Thyroid dysfunction in patients of depression and anxiety and response to therapy
Keywords:Anxiety disorder, Depression, Hypothyroidism, Levothyroxine
Background: Depression and anxiety are the most common psychiatric presentation in thyroid dysfunction. Aim of the study was to determine the thyroid profile in patients with depressive and anxiety symptoms and to determine the change in symptoms with correction of thyroid profile.
Methods: This longitudinal observational study was conducted in patients presented with depressive or anxiety symptoms who visited the psychiatry out patient department (OPD) first time. Two groups were made based on the serum thyroid profile. First group, (n=27) was patients with depression and anxiety with hypothyroidism (experimental group) and second was (n=123) without hypothyroidism (control group). Experimental group, (n=27) was then exposed to thyroxine, 15 patients came for first follow up and 11 patients came for second follow up.
Results: The 63% of patients in the experimental group and 62.6% of patients in the control group were of female gender, 66.7% and 33.3% of patients in the experimental group had depressive disorder and anxiety disorder respectively. TSH level of 11 patients of experimental group had significantly less value in first follow up compared to entry point (p=0.002). Generalized anxiety disorder (GAD) 7 scores were significantly lower in first and second follow up than that of the entry point in 11 patients of experimental group (p=0.008, 0.016 respectively).
Conclusions: Many patients of the clinical diagnosis of depression (17.6%) and clinical diagnosis of anxiety (18.75%) had hypothyroidism during the first visit to the psychiatry OPD. There was significant reduction in the hypothyroid patients of the serum thyroid stimulating hormone (TSH) value and anxiety scores during the follow up after treatment with levothyroxine.
Porterfield SP, Hendrich CE. The role of thyroid hormones in prenatal and neonatal neurological development-current perspectives. Endocrine reviews. 1993;14(1):94-106.
Bernal J, Nunez J. Thyroid hormones and brain development. Eur J Endocrinol. 1995;133(4):390-8.
Geffken GR, Ward HE, Staab JP, Carmichael SL, Evans DL. Psychiatric morbidity in endocrine disorders. Psychiatr Clin North Am. 1998;21(2):473-89.
Ojha SP, Dhungana S, Chapagain M, Tulachan P. Association of thyroid dysfunction with depression in a teaching hospital. J Nepal Health Res Counc. 2013;11(23):30-4.
Sartorius N, Ustun TB, Lecrubier Y, Wittchen HU. Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry. 1996;168 (S30):38-43.
Sapini Y, Rokiah P. Thyroid disorders and psychiatric morbidities. Malaysian J Psychiatry. 2009;18:2.
Khouzam HR, Weiser PM, Gill T, Raroque R. Thyroid hormones therapy: A review of their effects in the treatment of psychiatric and medical conditions. Comprehensive therapy. 2004;30(3):148-54.
Sakai Y, Iversen V, Reitan SK. FT4 and TSH, relation to diagnoses in an unselected psychiatric acute-ward population, and change during acute psychiatric admission. BMC psychiatry. 2018;18(1):244.
Ralston S, Penman I, Strachan M, Hobson R. Davidson’s Principles and Practice of Medicine. 23rd ed. Elsevier. 2018.
Akiskal SH. Mood disorders: historical introduction and conceptual interview. In: Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry 10th ed. Lippincott William and Wilkins. 2017.
Merikangas KR, Eun JD. Epidemiology of Anxiety Disorders. In: Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry.10th ed. Lippincott William and Wilkins. 2017.
Vishnoi G, Chakraborty B, Garda H, Gowda SH, Goswami B. Low mood and response to Levothyroxine treatment in Indian patients with subclinical hypothyroidism. Asian J Psychiatr. 2014;8(1):89-93.
Rogers MP, White K, Warshaw MG, Yonkers KA, Rodriguez-Villa F, Chang G et al. Prevalence of medical illness in patients with anxiety disorders. Int J Psychiat Med. 1994;24(1):83-96.
Sareen J, Jacobi F, Cox BJ, Belik SL, Clara I, Stein MB. Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med. 2006;166(19):2109-16.
Simon NM, Blacker D, Korbly NB, Sharma SG, Worthington JJ, Otto MW et al. Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. J Affect. 2002;69(1-3):209-17.
Radhakrishnan R, Calvin S, Singh JK, Thomas B, Srinivasan K. Thyroid dysfunction in major psychiatric disorders in a hospital-based sample. Indian J Med Res. 2013;138(6):888.
Chhetry MG, Sapkota N, Ojha N, Thapa S, Pandey AK. Association of Thyroid Dysfunction with Mood Disorders in an OPD setting. J Psychiatrists' Association Nepal. 2014;3(1):23-8.
Bensenor IM, Nunes MA, Sander Diniz MD, Santos IS, Brunoni AR, Lotufo PA. Subclinical thyroid dysfunction and psychiatric disorders: cross-sectional results from the Brazilian Study of Adult Health (ELSA-Brasil). Clin endocrinol. 2016;84(2):250-6.
Witthauer C, Ajdacic-Gross V, Meyer AH, Vollenweider P, Waeber G, Preisig M et al. Associations of specific phobia and its subtypes with physical diseases: an adult community study. BMC psychiatry. 2016;16(1):155.