TSH cut off point based on depression in hypothyroid patients

The Assessment of Geriatric Depression Among Primary Healthcare Physicians in Buraidah City, Saudi Arabia

BACKGROUND

 The global geriatric population is increasing, leading to a higher prevalence of non-communicable diseases, including depression. This condition often remains underdiagnosed and untreated disease.

METHODOLOGY

A cross-sectional study was conducted among 130 primary healthcare physicians (PCPs) in Buraidah to assess their practices in diagnosing geriatric depression from March 2023 to March 2024. After ethical committee approval, data were collected through a self-administered questionnaire, entered, cleaned, and analyzed with Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 21.0, Armonk, NY). Informed consent was obtained and the confidentiality of the participant information was maintained. Statistical tests, including the Chi-square test, were used for inference.

RESULTS

Out of 130 PCPs, 85.4% (n=111) were diagnosing depression during their clinical practice. The most common depression scale used in their regular practice was the patient health questionnaire (PHQ)-2 (70%, n=91), followed by the Geriatric Depression Scale (53.8%, n=70). Nearly 26.2% (n=34) of physicians responded that there is no need for routine lab tests for the diagnosis of depression. Concerning the initial plan of depression management, nearly 76.2% (n=99) of physicians preferred non-pharmacological treatment. Regarding barriers to diagnosis of depression in elderly patients, nearly 76.2% (n=99) mentioned the need for more training about geriatric depression, followed by 70% for both short consultation time and the need for Ministry of Health guidelines. There was a statistically significant association observed between <35 years of age group and a preference for a high percentage of pharmacological therapy (P<0.05).

CONCLUSIONS

Based on the findings of the study, there was a good number (85.4%) of PCPs diagnosing depression in their clinics, and also three-fourths of the physicians (76.2%) preferred non-pharmacological treatment. Only one-fourth (26.2%) of the PCPs mentioned no lab is required for the diagnosis of depression.

Variation in Thyroid-Stimulating Hormone and Cognitive Disorders in Unmedicated Middle-Aged Patients with Major Depressive Disorder: A Proton Magnetic Resonance Spectroscopy Study

Background

Middle-aged (45-59 years old) patients with major depressive disorder (MDD) have a predilection for dementia and cognitive disorders (CDs); however, the characteristics and mechanisms of CDs in these patients remain unclear. There are also known connections between thyroid-stimulating hormone (TSH), brain biochemical metabolism, and cognitive function (CF); however, there is scanty of information about these connections in middle-aged MDD patients.

Methods

Cognitive assessment was performed on 30 first-episode, untreated middle-aged patients with MDD and 30 well-matched healthy controls (HCs) using the MATRICS Consensus Cognitive Battery (MCCB). N-acetyl aspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios in the prefrontal cortex (PFC) and cerebellum were also obtained via proton magnetic resonance spectroscopy (¹H-MRS), and the TSH level was measured by chemiluminescence analysis.

Results

MDD patients presented significantly lower processing speed, working memory, verbal learning, reasoning problem-solving, visual learning, and composite cognition scores than controls, with a statistically lower NAA/Cr ratio in the right cerebellum. Age was positively related to reasoning problem-solving in the MDD group (r = 0.6249, p = 0.0220). Education also showed a positive association with visual learning, social cognition, and composite cognition. The 24-item Hamilton Depression Rating Scale (HDRS-24) score was negatively related to all domains of CF. TSH levels were markedly decreased in the MDD group, and a positive connection was determined between the NAA/Cr ratio in the right PFC and the TSH level.

Conclusions

Middle-aged MDD patients have multidimensional CDs. There are changes in PFC and cerebellar biochemical metabolism in middle-aged patients with MDD, which may be related to CDs or altered TSH levels.

Using the Biopsychosocial Approach to Identify Factors Associated with Major Depressive Disorder for Individuals with Hypothyroidism

Previous research has found that major depressive disorder (MDD) commonly occurs in hypothyroid populations. The purpose of this study was to use the biopsychosocial model to investigate factors associated with MDD and hypothyroidism by comparing hypothyroid patients with MDD and without MDD. A sample of 386 participants with hypothyroidism completed both cognitive and psychosocial self-reported assessments along with a questionnaire rating the severity of common hypothyroid symptoms. Participants were divided into two groups (MDD and no MDD) using the diagnostic criteria of the Patient Health Questionnaire. Univariate comparisons were used to assess differences in the severity of physical, psychological, and social correlates in participants with and without MDD. Participants with MDD reported significantly worse symptom severity, increased stress, and disruptions of cognitive functioning. Compared to individuals without MDD, they also indicated poorer quality of life, doctor-patient relationships, and treatment adherence. Individuals with comorbid depression and hypothyroidism reported worse outcomes across physical symptoms, social factors, and psychological and cognitive states than individuals without MDD. Integrating depression screeners and independent treatment for MDD, in addition to the patient's hypothyroid treatment plan, may result in hypothyroid symptom relief and greater quality of life.

Thyroid Function Affects the Risk of Post-stroke Depression in Patients With Acute Lacunar Stroke

Objective

This study aimed to investigate whether thyroid function profiles are associated with post-stroke depression (PSD) and evaluate the mediation effect of cerebral small vessel disease (cSVD) on the association of thyroid function profiles and PSD in patients with acute ischemic lacunar stroke.

Methods

In this study, 372 patients with confirmed acute ischemic lacunar stroke within 3 days of onset were consecutively recruited. Serum levels of thyroid hormones and thyroid antibodies were detected on admission. Lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces were rated using validated scales. The severity of depression was scored with the 24-item Hamilton Depression Scale in the hospital after a week of stroke onset. Multivariate regression was utilized to analyze the association of thyroid function profiles and PSD. Mediation analysis was employed to evaluate the effect of cSVD on the association of thyroid function profiles and PSD.

Results

A total of 87 (23.4%) participants were diagnosed with depression after stroke. Serum thyroid-stimulating hormone (TSH) levels were significantly higher in patients with PSD than in those without PSD, while free triiodothyronine (FT3) and free thyroxine (FT4) were not significantly different between the two groups. After adjusting for potential confounders, serum TSH levels were positively associated with the risk of PSD (OR = 1.228; 95% CI: 1.053–1.431, p = 0.009). A similar association was also found between the total cSVD burden score and PSD (OR = 2.137; 95% CI: 1.634–2.793, p < 0.001). Further mediation analysis indicated that 26.37% of the association between TSH and PSD was mediated by cSVD.

Conclusions

Serum TSH levels on admission can probably predict depression after acute ischemic lacunar stroke.

Subclinical thyroid dysfunction and major depressive disorder

PURPOSE

This review attempts to investigate the link between subclinical thyroid dysfunction (SCH) and major depressive disorder (MDD). It has been speculated that SCH may be related to MDD through an autoimmune mechanism.

METHODS

A comprehensive literature search was conducted in the PubMed database for relevant research and review articles.

RESULTS

There appears to be an association between an autoimmune mechanism, possibly involving the thyroid gland, and depressive disorders, but the available evidence is so far inconclusive.

CONCLUSION

Lifetime prevalence of depression is significantly higher in patients with SCH, a finding reflecting a possible effect of SCH in lowering the threshold for the emergence of MDD. The relationship between SCH and MDD is, however, not clear, with large and well-designed studies investigating possible links between reference-range thyroid hormone levels and MDD having as yet found no relation between the two.

Nicotinic ganglionic acetylcholine receptor autoantibodies associated with paraneoplastic disease in a neuropsychiatric patient

Nicotinic ganglionic acetylcholine receptor autoantibodies (alpha-3-AChR Ab) are associated with paraneoplastic syndromes when present in low elevations. These antibodies can be tested for as part of an autoimmune encephalopathy panel in neuropsychiatric patients; a mildly elevated titre of alpha-3-AChR Ab that may start as an incidental finding can lead to the diagnosis of a previously undetected cancer. While alpha-3-AChR Ab are most typically associated with thymomas and small cell lung cancer, the presence of these antibodies can suggest a diverse range of other cancers. This case presents a patient with longstanding neuropsychiatric symptoms and possible functional hypothyroidism for whom a low elevation in alpha-3-AChR Ab led to the finding of papillary thyroid carcinoma.

Increased prevalence of subclinical hypothyroidism in female hospitalized patients with depression

BACKGROUNDS

Sex differences in depressive disorder (DD) and subclinical hypothyroidism (SCH) have been well recognized. However, few studies focus on the sex differences in DD patients with SCH. The purpose of this study is to address the sex differences in DD inpatients with SCH and further investigate the clinical characteristics and associations between DD and SCH among female and male depressed inpatients.

METHODS

A total of 1787 hospitalized patients with a diagnosis of DD were recruited. Depression was assessed using the Hamilton Depression Rating Scale-17 items (HAMD), and anxiety was assessed using the Hamilton Anxiety Rating Scale. Blood test, including serum thyroid hormone levels, was measured. According to different genders, associations between DD and the presence of SCH were estimated using binary logistic regression.

RESULTS

In the 1787 hospitalized patients with DD, the prevalence of SCH was 11.8%; the prevalence of SCH in female depressed inpatients is approximately two times that of male inpatients (14.6 vs. 7.4%, P < 0.05). Logistic regression showed that recurrent episodes and high BMI were associated with SCH in female inpatients (both P < 0.05). Spearman correlation analysis showed that thyroid stimulating hormone levels were associated with BMI (P < 0.05), total cholesterol levels (P < 0.05), and low-density lipoprotein cholesterol levels (P < 0.05) in female inpatients.

CONCLUSIONS

Our present study showed that the prevalence of SCH among female hospitalized patients with depression is approximately two times that of male inpatients. Recurrent and high-BMI female depressed inpatients are at high risk to develop SCH. More attention should be paid to the thyroid function of female inpatients with DD in future clinical work.

Effect of yoga on depression in hypothyroidism: A pilot study

Background

The prevalence of hypothyroidism among Indian women is 15.8%. Depression is frequently reported in hypothyroidism. Yoga is an effective intervention for depression. However, the influence of yoga on depression in patients with hypothyroidism has not been studied.

Aim

The present study investigated the effect of a 3-month integrated yoga intervention (3-IY) on depression, lipid indices, and serum thyroid-stimulating hormone (sTSH) levels among female patients having hypothyroidism, and mild-to-moderate depression.

Method

The present single-arm pre-post design study was conducted in thirty-eight women (average age 34.2 ± 4.7 years). Participants received a 3-IY comprising asanas, pranayama, and relaxation techniques for 60 min daily (5 days a week). Depression, sTSH, lipid profile indices, Body Mass Index (BMI), fatigue, anxiety, and stress were assessed at baseline and after 12 weeks. Thyroid medication was kept constant during the study period. Data were analysed using R Studio software.

Result

A significant (P < 0.05) reduction in depression (58%), sTSH (37%), BMI (6%), fatigue (64%), anxiety (57%), lipid profile indices (HLD increased significanty), and stress (55%) levels was observed after 3 months, compared with the corresponding baseline levels.

Conclusion

The 3-IY is useful for reducing depression, dyslipidemia, and sTSH in women with hypothyroidism and depression. Further studies with a larger sample size and a robust research design using objective variables must be conducted to strengthen the study findings.

Depression, Metabolic Syndrome, Serum TSH, and Vitamin D Concentrations in Rural and Urban Postmenopausal Women

Background and objectives: Depression is a serious problem affecting people worldwide, however it more commonly concerns women. Depression reduces the quality of life and, in many cases, leads to suicide. Numerous new biological factors have been demonstrated to have an impact on the pathogenesis of depression, including vitamin D, thyroid hormones, as well as factors related to heart disease. The aim of the study was to assess the impact of serum thyroid stimulating hormone (TSH) and vitamin D concentrations as well as metabolic syndrome on the severity of depression in Polish postmenopausal women from urban and rural areas. Materials and Methods: The study was conducted in 2018–2019 in the Lublin region, Poland, and comprised 396 postmenopausal women (239 living in rural areas and 157 living in urban areas). Metabolic syndrome criteria according to the International Diabetes Federation and Beck Depression Inventory were used, and laboratory blood tests were performed. Results: A significantly higher percentage of the examined rural residents had moderate or severe depression in comparison to the urban ones (p = 0.049). The examined women from rural areas had a significantly higher serum vitamin D concentration in comparison to the urban ones (p < 0.001). The rural residents more commonly had below-normal levels of serum TSH and less commonly had normal levels in comparison to the urban residents. Metabolic syndrome was found in 70% of the rural residents, and that number was significantly lower in the urban ones (22%, p < 0.001). Conclusions: The severity of depression in postmenopausal Polish women was correlated negatively with the serum TSH concentration in women from rural areas. The severity of depression was increased in urban postmenopausal women with hypertension. No correlation of the depression severity with the serum vitamin D concentration or other criteria of metabolic syndrome was found.

TSH and T4 Levels in a Cohort of Depressive Patients

Depression is a significant contributor to the overall burden of disease on a global scale. Thyroid hormones thyroxine (T4) and triiodothyronine (T3) have been shown to play a critical role in the development and normal function of the brain. It has been suggested that dysregulation of thyroid function could be associated with depression, especially hypothyroidism, but not all studies support this hypothesis. We enrolled a cohort of 96 subjects with major depressive disorder and tested TSH and FT4 levels for 80 of them in order to assess the status of the hypothalamic-pituitary-thyroid axis (HPT). We found 7 cases (8.75% of the tested) of subclinical hyperthyroidism and 1 case (1.25%) of overt hyperthyroidism. While we did not find supporting evidence for association between TSH and FT4 levels and depression, our findings question whether screening depressive patients for HPT axis anomalies could be clinically relevant, if anything, in a regional context.

Prevalence and clinical correlates of subclinical hypothyroidism in first-episode drug-naive patients with major depressive disorder in a large sample of Chinese

BACKGROUND

The coexistence of subclinical hypothyroidism (SCH) and depression has been intensively examined in the patients receiving thyroxine or antidepressant treatment. This study aimed to investigate the prevalence and clinical correlates of severe SCH in Chinese first-episode drug naïve patients with major depressive disorder (MDD).

METHODS

Using a cross-sectional design, we recruited a total of 1706 MDD patients. Depressive symptoms were evaluated using the 17-item Hamilton Depression Rating Scale (HAMD). Severity of anxiety and psychiatric symptoms were evaluated by the Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS), respectively. Serum thyroid function parameters were measured by a chemiluminescence immunoassay. Based on the serum thyroid stimulating hormone (TSH) level, SCH was further divided into mild (TSH < 10 mIU/L) and severe SCH (TSH ≥ 10 mIU/L).

RESULTS

More patients with severe SCH had severe anxiety, psychotic symptoms, suicide attempts (all p < 0.001), compared with those without severe SCH. Logistic regression showed that suicide attempts and psychiatric symptoms were associated with severe SCH (both p < 0.001). Multiple linear regression showed that age (p < 0.05), BMI (p < 0.001), HAMD score (p < 0.001), HAMA score (p < 0.001), PANSS positive subscore (p = 0.001) and CGI score (p = 0.001) were associated with TSH levels.

CONCLUSION

Our findings suggest that suicide attempts and psychiatric symptoms may be associated with severe SCH. Moreover, severe anxiety, depressive and psychotic symptoms, as well as older age and higher BMI are possibly related to elevated TSH levels.

Mood Disorders in Levothyroxine-Treated Hypothyroid Women

Background: Hypothyroidism has several symptoms (weight gain, arrhythmias, mood changes, etc.). The aims of this study were (1) to assess the prevalence of anxiety and depression in levothyroxine-treated hypothyroid women and in women without hypothyroidism; (2) to identify variables associated with anxiety and depression. Methods: A case-control study was performed with 393 women. Case-group: 153 levothyroxine-treated hypothyroid women. Control-group: 240 women without hypothyroidism. Convenience sampling. Instrument: The Hamilton Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire. Results: The prevalence of anxiety in levothyroxine-treated hypothyroid women was higher than in women without hypothyroidism (29.4% vs. 16.7%, χ² p < 0.001). The prevalence of depression in the case group was higher than in the control group (13.1% vs. 4.6%, χ² p < 0.001). Levothyroxine-treated hypothyroid women were more likely to have anxiety (OR = 2.08, CI: 1.28-3.38) and depression (OR = 3.13, IC = 1.45-6.45). Conclusion: In spite of receiving treatment with levothyroxine, women with hypothyroidism are more likely to have depression and anxiety. Health professionals need to assess the mood of women with hypothyroidism. Although levothyroxine is a good treatment for the symptoms of hypothyroidism, it may not be enough to prevent development or persistence of depression and anxiety by itself.

The association between anxiety and depression with 25(OH)D and thyroid stimulating hormone levels

OBJECTIVE

To evaluate the relationships between the serum levels of these parameters and mood disorders, including depression and anxiety.

METHODS

One hundred and fifty patients (77 with anxiety and 73 with depression), aged 18 to 79 years old, who were referred to the Neuro Psychiatry Clinic of Uskudar University in Istanbul, Turkey were included in this study from June 2018 to December 2018. According to the Beck Anxiety Inventory and Beck Depression Inventory II results, the anxiety patients met the mild and moderate anxiety criteria and the depression patients met the moderate and severe depression criteria, respectively. Venous blood samples were collected after overnight fasting, and the 25(OH)D and thyroid stimulating hormone (TSH) levels were measured.

RESULTS

The data showed a significantly higher TSH level in the females when compared to their male counterparts in the severe depression subgroup (p=0.011).

CONCLUSION

A serum TSH evaluation may be considered as a useful biochemical marker for more efficient depression management.

Prevalence of depression among hypothyroid patients attending the primary healthcare and endocrine clinics of King Fahad Hospital of the University (KFHU)

Context:

Hypothyroidism is the most prevalent endocrine disorder worldwide, with a prevalence of 4%–5%. Thyroid hormone has a role in neurological development, and hormone deficiency can be manifested by many neurological signs and symptoms such as behavioral disturbances, anxiety, and depressive symptoms.

Aims:

To estimate the prevalence of depression among hypothyroid patients attending primary healthcare and endocrine clinic of King Fahad Hospital of the University (KFHU) and to assess the relationship between depression and different factors.

Settings and Design:

A cross-sectional study was conducted to estimate the prevalence of depression among hypothyroid patients attending the primary healthcare and endocrine clinics of KFHU in Al Khobar.

Materials and Methods:

Patients were screened for depression using Patient Health Questionnaire-9 screening tool, in addition to obtaining their sociodemographic data, details of their thyroid function status, and other risk factors for depression. Also, patient medical files were used to obtain the laboratory results.

Statistical Analysis Used:

Data were analyzed using the Statistical Package for the Social Science (SPSS) version 23. Continuous data were displayed using mean and standard deviation; categorical data were displayed in numbers and percentage. Chi-square test was used to assess the relationship between the variables. A P value of less than 0.05 was considered as statistically significant.

Results:

It was found that 33.9% of patients were depressed with varying degree of depression. Certain symptoms were found to be associated with higher risk of depression such as fatigue, memory problems, hair loss, and gland enlargement.

Conclusion:

Depression was concluded to be prevalent among hypothyroid patients. And screening for depression among hypothyroid patients is recommended.

Depressive Disorder in Thyroid Cancer Patients after Thyroidectomy: A Longitudinal Follow-up Study Using a National Cohort

Objective

The present study compared the frequency of depressive disorder in patients with thyroid cancer who had undergone thyroidectomy with the frequency in control individuals.

Study Design

Retrospective population-based cohort study.

Setting

This study used data from the Korean Health Insurance Review and Assessment Service–National Sample Cohort.

Subject and Methods

A total of 3609 participants with thyroid cancer who had undergone thyroidectomy between 2003 and 2011 were enrolled in this study and matched 1:4 with 14,436 control participants by age, sex, income, and region of residence. The cumulative incidence of postoperative depressive disorder was evaluated over a period of 10 years after the thyroidectomies and compared with the incidence in controls. Depressive disorder was diagnosed by a psychiatrist.

Results

The incidence of depressive disorder was significantly higher in the thyroid cancer with thyroidectomy group than in the controls up to postoperative year 1. A subgroup analysis showed the same higher incidence of depressive disorder in the thyroid cancer group than controls for up to 1 year after operations in young adult (≤44 years old), female, urban, and low-income groups. However, the incidence was elevated only in the year of the thyroidectomies themselves in middle-aged and older, rural, and high-income groups.

Conclusion

Patients with thyroid cancer who undergo thyroidectomy have depressive disorder more frequently than normal controls. However, the frequency of depressive disorder after thyroidectomy recovers in a shorter period in middle-aged or older, high-income, and rural-dwelling patients, compared to younger, low-income, and urban-dwelling patients.

Plasma nesfatin-1 level is associated with severity of depression in Chinese depressive patients

BACKGROUND

Nesfatin-1 plays a role in the regulation of emotional states like depression. The aim of this study was to investigate the plasma nesfatin-1levels in Chinese patients with depression and healthy subjects, and to determine the possible association between the plasma nesfatin-1 level and the severity of depression.

METHODS

A total of 103 depressive patients and 32 healthy subjects were assessed. According to HAMD-17scores, 51, 18, and 34 patients were enrolled in the mild depression, moderate depression, and severe depression groups, respectively. Plasma nesfatin-1 levels were determined by the ELISA method. Differences between groups were compared and associations between plasma nesfatin-1 and other variables were analyzed.

RESULTS

The plasma nesfatin-1 was significantly positively correlated with HAMD-17 score (r = 0.651). Compared with healthy controls (8.11 ± 3.31 ng/mL), the plasma nesfatin-1 level significantly increased in patients with mild depression (11.17 ± 3.58 ng/mL), with moderate depression (16.33 ± 8.78 ng/mL), and with severe depression (27.65 ± 8.26 ng/mL) respectively. Plasma nesfatin-1 level (Odds ratio [OR] = 1.269) was an independent indicator for severe depression by multivariate logistic regression analysis.

CONCLUSION

The plasma nesfatin-1 level is positively correlated with the severity of depression. Plasma nesfatin-1 level may be a potential indicator for depression severity.