid function and/or MDD risk. The same approach was chosen to investigate the relationship between quartiles of thyrotropin (TSH) and free thyroxine (fT4) levels and incident MDD in euthyroid participants to broaden the focus on the relationship between thyroid hormone levels and MDD in a dose-response manner. Results: During the observation period, 121 cases of MDD were reported. There was no association between subclinical hypothyroidism and MDD when comparing 111 adolescents with subclinical hypothyroidism with 4007 euthyroid adolescents, representative of ∼106,000 and 3,610,000 adolescents from the general pediatric population, respectively. This also applied when studying the relationship between quartiles of TSH and fT4 levels and MDD in euthyroid participants. All results were confirmed by sensitivity analyses accounting for thyroid autoimmunity. Conclusions: Consistent with findings in adults, there is no association between subclinical hypothyroidism or quartiles of TSH and fT4 levels in the normal range and MDD in adolescents, despite potential age-related differences regarding thyroid function and MDD risk.
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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
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, 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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18
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Xu YX, Wang C, Li XD, Guo WL, Liu GY, Zhang HB, Sun Y, Zhu DF, Xu Q. Activation of cholinergic basal forebrain neurons improved cognitive functions in adult-onset hypothyroid mice. Biomed Pharmacother 2022; 153:113495. [DOI: 10.1016/j.biopha.2022.113495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
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Li X, Li H, Cheng J, Wang M, Zhong Y, Shi G, Yu AY. Causal Associations of Thyroid Function and Age-Related Macular Degeneration: A Two-Sample Mendelian Randomization Study. Am J Ophthalmol 2022; 239:108-114. [PMID: 35176254 DOI: 10.1016/j.ajo.2022.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine whether causal association lies between thyroid function and age-related macular degeneration (AMD) risk in human beings. DESIGN Two-sample Mendelian randomization (MR) study. METHODS The single-nucleotide polymorphisms associated with free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were selected from a genome-wide association study (GWAS) of 72,167 individuals of European descent. Summary-level data for AMD were obtained from a GWAS published by the International Age-related Macular Degeneration Genomics Consortium of 33,526 individuals (16,144 cases and 17,832 controls). An inverse-variance-weighted (IVW) method was the main MR analysis. Maximum likelihood, weighted median, MR-Egger, MR-pleiotropy residual sum outlier methods were used for the sensitivity analysis. RESULTS An increase of 1 SD in genetically predicted FT4 levels was found to be significantly associated with an 18.9 % increase in the overall AMD risk (P = .005). In the multivariable MR analysis controlling for TSH level, the causal effect of FT4 level on the risk of AMD remained (odds ratio [OR] = 1.207, P = .004). A 1-SD increase in TSH levels was nominally associated with a 10.0% decrease in the overall AMD risk (P = .032). After adjusting for FT4 level by multivariable MR analysis, no direct causal relationship was found between TSH level and AMD risk (95% CI = 0.810, 1.125, P = .582). CONCLUSIONS Genetic variants predisposing to higher FT4 levels within the normal range were associated with higher AMD risk. Further studies are required to understand the mechanism underlying this putative causal relationship.
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Relationship of free thyroxine and triiodothyronine on recurrence in maintenance therapy for bipolar depression. Asian J Psychiatr 2022; 71:103086. [PMID: 35316669 DOI: 10.1016/j.ajp.2022.103086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine whether thyroid function in the normal range is associated with recurrence of depressive or mania in bipolar disorder patients. METHODS 104 patients with bipolar disorder in maintenance therapy phase were assigned randomly to mood stabilizer combined with antidepressant group or mood stabilizer group. There were 52 patients in both groups respectively. Clinical symptoms were assessed at baseline, 3rd month, 6th month, 9th month, and 12th month using HAMD-17 and YMRS. Blood samples were analyzed for thyroid function. RESULTS There was no statistically significant difference of recurrence rate of depressive episode and mania episode at the end of the 12-months between mood stabilizer combined with antidepressant group and mood stabilizer group. There was significant relation of baseline TT4 (P = 0.020, HR = 0.948), FT3 (P = 0.035, HR = 2.055), and FT4 (P = 0.047, OR=0.769) with the recurrence of depressive episode in mood stabilizer group. The area under curve (AUC) of TT4, FT3, FT4 were 0.685, 0.613, 0.544, respectively. There was significant relation of baseline FT3 (P = 0.044,HR = 4.493) with the recurrence of mania episode for mood stabilizer combined with antidepressants group. The AUC of FT3 was 0.806. CONCLUSION Low level of TT4, FT4 and high level of FT3 within normal-range were related with the recurrence of depressive episode in the maintenance treatment with mood stabilizer of bipolar disorder. High level of FT3 within normal-range were related with recurrence of mania when mood stabilizer combined with antidepressants were used in the maintenance treatment of bipolar disorder.
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Chen G, Lv H, Zhang X, Gao Y, Liu X, Gu C, Xue R, Wang Q, Chen M, Zhai J, Yue W, Yu H. Assessment of the relationships between genetic determinants of thyroid functions and bipolar disorder: A mendelian randomization study. J Affect Disord 2022; 298:373-380. [PMID: 34728293 DOI: 10.1016/j.jad.2021.10.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid functions (TFs) have been implicated in the initiation and propagation of psychiatric disorders. Observational studies have shown associations of TFs with psychiatric disorders. However, the relationship between TFs and psychiatric diseases were still unclear. METHODS Genetic instruments for 6 TF-realted indexes, including free thyroxine (FT4), triiodothyronine (FT3):FT4 ratio, thyrotropin (TSH), thyroid peroxidase antibodies (TPOAb) concentration, hypothyroidism, and hyperthyroidism, were obtained from several genome-wide association studies (GWASs). Their associations with BD were evaluated using Psychiatric Genomics Consortium (PGC) datasets (41,917 cases and 371,549 controls). All GWAS summary statitics were from European ancestry. Mendelian randomization (MR) estimates from each genetic instrument were combined using inverse variance weighted (IVW) meta-analysis, with complementary methods (eg, weighted median and MR Egger). We also multiple sensitivity analyses to examine horizontal pleiotropy and heterogeneity. RESULTS Genetically predicted level of FT4 was significantly associated with BD (odds ratio (OR)=0.89, 95% confidence interval (CI): 0.83-0.95; P=4.65 × 10-3), survived after the Bonferroni correction (P<0.05/6=0.008). Consistent directional effects for all sensitivity analyses were observed in the weighted median and MR Egger methods. Furthermore, our sensitive test suggested no significant horizontal pleiotropy (intercept=-0.01, P=0.12) and no notable heterogeneity (Q = 29.9; P=0.09). However, other TF indexes (FT3:FT4 ratio [OR=1.24, P=0.10], TSH [OR=1.01, P=0.61], TPOAb concentration [OR=1.20, P=0.54], hypothyroidism [OR=1.00, P=0.91], and hyperthyroidism [OR=0.99, P=0.57]) were not associated with BD. CONCLUSIONS Our results provide further evidence that higher FT4 level is associated with a reduced risk of BD, and suggest the importance of FT4 level in BD risk assessment and potential therapeutic targets development.
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Affiliation(s)
- Guoqing Chen
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Honggang Lv
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Xiao Zhang
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China
| | - Yan Gao
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Xia Liu
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, Shandong 272051, China
| | - Chuanzheng Gu
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, Shandong 272051, China
| | - Ranran Xue
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, Shandong 272051, China
| | - Qiuling Wang
- Department of Psychiatry, Shandong Daizhuang Hospital, Jining, Shandong 272051, China
| | - Min Chen
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Jinguo Zhai
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China
| | - Weihua Yue
- National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Peking University Sixth Hospital (Institute of Mental Health), Beijing 100191, China; PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China.
| | - Hao Yu
- Department of Psychiatry, Jining Medical University, Jining, Shandong 272067, China.
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Yang R, Du X, Li Z, Zhao X, Lyu X, Ye G, Lu X, Zhang G, Li C, Yue Y, Wu Y, Peng R, Zhou Y, Wang H, Wu S, Ganapathi PB, Wu HE, Zhang X. Association of Subclinical Hypothyroidism With Anxiety Symptom in Young First-Episode and Drug-Naïve Patients With Major Depressive Disorder. Front Psychiatry 2022; 13:920723. [PMID: 35815037 PMCID: PMC9263214 DOI: 10.3389/fpsyt.2022.920723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/06/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUNDS Subclinical hypothyroidism (SCH) was reported to be associated with depression; however, its role in coexisting anxiety symptom in young patients with major depressive disorder (MDD) remains unclear. The objective of this study was to explore the relationship between SCH and anxiety symptom in young first-episode and drug-naïve (FEDN) MDD patients. METHODS A total of 520 outpatients diagnosed as FEDN MDD with SCH were recruited in this study. Their socio-demographic, clinical data and thyroid function parameters were collected. The Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD) were employed to measure the severity of anxiety symptom and depressive symptom, respectively. Based on the HAMA scores, patients who scored ≥ 25 were defined as anxious major depressive disorder (A-MDD) while others as non-anxious major depressive disorder (NA-MDD). RESULTS The prevalence rate of A-MDD was 15.8% in young FEDN MDD patients with comorbid SCH. Moreover, serum thyroid stimulating hormone (TSH) levels were significantly higher in patients with A-MDD compared with those with NA-MDD (p < 0.001). Multivariate binary logistic regression analysis indicated that A-MDD was associated with serum TSH levels with an odds ratio (OR) of 1.602. Serum TSH level of 6.17 mIU/L was the critical value to distinguish A-MDD and NA-MDD, with sensitivity of 0.805 and specificity of 0.539. There were no statistically significant differences between NA-MDD and A-MDD patients in terms of socio-demographic variables, serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidases antibody (TPOAb) and anti-thyroglobulin (TgAb) levels. CONCLUSIONS A-MDD patients presented higher serum TSH level. It is suggested that serum TSH level may be a potential biomarker for predicting moderate and severe anxiety symptoms in young FEDN MDD patients with SCH.
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Affiliation(s)
- Ruchang Yang
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaoli Lyu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Gang Ye
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Guangya Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chuanwei Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuxuan Wu
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ruijie Peng
- Suzhou Medical College of Soochow University, Suzhou, China.,Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yue Zhou
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.,Xuzhou Medical University, Xuzhou, China
| | - Haitao Wang
- School Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Siqi Wu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.,School Psychology and Mental Health, North China University of Science and Technology, Tangshan, China
| | - Pallavi B Ganapathi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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