Summary
The characteristic psychic and somatic features found in patients with overt hyper- or hypothyroidism are usually attributed to elevated or diminished levels, respectively, of thyroid hormones. This concept does not sufficiently explain our previous investigations in which the same symptoms, albeit attenuated, were also seen in patients suffering from so-called latent disturbances of thyroid function. This state of disorder, however, exhibits normal concentrations of peripheral thyroid hormones. Only the response of thyroid-stimulating hormone (TSH) to thyrotropin-releasing hormone (TRH) stimulation is in accordance with the behaviour of the overt thyroid dysfunction and enables its differentiation from the euthyroid state. In this context, we investigated the question as to whether pathologic signs in thyroid disorders are correlated to alterations of peripheral thyroid hormones or to changes in the hypothalamus pituitary axis. Therefore, we investigated two groups of ten patients each who suffered from latent hyper- or hypothyroidism, respectively, and ten euthyroid controls. All were matched from sex and age. Endocrine function was estimated by TRH testing, TT3, TT4 and thyroxine binding globuline (TBG). Psychologic testing was performed by questionnaires concerning subjective somatic symptoms, emotional disturbances, psychomotoric performance, cognitive impairment and personality. Patients with latent hyperthyroidism were more subject to somatic symptoms and affective complaints than were those who had latent hypothyroidism. As compared with controls, there were significant differences in exhaustion and pain in the limbs and heart. In terms of affective complaints, patients were more depressive, anxious, touchy and irritable; their personalities showed a higher degree of emotional lability, excitement and irritability. Many symptoms described in overt thyroid dysfunction could be found in latent metabolic disturbances. Therefore, we conclude that the alterations of health in thyroid disorders are more likely to be caused by hypothalamic pituitary impairment than by changes in peripheral hormone levels. The stronger symptoms occurring in overt thyroid dysfunction as compared with latent metabolic disturbances may reflect the degree of hypothalamic pituitary dysfunction.
Similar content being viewed by others
Literatur
Artunkal S, Togrol B (1964) Psychological Studies in Hyperthyroidism. Aus: Cameron (ed) Brain-Thyroid-Relationship with Special Reference to Thyroid Disorders. Boston, Brown
BrÄhler E (1978) Der Gie\ener Beschwerdebogen. Habilitationsschrift, Gie\en
Brickenkamp R (1978) Test d2 Aufmerksamkeits-Belastungs-Test. Hogrefe, Göttingen
Bungard W (1979) Methodische Probleme bei der Befragung Älterer Menschen. Z Exp Angew Psychol XXVI/2:211–237
Campbell (1986) Thyroid Disorders in the Elderly. Difficulties in Diagnosis and Treatment. Drugs 31:455–461
Cooper DS et al. (1984) L-Thyroxine therapy in Subclinical Hypothyroidism. Ann Intern Med 101:18–24
Crooks J, Murray IPC, Wayne EJ (1959) Statistical methods applied to the clinical diagnosis of thyrotoxicosis. Qu J Med, New Serie XXVIII/110:211–234
Fahrenberg J, Selg H, Hampel R (1978) Das Freiburger Persönlichkeitsinventar (FPI). Handanweisung, 3. ergÄnzte Aufl. Hogrefe, Göttingen Toronto Zürich
Hall PCW (1983) Psychiatric effects of thyroid hormone disturbance. Psychosomatics 24 (3):7–18
Hamster W (1980) Die Motorische Leistungsserie. Dr. G. Schuhfried, Mödling
Hehrmann R, Heinen E (1983) Vorgehen und Probleme bei der Diagnose hypothyreoter ZustÄnde des Erwachsenen. Internist 24:447–452
Hermann MT, Quarton GC (1965) Psychological changes and psychogenesis in thyroid hormone disorders. J Clin Endocrinol 25:327–338
Hoff HG, Olbricht T (1988) Die subklinische Hypothyreose — eine behandlungsbedürftige Exkrankung? Med Klin 83/8-9:296–301
Kathol RG, Turner MD, Delahunt J (1986) Depression and anxiety associated with hyperthyroidism: Response to antithyroid therapy. Psychosomatics 27/7
Köbberling J (1984) Besonderheiten der Hyperthyreose im höheren Lebensalter. Münchner Med Wochenschr 126/27:864–868
Kopell BS, Wittner WK, Lunde D, Warik G, Edwards D (1970) Influence of Trijodothyronine on Selective Attention in Man as Measured by the Visual Averaged Evolud Potential. Psychosom Med 32/5:494–503
Laux L, Glanzmann P, Schaffner P, Spielberger CD (1979) Das State-Trait-Angstinventar. Consulting Psychologist Press, Palo Alto, Calif.
Lawton MP, Whelihan WM, Belsky JK (1980) Personality Tests and their uses with older adults. In: Birren JE, Sloane RB (eds) Handbook of Mental Health and Aging. Prentice-Hall, Englewood Cliffs, pp 537–553
Loosen PT (1987) Thyroid Hormones and Affective State. In: Halbreich U (eds) Hormones and Depression. Raven Press, New York
Loosen PT (1986) Hormones of the Hypothalamic-pituitary-thyroid Axis: A Psychoneuroendocrine Perspective. Pharmacopsychiatr 19:401–415
Noelpp B, Staub JJI, Heinimann T, Graeni R, Girard J (1981) Schilddrüsenhormone und thyreoidale Reserve bei prÄklinischer Hypothyreose. Schweiz Med Wochenschr 111/49:1904–1905
Nowotny B, Schlote-Sautter B, Rey E-R, Usadel KH (in press) Anwendung von Selbstbeurteilungsinstrumenten bei Älteren Krankenhauspatienten. Gerontol
Oswald W, Fleischmann UM (1983) Gerontopsychologie. Kohlhammer, Stuttgart
Perrild H et al. (1986) Intellectual impairment after hyperthyroidism. Acta Endocrinol 112:185–191
Reitan RM (1963) Intellectual function in myxedema. Arch Neurol Psychiatr 69:436–449
Rockey PH, Griep RJ (1980) Behavioral dysfunktion in hyperthyroidism, improvement with treatment. Arch Int Med 140:1194–1197
Röckel M (1987) Untersuchungen zur Korrelation einer latenten Hyperthyreose mit psychischen und somatischen VerÄnderungen. Inauguraldissertation, Heidelberg
Schachter S, Singer JE (1962) Cognitive, Social and Physiological Determinants of Emotional State. Psychological Review 69:379–399
Schlote B, Nowotny B, Schmidt R, Kleinböhl D, Lösbrock R, Teuber J, Vardarli I, Schaaf L, Usadel KH (1989) AltersabhÄngigkeit körperlicher und psychischer Befunde bei manifesten Hyperthyreosen. In: Schilddrüse 1989. 12. Konferenz über die menschl. Schilddrüse Homburg/Saar. Henning Symposium Publikation. Thieme, Stuttgart
Schlote B, Nowotny B, Kleinböhl D, Schaaf L, Schmidt R, Teuber J, Paschke R, Vardarli I, Usadel KH (in press) Latent hyperthyroidism: Physical and mental state of patients
Smith CK, Barish J, Correa J, Williams RH (1972) Psychiatric disturbance in endocrinologic disease. Psychosom Med 34:69–86
Staub JJ, GrÄni R, Bechtel M (1982a) PrÄklinische Hypothyreose: Bedeutung, Evaluation und therapeutische Konsequenzen. Akt Endokr Stoffwechsel 2:51–58
Staub JJ, Hauenstein M, GrÄni R, GemsenjÄger E (1982b) PrÄklinische Hypothyreose. In: Dtsch Med Wochenschr 197/47:1787–1790
Tibaldi JM, Barzel US, Albin J, Surks M (1986) Thyrotoxicosis in the very old. Am J Med 81:619–622
Wallace JE et al. (1980) Acute hyperthyroidism: cognitive and emotional correlations. J Abnorm Psychol 89/4:519–527
Wechsler D (1982) Handanweisung zum Hamburg-Wechsler-Intelligenztest für Erwachsene (HAWIE). Hans Huber, Bern
Whybrow P, Ferrell R (1974) Thyroid state and Human Behavior. In: Prange AJ (ed) The Thyroid Axis, Drugs and Behavior. Raven Press, New York
Whybrow PC, Prange AJ, Treadway CR, Hill C (1969) Mental changes accompanying thyroid gland dysfunction. Arch Gen Psychiatry 20
Wilson WP, Johnson DE, Feist FW (1964) Thyroid hormone in brain function. 2. changes in photically elicited EEG responses following the administration of trijodthyronine to normal subjects. Electroencephalogr Clin Neurophysiol 16:329–331
Zeitlhofer J, Saletu B, Stary J, Ahmadi R (1984) Cerebral function in hyperthyroid patients. Neuropsychobiology 11:89–93
Zerssen D v (1976) Paranoid-DepressivitÄts-Skala und DepressivitÄts-Skala, Manual. Beltz-Test Gesellschaft, Weinheim
Author information
Authors and Affiliations
Additional information
Diese Arbeit wurde erstellt im Rahmen des Sonderforschungsbereichs 258 der UniversitÄt Heidelberg, gefördert von der DFG
Rights and permissions
About this article
Cite this article
Nowotny, B., Teuber, J., Van der Heiden, W. et al. Die Rolle des TSH für Psychische VerÄnderungen und BefindlichkeitsverÄnderungen bei Schilddrüsenfunktionsstörungen. Klin Wochenschr 68, 964–970 (1990). https://doi.org/10.1007/BF01646655
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01646655