Skip to main content

Advertisement

SpringerLink
Log in

Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Both metabolic syndrome (MetS) and subclinical hypothyroidism (SCH) are prevalent in major depressive disorder (MDD) patients. However, their relationship in this population remains unknown. The study assessed the association between SCH and MetS in 1706 first-episode drug-naïve (FEDN) MDD patients. We also compared the relationship between MetS and clinical symptoms in patients with and without comorbid SCH. The Positive and Negative Syndrome Scale positive subscale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale were used to detect clinical symptoms. Serum levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), anti-thyroglobulin, thyroid peroxidases antibody, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose were measured. The Area Under the Curve (AUC) was used to test the performance of serum TSH in identifying MetS patients. The prevalence of MetS and SCH was 34.5% (n = 585) and 61% (n = 1034), respectively. The presence of SCH increased the risk of MetS, hyperglycemia, hypertension, obesity, and low HDL-C by 4.91, 3.51, 3.54, 2.02, and 2.34 times, respectively. Serum TSH had a nice ability to distinguish MetS patients from non-MetS patients (AUC value = 0.77). MetS and its components exhibited a positive association with clinical profiles only in SCH patients, but not in non-SCH patients. Taken together, our study suggested SCH was closely related to MetS and might play a vital role in the relationship between MetS and clinical symptoms. Regular thyroid function checks might help early detect MetS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, Xiangyang Zhang, upon reasonable request.

References

  1. Malhi GS, Mann JJ (2018) Depression. The Lancet 392:2299–2312. https://doi.org/10.1016/S0140-6736(18)31948-2

    Article  Google Scholar 

  2. Chan KL, Cathomas F, Russo SJ (2019) Central and peripheral inflammation link metabolic syndrome and major depressive disorder. Physiology (Bethesda) 34:123–133. https://doi.org/10.1152/physiol.00047.2018

    Article  CAS  PubMed  Google Scholar 

  3. Vancampfort D, Correll CU, Wampers M et al (2014) Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med 44:2017–2028. https://doi.org/10.1017/S0033291713002778

    Article  CAS  PubMed  Google Scholar 

  4. Pan A, Keum N, Okereke OI et al (2012) Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care 35:1171–1180. https://doi.org/10.2337/dc11-2055

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hough CM, Bersani FS, Mellon SH et al (2020) Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder: a preliminary report. Psychol Med. https://doi.org/10.1017/S0033291720000896

    Article  PubMed  Google Scholar 

  6. Mulvahill JS, Nicol GE, Dixon D et al (2017) Effect of metabolic syndrome on late-life depression: associations with disease severity and treatment resistance. J Am Geriatr Soc 65:2651–2658. https://doi.org/10.1111/jgs.15129

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yang L, Yang X, Yang T et al (2021) The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Res 305:114205. https://doi.org/10.1016/j.psychres.2021.114205

    Article  PubMed  Google Scholar 

  8. Bekkering GE, Agoritsas T, Lytvyn L et al (2019) Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. BMJ 365:I2006. https://doi.org/10.1136/bmj.l2006

    Article  Google Scholar 

  9. Liu F-H, Hwang J-S, Kuo C-F et al (2018) Subclinical hypothyroidism and metabolic risk factors association: a health examination-based study in northern Taiwan. Biomed J 41:52–58. https://doi.org/10.1016/j.bj.2018.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  10. He J, Lai Y, Yang J et al (2021) The relationship between thyroid function and metabolic syndrome and its components: a cross-sectional study in a Chinese population. Front Endocrinol (Lausanne) 12:661160. https://doi.org/10.3389/fendo.2021.661160

    Article  PubMed  Google Scholar 

  11. Chang C-H, Yeh Y-C, Caffrey JL et al (2017) Metabolic syndrome is associated with an increased incidence of subclinical hypothyroidism—a Cohort Study. Sci Rep 7:6754. https://doi.org/10.1038/s41598-017-07004-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wu Z, Jiang Y, Zhou D et al (2022) Sex-specific association of subclinical hypothyroidism with incident metabolic syndrome: a population-based cohort study. J Clin Endocrinol Metab 107:e2365–e2372. https://doi.org/10.1210/clinem/dgac110

    Article  PubMed  Google Scholar 

  13. Loh HH, Lim LL, Yee A, Loh HS (2019) Association between subclinical hypothyroidism and depression: an updated systematic review and meta-analysis. BMC Psychiatry 19:12. https://doi.org/10.1186/s12888-018-2006-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tang R, Wang J, Yang L et al (2019) Subclinical hypothyroidism and depression: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 10:340. https://doi.org/10.3389/fendo.2019.00340

    Article  PubMed  Google Scholar 

  15. Kim M-D, Yang H-J, Kang NR et al (2020) Association between subclinical hypothyroidism and metabolic syndrome among individuals with depression. J Affect Disord 264:494–497. https://doi.org/10.1016/j.jad.2019.11.080

    Article  PubMed  Google Scholar 

  16. Fang X, Wang D, Tang W et al (2021) Anhedonia difference between major depressive disorder and bipolar disorder II. BMC Psychiatry 21:531. https://doi.org/10.1186/s12888-021-03548-w

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liu W, Wu Z, Sun M et al (2022) Association between fasting blood glucose and thyroid stimulating hormones and suicidal tendency and disease severity in patients with major depressive disorder. Bosn J Basic Med Sci 22:635–642. https://doi.org/10.17305/bjbms.2021.6754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zimmerman M, Martinez JH, Young D et al (2013) Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 150:384–388. https://doi.org/10.1016/j.jad.2013.04.028

    Article  PubMed  Google Scholar 

  19. Thompson E (2015) Hamilton Rating Scale for Anxiety (HAM-A). Occup Med (Lond) 65:601. https://doi.org/10.1093/occmed/kqv054

    Article  PubMed  Google Scholar 

  20. Zhou Y, Wang Q, Ren H et al (2022) Prevalence and related factors of anxiety in first episode and drug naïve Chinese Han outpatients with psychotic major depression. J Affect Disord 316:217–222. https://doi.org/10.1016/j.jad.2022.08.018

    Article  PubMed  Google Scholar 

  21. Lim K, Peh O-H, Yang Z et al (2021) Large-scale evaluation of the Positive and Negative Syndrome Scale (PANSS) symptom architecture in schizophrenia. Asian J Psychiatr 62:102732. https://doi.org/10.1016/j.ajp.2021.102732

    Article  PubMed  Google Scholar 

  22. Shen Y, Wei Y, Yang X-N et al (2020) Psychotic symptoms in first-episode and drug naïve patients with major depressive disorder: Prevalence and related clinical factors. Depress Anxiety 37:793–800. https://doi.org/10.1002/da.23026

    Article  PubMed  Google Scholar 

  23. Li Y-C, Bai W, Cai H et al (2022) Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 12:303. https://doi.org/10.1038/s41398-022-02045-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Zhao M, Yang T, Chen L et al (2015) Subclinical hypothyroidism might worsen the effects of aging on serum lipid profiles: a population-based case-control study. Thyroid 25:485–493. https://doi.org/10.1089/thy.2014.0219

    Article  CAS  PubMed  Google Scholar 

  25. Li X, Zhen D, Zhao M et al (2017) Natural history of mild subclinical hypothyroidism in a middle-aged and elderly Chinese population: a prospective study. Endocr J 64:437–447. https://doi.org/10.1507/endocrj.EJ16-0549

    Article  PubMed  Google Scholar 

  26. Chen Q, Zhu H, Shen F et al (2020) Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 diabetes. J Diabetes Complic 34:107537. https://doi.org/10.1016/j.jdiacomp.2020.107537

    Article  Google Scholar 

  27. Su Y, Lu Y, Li W et al (2020) Prevalence and correlation of metabolic syndrome: a cross-sectional study of nearly 10 million multi-ethnic Chinese adults. Diabetes Metab Syndr Obes 13:4869–4883. https://doi.org/10.2147/DMSO.S278346

    Article  PubMed  PubMed Central  Google Scholar 

  28. Qin X, Qiu L, Tang G et al (2020) Prevalence of metabolic syndrome among ethnic groups in China. BMC Public Health 20:297. https://doi.org/10.1186/s12889-020-8393-6

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lan Y, Mai Z, Zhou S et al (2018) Prevalence of metabolic syndrome in China: An up-dated cross-sectional study. PLoS ONE 13:e0196012. https://doi.org/10.1371/journal.pone.0196012

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Li R, Li W, Lun Z et al (2016) Prevalence of metabolic syndrome in Mainland China: a meta-analysis of published studies. BMC Public Health 16:296. https://doi.org/10.1186/s12889-016-2870-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Huang Y-C, Lin P-Y, Lee Y et al (2021) Metabolic syndrome components and leukocyte telomere length in patients with major depressive disorder. World J Biol Psychiatry. https://doi.org/10.1080/15622975.2021.2013091

    Article  PubMed  Google Scholar 

  32. Kahl KG, Greggersen W, Schweiger U et al (2012) Prevalence of the metabolic syndrome in unipolar major depression. Eur Arch Psychiatry Clin Neurosci 262:313–320. https://doi.org/10.1007/s00406-011-0277-4

    Article  PubMed  Google Scholar 

  33. Moreira FP, Jansen K, de Cardoso TA et al (2017) Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: population-based study: Metabolic syndrome in current depressive episode. J Psychiatr Res 92:119–123. https://doi.org/10.1016/j.jpsychires.2017.03.025

    Article  PubMed  Google Scholar 

  34. Marazziti D, Rutigliano G, Baroni S et al (2014) Metabolic syndrome and major depression. CNS Spectr 19:293–304. https://doi.org/10.1017/S1092852913000667

    Article  PubMed  Google Scholar 

  35. Qiu W, Cai X, Zheng C et al (2021) Update on the relationship between depression and neuroendocrine metabolism. Front Neurosci 15:728810. https://doi.org/10.3389/fnins.2021.728810

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wei Y-G, Cai D-B, Liu J et al (2020) Cholesterol and triglyceride levels in first-episode patients with major depressive disorder: a meta-analysis of case-control studies. J Affect Disord 266:465–472. https://doi.org/10.1016/j.jad.2020.01.114

    Article  CAS  PubMed  Google Scholar 

  37. Bharti V, Bhardwaj A, Hood K et al (2021) A systematic review and meta-analysis of lipid metabolomic signatures of Major Depressive Disorder. J Psychiatr Res 139:197–205. https://doi.org/10.1016/j.jpsychires.2021.05.036

    Article  PubMed  Google Scholar 

  38. Wang X, Yang L, Liu J et al (2022) Association of serum lipid levels with psychotic symptoms in first-episode and drug naïve outpatients with major depressive disorder: a large-scale cross-sectional study. J Affect Disord 297:321–326. https://doi.org/10.1016/j.jad.2021.10.053

    Article  CAS  PubMed  Google Scholar 

  39. Ma Y-J, Zhou Y-J, Wang D-F et al (2020) Association of lipid profile and suicide attempts in a large sample of first episode drug-naive patients with major depressive disorder. Front Psychiatry 11:543632. https://doi.org/10.3389/fpsyt.2020.543632

    Article  PubMed  PubMed Central  Google Scholar 

  40. Delitala AP, Scuteri A, Maioli M et al (2019) Subclinical hypothyroidism and cardiovascular risk factors. Minerva Med 110:530–545. https://doi.org/10.23736/S0026-4806.19.06292-X

    Article  PubMed  Google Scholar 

  41. Li R-C, Zhang L, Luo H et al (2020) Subclinical hypothyroidism and anxiety may contribute to metabolic syndrome in Sichuan of China: a hospital-based population study. Sci Rep 10:2261. https://doi.org/10.1038/s41598-020-58973-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Zhao S, Chen Z, Wang X et al (2021) Increased prevalence of subclinical hypothyroidism in female hospitalized patients with depression. Endocrine 72:479–485. https://doi.org/10.1007/s12020-020-02490-3

    Article  CAS  PubMed  Google Scholar 

  43. Ding X, Zhao Y, Zhu C-Y et al (2021) The association between subclinical hypothyroidism and metabolic syndrome: an update meta-analysis of observational studies. Endocr J 68:1043–1056. https://doi.org/10.1507/endocrj.EJ20-0796

    Article  CAS  PubMed  Google Scholar 

  44. Biondi B, Kahaly GJ, Robertson RP (2019) Thyroid dysfunction and diabetes mellitus: two closely associated disorders. Endocr Rev 40:789–824. https://doi.org/10.1210/er.2018-00163

    Article  PubMed  PubMed Central  Google Scholar 

  45. Gupta S, Mukherjee A, Biswas S et al (2017) Evaluation of endocrine parameters as predictor of major depressive disorder. Indian J Psychol Med 39:766–769. https://doi.org/10.4103/IJPSYM.IJPSYM_120_17

    Article  PubMed  PubMed Central  Google Scholar 

  46. Kvetny J, Heldgaard PE, Bladbjerg EM, Gram J (2004) Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf) 61:232–238. https://doi.org/10.1111/j.1365-2265.2004.02088.x

    Article  CAS  PubMed  Google Scholar 

  47. Kalinowska S, Trześniowska-Drukała B, Safranow K et al (2019) Association between thyroid function and metabolic syndrome in male and female schizophrenia patients. Psychiatry Res 274:167–175. https://doi.org/10.1016/j.psychres.2019.02.029

    Article  CAS  PubMed  Google Scholar 

  48. Zhao C, Wang Y, Xiao L, Li L (2022) Effect of levothyroxine on older patients with subclinical hypothyroidism: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 13:913749. https://doi.org/10.3389/fendo.2022.913749

    Article  PubMed  Google Scholar 

  49. Gurka MJ, Filipp SL, Musani SK et al (2018) Use of BMI as marker of adiposity in a metabolic syndrome severity score: derivation and validation in predicting long-term disease outcomes. Metabolism 83:68–74. https://doi.org/10.1016/j.metabol.2018.01.015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Li Y, Zhao L, Yu D et al (2018) Metabolic syndrome prevalence and its risk factors among adults in China: a nationally representative cross-sectional study. PLoS ONE 13:e0199293. https://doi.org/10.1371/journal.pone.0199293

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Grundy SM (2016) Metabolic syndrome update. Trends Cardiovasc Med 26:364–373. https://doi.org/10.1016/j.tcm.2015.10.004

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge all the participants.

Funding

This work was supported by the CAS Pioneer Hundred Talents Program and the National Natural Science Foundation of China (81371477). These sources had no further role in this study design, in the data collection and analysis, in the writing of the report, and in the decision to submit the paper for publication.

Author information

Authors and Affiliations

  1. Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China

    Pu Peng, Qianjin Wang, Yuzhu Hao, Shubao Chen, Qiuxia Wu, Manyun Li, Yunfei Wang, Qian Yang, Xin Wang, Yueheng Liu, Yuejiao Ma, Li He, Huixue Xu, Zejun Li & Tieqiao Liu

  2. Department of Psychiatry, Hunan Brain Hospital (Hunan Second People’s Hospital), Changsha, China

    Yanan Zhou

  3. Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China

    XiaoE Lang

  4. CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China

    Xiangyang Zhang

  5. Department of Psychology, University of Chinese Academy of Sciences, Beijing, China

    Xiangyang Zhang

Authors
  1. Pu Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qianjin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanan Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuzhu Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shubao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qiuxia Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manyun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yunfei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Qian Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yueheng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yuejiao Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Li He
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Huixue Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Zejun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. XiaoE Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Tieqiao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Xiangyang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PP: Formal analysis, Writing—original draft. QW: Writing—review & editing. YZ: Writing—review & editing. YH: Writing—review & editing. SC: Writing—review & editing. QW: Writing—review & editing. ML: Writing—review & editing. YW: Writing—review & editing. QY: Writing—review & editing. XW: Writing—review & editing. YL: Writing—review & editing. YM: Writing—review & editing. HL: Writing—review & editing. HX: Writing—review & editing. ZL: Writing—review & editing. XEL: Writing—review & editing. TL: Conceptualization, Writing–review & editing. XZ: Conceptualization, Writing–review & editing.

Corresponding authors

Correspondence to Tieqiao Liu or Xiangyang Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Institutional Review Board (IRB) of the First Hospital of Shanxi Medical University (No. 2016-Y27).

Consent to participate

Informed consent was obtained from all participants.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 20 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peng, P., Wang, Q., Zhou, Y. et al. Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study. Eur Arch Psychiatry Clin Neurosci 274, 573–582 (2024). https://doi.org/10.1007/s00406-023-01588-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-023-01588-9

Keywords

Search

Navigation