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Increased prevalence of subclinical hypothyroidism in female hospitalized patients with depression

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Abstract

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.

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References

  1. X. Lang, X. Hou, F. Shangguan, X.Y. Zhang, Prevalence and clinical correlates of subclinical hypothyroidism in first-episode drug-naive patients with major depressive disorder in a large sample of Chinese. J. Affect Disord. 263, 507–515 (2020). https://doi.org/10.1016/j.jad.2019.11.004

    Article  CAS  PubMed  Google Scholar 

  2. M.D. Kim, H.J. Yang, N.R. Kang, J.H. Park, Y.E. Jung, Association between subclinical hypothyroidism and metabolic syndrome among individuals with depression. J. Affect Disord. 264, 494–497 (2020). https://doi.org/10.1016/j.jad.2019.11.080

    Article  PubMed  Google Scholar 

  3. M.H. Samuels, Subclinical hypothyroidism and depression: is there a link? J. Clin. Endocrinol. Metab. 103(5), 2061–2064 (2018). https://doi.org/10.1210/jc.2018-00276

    Article  PubMed  PubMed Central  Google Scholar 

  4. B.M. Cohen, B.R. Sommer, A. Vuckovic, Antidepressant-resistant depression in patients with comorbid subclinical hypothyroidism or high-normal TSH levels. Am. J. Psychiatry 175(7), 598–604 (2018). https://doi.org/10.1176/appi.ajp.2017.17080949

    Article  PubMed  Google Scholar 

  5. S. Lee, S.S. Oh, E.C. Park, S.I. Jang, Sex differences in the association between thyroid-stimulating hormone levels and depressive symptoms among the general population with normal free T4 levels. J. Affect Disord. 249, 151–158 (2019). https://doi.org/10.1016/j.jad.2019.02.027

    Article  CAS  PubMed  Google Scholar 

  6. A. Talaei, N. Rafee, F. Rafei, A. Chehrei, TSH cut off point based on depression in hypothyroid patients. BMC Psychiatry 17(1) (2017). https://doi.org/10.1186/s12888-017-1478-9

  7. D.S. Cooper, B. Biondi, Subclinical thyroid disease. Lancet 379(9821), 1142–1154 (2012). https://doi.org/10.1016/s0140-6736(11)60276-6

    Article  PubMed  Google Scholar 

  8. Y. Shen, F. Wu, Y. Zhou, Y. Ma, X. Huang, Y. Ning, X. Lang, X. Luo, X. Zhang, Association of thyroid dysfunction with suicide attempts in first-episode and drug naive patients with major depressive disorder. J. Affect Disord. 259, 180–185 (2019). https://doi.org/10.1016/j.jad.2019.08.067

    Article  CAS  PubMed  Google Scholar 

  9. A. Labaka, O. Goni-Balentziaga, A. Lebena, J. Perez-Tejada, Biological sex differences in depression: a systematic review. Biol. Res. Nurs. 20(4), 383–392 (2018). https://doi.org/10.1177/1099800418776082

    Article  PubMed  Google Scholar 

  10. R.H. Salk, J.S. Hyde, L.Y. Abramson, Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol. Bull. 143(8), 783–822 (2017). https://doi.org/10.1037/bul0000102

    Article  PubMed  PubMed Central  Google Scholar 

  11. S.M. Marcus, K.B. Kerber, A.J. Rush, S.R. Wisniewski, A. Nierenberg, G.K. Balasubramani, L. Ritz, S. Kornstein, E.A. Young, M.H. Trivedi, Sex differences in depression symptoms in treatment-seeking adults: confirmatory analyses from the Sequenced Treatment Alternatives to Relieve Depression study. Compr. Psychiatry 49(3), 238–246 (2008). https://doi.org/10.1016/j.comppsych.2007.06.012

    Article  PubMed  PubMed Central  Google Scholar 

  12. M. Altemus, N. Sarvaiya, C. Neill Epperson, Sex differences in anxiety and depression clinical perspectives. Front. Neuroendocrinol. 35(3), 320–330 (2014). https://doi.org/10.1016/j.yfrne.2014.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  13. R.P. Peeters, Subclinical hypothyroidism. N. Engl. J. Med. 376(26), 2556–2565 (2017). https://doi.org/10.1056/NEJMcp1611144

    Article  PubMed  Google Scholar 

  14. B. Biondi, A.R. Cappola, D.S. Cooper, Subclinical hypothyroidism: a review. JAMA 322(2), 153–160 (2019). https://doi.org/10.1001/jama.2019.9052

    Article  CAS  PubMed  Google Scholar 

  15. D.V. Sheehan, Y. Lecrubier, K.H. Sheehan, P. Amorim, J. Janavs, E. Weiller, T. Hergueta, R. Baker, G.C. Dunbar, The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry 59(Suppl 20), 22–33 (1998)

    PubMed  Google Scholar 

  16. American Psychiatri Association, Diagnostic Criteria from DSM-IV (American Psychiatric Association, Washington, 1994)

    Google Scholar 

  17. World Medical Association, World medical association declaration of helsinki: ethical principles for medical research involving human subjects. JAMA 310, 2191–2194 (2013)

    Article  Google Scholar 

  18. M. Hamilton, A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 23(1), 56–62 (1960). https://doi.org/10.1136/jnnp.23.1.56

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. M. Hamilton, The assessment of anxiety states by rating. Psychol. Psychother. 32, 50–55 (1959)

    CAS  Google Scholar 

  20. Z. Shan, L. Chen, X. Lian, C. Liu, B. Shi, L. Shi, N. Tong, S. Wang, J. Weng, J. Zhao, X. Teng, X. Yu, Y. Lai, W. Wang, C. Li, J. Mao, Y. Li, C. Fan, W. Teng, Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China: a cross-sectional study in 10 cities. Thyroid 26(8), 1125–1130 (2016). https://doi.org/10.1089/thy.2015.0613

    Article  CAS  PubMed  Google Scholar 

  21. A. Rogowicz-Frontczak, B. Falkowski, A. Grzelka-Wozniak, A. Uruska, A. Araszkiewicz, D. Zozulinska-Ziolkiewicz, Does autoimmune hypothyroidism increase the risk of neurovascular complications in type 1 diabetes? J. Endocrinol. Investig. (2020). https://doi.org/10.1007/s40618-019-01171-x

  22. E. Fuller-Thomson, J. Saini, S. Brennenstuhl, The association between depression and thyroid disorders in a regionally representative Canadian sample. Psychol. Health Med. 17, 335–345 (2012)

    Article  Google Scholar 

  23. L. Jain, H. A., K. Verma, H. Singh, S. Aswal, A study of correlation between depression and hypothyroidism in female patients. Psychiatry J. 16(2), 283–287 (2013)

    Google Scholar 

  24. J. Hazarika, K.N. Kalita, M. Sharma, S. Saikia, P. Patangia, P. Hazarika, A.C. Sarmah, Thyroid profile in depression: a cross-sectional study from North-East India. Int. J. Res. Med. Sci. 5(3) (2017). https://doi.org/10.18203/2320-6012.ijrms20170663

  25. Y.Y. Xu, J. Liang, Y. Cao, F. Shan, Y. Liu, Q.R. Xia, High levels of Nesfatin-1 in relation to the dysfunction of the hypothalamic-pituitary-adrenal and hypothalamus-pituitary-thyroid axes in depressed patients with subclinical hypothyroidism. Neuropsychiatr. Dis. Treat. 13, 1647–1653 (2017). https://doi.org/10.2147/NDT.S138954

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Y. Duan, X. Wang, W. Peng, Y. Feng, W. Tang, X. Wu, X. Mao, R. Bo, W. Li, J. Chen, Y. Qin, C. Liu, C. Liu, Gender-specific associations between subclinical hypothyroidism and blood pressure in Chinese adults. Endocrine 36(3), 438–444 (2009). https://doi.org/10.1007/s12020-009-9244-5

    Article  CAS  PubMed  Google Scholar 

  27. C. Kuehner, Why is depression more common among women than among men? Lancet Psychiatry 2(4), 146–158 (2017)

    Article  Google Scholar 

  28. P.T. Loosen, A.J. Prange Jr., Serum thyrotropin response to thyrotropin-releasing hormone in psychiatric patients: a review. Am. J. Psychiatry 139(4), 405–416 (1982). https://doi.org/10.1176/ajp.139.4.405

    Article  CAS  PubMed  Google Scholar 

  29. F. Duval, M.C. Mokrani, A. Erb, F. Gonzalez Opera, C. Calleja, V. Paris, Relationship between chronobiological thyrotropin and prolactin responses to protirelin (TRH) and suicidal behavior in depressed patients. Psychoneuroendocrinology 85, 100–109 (2017). https://doi.org/10.1016/j.psyneuen.2017.07.488

    Article  CAS  PubMed  Google Scholar 

  30. S.D. Targum, A.C. Sullivan, S.M. Byrnes, Compensatory pituitary-thyroid mechanisms in major depressive disorder. Psychiatry Res. 6(1), 85–96 (1982). https://doi.org/10.1016/0165-1781(82)90041-5

    Article  CAS  PubMed  Google Scholar 

  31. M.R. Garcia, N.D. Ryan, H. Rabinovitch, P. Ambrosini, J.A.N. Twomey, S. Iyengar, H. Novacenko, B. Nelson, J. Puig-Antich, Thyroid stimulating hormone response to thyrotropin in prepubertal depression. J. Am. Acad. Child Adolesc. Psychiatry 30(3), 398–406 (1991). https://doi.org/10.1097/00004583-199105000-00008

    Article  CAS  PubMed  Google Scholar 

  32. N. de Souza Duarte, L.M. de Almeida Corrêa, L.R. Assunção, A.A. de Menezes, O.B. de Castro, L.F. Teixeira, Relation between depression and hormonal dysregulation. Open J. Depression 6(3), 69–78 (2017). https://doi.org/10.4236/ojd.2017.63005

    Article  Google Scholar 

  33. B. Lisowska-Myjak, A. Puchalska, N. Halasa, M. Plazinska, A. Strawa, The association between clinical and laboratory parameters in thyroid disease and nonthyroidal illness in young women. Eur. Rev. Med. Pharmacol. Sci. 23(7), 2950–2959 (2019). https://doi.org/10.26355/eurrev_201904_17575

    Article  CAS  PubMed  Google Scholar 

  34. M. Bauer, A. Heinz, P.C. Whybrow, Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol. Psychiatry 7(2), 140–156 (2002). https://doi.org/10.1038/sj.mp.4000963

    Article  CAS  PubMed  Google Scholar 

  35. C.M. Dayan, V. Panicker, Hypothyroidism and depression. Eur. Thyroid J. 2(3), 168–179 (2013). https://doi.org/10.1159/000353777

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. S. Koner, A. Chaudhuri, A study of correlation of perceived stress and thyroid function among females in a rural population of reproductive age group. Med. J. Dr. D.Y. Patil Vidyapeeth 13(1) (2020). https://doi.org/10.4103/mjdrdypu.mjdrdypu_219_18

  37. S. Fischer, J. Strahler, C. Markert, N. Skoluda, J.M. Doerr, M. Kappert, U.M. Nater, Effects of acute psychosocial stress on the hypothalamic-pituitary-thyroid (HPT) axis in healthy women. Psychoneuroendocrinology 110, 104438 (2019). https://doi.org/10.1016/j.psyneuen.2019.104438

    Article  CAS  PubMed  Google Scholar 

  38. R. Arrojo e Drigo, T.L. Fonseca, J.P.S. Werneck-de-Castro, A.C. Bianco, Role of the type 2 iodothyronine deiodinase (D2) in the control of thyroid hormone signaling. Biochim. Biophys. Acta 1830(7), 3956–3964 (2013). https://doi.org/10.1016/j.bbagen.2012.08.019

    Article  CAS  PubMed  Google Scholar 

  39. E. Gałecka, M. Talarowska, A. Orzechowska, P. Górski, M. Bie nkiewicz, J. Szemraj, Association of the DIO2 gene single nucleotide polymorphisms with recurrent depressive disorder. Acta Biochim. 62(2), 297–302 (2015). https://doi.org/10.18388/abp.2015_1002

    Article  Google Scholar 

  40. C. Luongo, C. Martin, K. Vella, A. Marsili, R. Ambrosio, M. Dentice, J.W. Harney, D. Salvatore, A.M. Zavacki, P.R. Larsen, The selective loss of the type 2 iodothyronine deiodinase in mouse thyrotrophs increases basal TSH but blunts the thyrotropin response to hypothyroidism. Endocrinology 156(2), 745–754 (2015). https://doi.org/10.1210/en.2014-1698

    Article  CAS  PubMed  Google Scholar 

  41. E. Gałecka, M. Talarowska, M. Maes, K.-P. Su, P. Górski, A. Kumor-Kisielewska, J. Szemraj, Expression levels of interferon-ɣ and type 2 deiodinase in patients diagnosed with recurrent depressive disorders. Pharmacol. Rep. 70(1), 133–138 (2018). https://doi.org/10.1016/j.pharep.2017.08.009

    Article  CAS  PubMed  Google Scholar 

  42. B.M. Bocco, J.P. Werneck-de-Castro, K.C. Oliveira, G.W. Fernandes, T.L. Fonseca, B.P. Nascimento, E.A. McAninch, E. Ricci, Z. Kvárta-Papp, C. Fekete, M.M. Bernardi, B. Gereben, A.C. Bianco, M.O. Ribeiro et al. Type 2 deiodinase disruption in astrocytes results in anxiety-Depressive-Like behavior in male mice. Endocrinology 157(9), 3682–3695 (2016).

    Article  CAS  Google Scholar 

  43. S.J. Jung, H.T. Woo, S. Cho, K. Park, S. Jeong, Y.J. Lee, D. Kang, A. Shin, Association between body size, weight change and depression: systematic review and meta-analysis. Br. J. Psychiatry 211(1), 14–21 (2017). https://doi.org/10.1192/bjp.bp.116.186726

    Article  PubMed  Google Scholar 

  44. S.E. Sharafi, G. Garmaroudi, M. Ghafouri, S.A. Bafghi, M. Ghafouri, M.R. Tabesh, Z. Alizadeh, Prevalence of anxiety and depression in patients with overweight and obesity. Obes. Med. 17 (2020). https://doi.org/10.1016/j.obmed.2019.100169

  45. C.M. Pariante, S.L. Lightman, The HPA axis in major depression: classical theories and new developments. Trends Neurosci. 31(9), 464–468 (2008). https://doi.org/10.1016/j.tins.2008.06.006

    Article  CAS  PubMed  Google Scholar 

  46. E. Pereira-Miranda, P.R.F. Costa, V.A.O. Queiroz, M. Pereira-Santos, M.L.P. Santana, Overweight and obesity associated with higher depression prevalence in adults: a systematic review and meta-analysis. J. Am. Coll. Nutr. 36(3), 223–233 (2017). https://doi.org/10.1080/07315724.2016.1261053

    Article  PubMed  Google Scholar 

  47. L. Schmaal, P.G. Samann et al. Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA Major Depressive Disorder Working Group. Mol. Psychiatry 22(6), 900–909 (2017). https://doi.org/10.1038/mp.2016.60

    Article  CAS  PubMed  Google Scholar 

  48. P. Bjorntorp, Do stress reactions cause abdominal obesity and comorbidities? Obes. Rev. 2(2), 73–86 (2001). https://doi.org/10.1046/j.1467-789x.2001.00027.x

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are grateful to all the physicians and nurses that participated in our current study and also to those research staff that contributed to the diagnosis of the subjects and clinical assessment.

Funding

This study was supported by grants of the National Natural Science Foundation of China (81871066); the Jiangsu Provincial key research and development program (BE2018609 and BE2019675); the Jiangsu Provincial Medical Innovation Team of the Project of Invigorating Health Care through Science, Technology and Education (CXTDC2016004); and the Key Project supported by Medical Science and Technology development Foundation, Jiangsu Commission of Health (K2019011).

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Authors and Affiliations

  1. Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, People’s Republic of China

    Shuai Zhao, Zhilu Chen, Xumiao Wang & Zhijian Yao

  2. School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, People’s Republic of China

    Zhijian Yao & Qing Lu

  3. Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, People’s Republic of China

    Zhijian Yao

  4. Child Development and Learning Science, Key Laboratory of Ministry of Education, Southeast University, Nanjing, 210096, People’s Republic of China

    Qing Lu

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

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