Title: Study of Thyroid Abnormalities in Psychiatric Out Patients with Depression At A Tertiatry Care Centre in Central India
Authors: Dr Parul Nema, Dr C V Kulkarni, Dr Meena Mittal, Dr Vishnu K Gupta, Dr Rangbhulan Razdar
DOI: http://dx.doi.org/10.18535/jmscr/v3i10.03
Introduction Thyroid hormones have a profound influence on the human brain and behaviour, and the interrelationship between thyroid dysfunction and psychiatric disturbances has been well documented. Up to one-third of psychiatric patients may demonstrate thyroid function test abnormalities that do not always reflect true thyroid disease, but rather are a manifestation of secondary effects on one or more levels of the hypothalamic-pituitary-thyroid (HPT) axis. Materials And Methods Samples collected from 69 O.P.D. patients who are newly diagnosed cases of depression, not on medication and more than 18 yrs of age. Patient having thyroid disorder or on medication affecting thyroid function are excluded from study. Serological test Thyroid Stimulating Hormone (TSH) Test, Total T4/ Total Thyroxine, Total T3 / Total Triiodothyronine are done for identifying thyroid functionabnormality in psychiatric patients. Results- Out of 69 psychiatric out patients with clinical diagnosis of depression investigated for thyroid abnormalities, Males were 37 & Female were 32. The mean age of the study subjects was 35.23 yr. Abnormal thyroid function test was observed in 26 out of 69 (37.6%) patients. Conclusion- As psychiatric disturbances may be a manifestation of thyroid disease, clinical assessment of physical signs and symptoms of thyroid disease should be a routine element of psychiatric evaluation. If there is suspicion for thyroid disease, measurement of TSH with a sensitive method should be the first test obtained. 1. Abnormal Thyroid Function Tests in Psychiatric Patients: A Red Herring? Am J Psychiatry 2012;169:127-133. 10.1176/appi.ajp.2011.11040631 2. Fardella C, Gloger S, Figueroa R, et Al High prevalence of thyroid abnormalities in a Chilean psychiatric outpatient population Department of Endocrinology, Faculty of Medicine, Catholic University of Chile, Santiago. J Endocrinol Invest. 2000 Feb;23(2):102-6. 3. Richard P. Levy, Jonathan B. Jensen, et al Serum thyroid hormone abnormalities in psychiatric disease Department of Psychiatry, University Hospitals of Clevel-and Cleveland. OhioUSA Volume 30, issue 11, Nov 1981,pages 1060-1064. 4. Purandare KN, Wagle AC, Parker SR et al Psychiatric morbidity in patients with systemic lupus erythematosus. Department of Psychiatry, Fairfield Hospital, Hutchen QJM. 1999 May;92(5):283 5. Rajiv Radhakrishnan, Sam Calvinet al Thyroid dysfunction in major psychiatric disorders in a hospital based sample Indian J Med Res 138, December 2013, pp 888-893 Department of Psychiatry, St. Johns Medical College, Bangalore, India & Department of Psychiatry,Yale School of Medicine, New Haven, CT, USA 6. Pla1cidi GP, Boldrini M, Patronelli A, Fiore E, Chiovato L, Perugi G, et al. Prevalence of psychiatric disorders in thyroid diseased patients. Neuropsycho-biology 1998; 38 : 222-5. 7. Gitlin M, Altshuler LL, Frye MA, Suri R, Huynh EL, Fairbanks 2. L, et al. Peripheral thyroid hormones and response to selective serotonin reuptake inhibitors. J Psychiatry Neurosci 2004; 29 : 383-6. 8. Carvalho AF, Machado JR, Cavalcante JL. Augmentation 3. strategies for treatment-resistant depression. Curr Opin Psychiatry 2009; 22 : 7-12. 9. Bauer M, London ED, Silverman DH, Rasgon N, Kirchheiner 4. J, Whybrow PC. Thyroid, brain and mood modulation in affective disorder: insights from molecular research and functional brain imaging. Pharmacopsychiatry 2003; 36 (Suppl 3): S215-21. 10. Unnikrishnan AG, Menon UV. Thyroid disorders in India: 15. An epidemiological perspective. Indian J Endocrinol Metab 2011; 15 (Suppl 2): S78-81. 11. Bartalena L, Pellegrini L, Meschi M, Antonangeli L, Bogazzi 16. F, Dell’Osso L, et al. Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorder. Psychiatry Res 1990; 34 : 13-7. 12. Cassidy F, Ahearn EP, Carroll BJ. Thyroid function in mixed 17. and pure manic episodes. Bipolar Disord 2002; 4 : 393-7. 13. Nader S, Warner MD, Doyle S, Peabody CA. Euthyroid sick . syndrome in psychiatric inpatients. Biol Psychiatry 1996; 40 : 1288-93. 14. Lambert TJ, Davidson R, McLellan GH. Euthyroidhyperthyroxineaemia in acute psychiatric admissions. Aust N Z J Psychiatry 1987; 21 : 608-12. 15. Chopra IJ. Clinical review 86: Euthyroid sick syndrome: is it a. misnomer? J Clin Endocrinol Metab 1997; 82 : 329-34. 16. Asher R. Myxoedematous madness. Br Med J 1949;9:555-62. 17. Brownlie BE, Rae AM, Walshe JW, Wells JE. Psychoses associated with thyrotoxicosis – ‘thyrotoxic psychosis.’ A report of 18 cases, with statistical analysis of incidence. Eur J Endocrinol 2000; 142:438-44. 18. Haggerty JJ Jr, Stern RA, Mason GA, Beckwith J, Morey CE, Prange AJ Jr. Subclinical hypothyroidism: A modifiable risk factor for depression? Am J Psychiatry 1993;150:508-10. 19. Oomen HA, Schipperijn AJ, Drexhage HA. The prevalence of affective disorder and in particular of a rapid cycling of bipolar disorder in patients with abnormal thyroid function tests. Clin Endocrinol (Oxf) 1996;45:215-23. 20. Sokolov STH, Levitt AJ, Joffe RT. Thyroid hormone levels before unsuccessful antidepressant therapy are associated with later response to T3 augmentation. Psychiatry Res 1997;69:203-6. 21. Parry CH. Collections From the Unpublished Writings of the Late C.H. Parry. Vol 2. London, UK: Underwoods; 1825. 22. Graves RJ. Newly observed affection of the thyroid gland in females. Lond Med Surg J. 1835;7:516-517. 23. Bauer MS, Whybrow PC, Winokur A. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch Gen Psychiatry. 1990;47(5):427-432. 24. Bauer M, Whybrow PC. Thyroid hormone, neural tissue and mood modulation. World J Biol Psychiatry. 2001;2(2):59-69. 25. Gold MS, Pottash AL, Extein I. Hypothyroidism and depression. Evidence from complete thyroid function evaluation. JAMA. 1981;245(19):1919-1922. 26. Haggerty JJ Jr, Prange AJ Jr. Borderline hypothyroidism and depression. Annu Rev Med. 1995;46:37-46. 27. Haggerty JJ Jr, Stern RA, Mason GA, Beckwith J, Morey CE, Prange AJ Jr. Subclinical hypothyroidism: a modifiable risk factor for depression? Am J Psychiatry. 1993;150(3):508-510. 28. Joffe RT,Thyroid hormone levels and recurrence of major depression. Am J Psychiatry. 2000;157(10):1689-1691. 29. Loosen PT, Prange AJ Jr. Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: a review. Am J Psychiatry. 1982; 139(4):405-416. 30. Bauer MS, Whybrow PC. Thyroid hormones and the central nervous system in affective illness: interactions that may have clinical significance. Integr Psychiatry. 1988;6:75-100. 31. Baumgartner A, Graf KJ, Kurten I, Meinhold H. The hypothalamic-pituitary-thyroid axis in psychiatric patients and healthy subjects: Parts 1-4. Psychiatry Res. 1988;24(3):271-332. 32. Loosen PT. The TRH-induced TSH response in psychiatric patients: a possible neuroendocrine marker. Psychoneuroend-ocrinology. 1985; 10(3):237-260. 33. Mason GA, Garbutt JC, Prange AJ. Thyrotropin-releasing hormone. In: Bloom, FE, Kupfer DJ, eds. Psychopharmacology: The Fourth Generation of Progress. New York, NY: Raven Press; 1995:493-503. 34. Banki CM, Bissette G, Arato M, Nemeroff CB. Elevation of immunoreactive CSF TRH in depressed patients. Am J Psychiatry. 1988;145(12):1526-1531. 35. Frye MA, Denicoff KD, Bryan AL, et al. Association between lower serum free T4 and greater mood instability and depression in lithium-maintained bipolar patients. Am J Psychiatry. 1999;156 (12): 1909-1914. 36. 4 Cole DP, Thase ME, Mallinger AG, et al. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002;159(1):116-121. 37. Andrea Pfennig, Mark A. Frye et al “The Mood Spectrum and Hypothalamic-Pituitary-Thyroid Axis” Primary psychiatry vol.11 no.10 2004. 38. Cavalieri RR: The effects of nonthyroid disease and drugs on thyroid function tests. Med Clin North Am 1991; 75:27–39 39. Roca RP; Blackman MR; Ackerley MB; Harman SM; Gregerman RI: Thyroid hormone elevations during acute psychiatric illness: relationship to severity and distinction from hyperthyroidism. Endocr Res 1990; 16:415–447 40. Reichlin S: Neuroendocrine immune interactions. N Engl J Med 1993; 329:1246–1253 41. Docter R; Krenning EP; de Jong M; Hennemann G: The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism. Clin Endocrinol (Oxf) 1993; 39:499–518Abstract
Key Words- Brain, HPT –axis,T3, T4, TSH, interrelationship.References