Abstract
Thyroid function and presence of thyroid autoantibodies were assessed in a group of 75 consecutive female patients with mood disturbances and in a group of 38 healthy women of similar age recruited as controls. Nine patients suffered from major (endogenous) depression and 66 from minor (neurotic) depression. The individual patients had normal values of circulating thyroid hormones. Nevertheless, endogenously depressed patients had total serum triiodothyronine (M±SE=1.49±0.09 nmol/l) and both total (83.9±4.3 nmol/l) and free serum thyroxine (13.9±1.1 pmol/l) lower than in the group of minor depressed and in the group of controls (p<0.01, in both comparison). The median value of serum thyrotropin was 5.22 mU/l in the major depressed patients versus 1.72 mU/l in the minor depressed and 1.69 mU/l in the controls. Thyroid function test results in the minor depressed group did not significantly differ from those in the controls. Five of the 9 endogenously depressed patients were subclinically hypothyroid, while none of the 66 patients with minor depressive disorder showed thyroid dysfunction. Antibodies against thyroglobulin and/or thyroid peroxidase were positive in all the 5 endogenously depressed women with subclinical hypothyroidism, revealing a symptomless autoimmune thyroiditis, which was also confirmed by ultrasonography in all cases and histopathologically demonstrated in one case. None of the endogenously depressed women without thyroid dysfunction and none of the 66 minor depressives were seropositive for thyroid autoantibodies. Only one of the non-depressed women in the control group was found seropositive for TPO-Ab and showed an exaggerated TSH responsiveness to TRH stimulation. The findings indicate the possibility that endogenous depression is accompained by latent hypothyroidism in an appreciable proportion of women. The detection of thyroid autoantibodies in such patients suggests that affective disorders might play a precipitating role in the development of thyroid autoimmune disease. Therefore, the possibility of immunological damage should be taken into consideration whenever depressed women display biochemical thyroid dysfunction.
Similar content being viewed by others
References
Loosen P.T., Prange Jr A.J. Serum thyrotropin response to thyrotropin-releasing-hormone in psychiatric patients: a review. Am. J. Psychiatry 139: 405, 1982.
Prange A.J., Garbutt J.C., Loosen P.T. The hypothalamic-pituitary-thyroid axis in affective disorders. In: Meltzer H.Y. (Ed.), Psychopharmacology — the third generation of progress. Raven Press, New York, 1987, p. 629.
Custro N., Scafidi V., Costanzo G., Corsello F.P. On the stimulated secretion of thyrotropin in patients with mild depression. Min. Psichiatr. (Turin) 31: 83, 1990.
McLarty D.G., Ratcliffe W.A., Ratcliffe J., Shimmins J.G., Goldberg A. A study of thyroid function in psychotic in-patients. Br. J. Psychiatry 133: 211, 1978.
Cowdry R., Wehr T., Zis A., Goodwin F. Thyroid abnormalities associated with rapid cycling bipolar illness. Arch. Gen. Psychiatry 40: 414, 1983.
Linstedt G., Nilsson L.A., Walinder J., Skott A., Ohman R. On the prevalence, diagnosis and manegement of lithium-induced hypothyroidism in psychiatric patients. Br. J. Psychiatry 130: 452, 1977.
Lazarus J., John R., Bennie E., Chalmers R., Crockett G. Lithium therapy and thyroid function: a long-term study. Psychol. Med. 11: 85, 1991.
Transbol I., Christiansen C., Beastrup P. Endocrine effects of lithium. I. Hypothyroidism, its prevalence in long-term treated patients. Acta Endocrinol. (Copenh.) 87: 759, 1987.
Nemeroff C.B., Simon J.S., Haggerty J.J., Evans D.L. Antithyroid antibodies in depressed patients. Am. J. Psychiatry 142: 840, 1985.
Rubin R.T., Poland R.E., Lesser I.M., Martin D.J. Neuroendocrine aspects of primary endogenous depression. IV Pituitary-thyroid axis activity in patients and matched control subjects. Psychoneuroendocrinology 72: 333, 1987.
Bauer M.S., Whybrow P.C., Winokur A. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch. Gen. Psychiatry 47: 427, 1990.
American Psychiatric Association. Diagnostic and Statistical Manual ed. 3. DSM-III, APA Press, Washington, DC, 1980.
Beck A.T., Beamesderfer A. Assessment of depression: the depression inventory. In: Pichot P. (Ed.) Psychological measurements in Psychopharmacology. Karger, Basel 1974, p. 151.
Mariotti S., Anelli S., Ruf J., Bechi R., Czarnocka B., Lombardi A., Carayon P., Pinchera A. Comparison of serum thyroid microsomal and thyroid peroxidase autoantibodies in thyroid diseases. J. Clin. Endocrinol. Metab. 65: 987, 1987.
Mariotti S., Pisani S., Russova A., Pinchera A. A new solid-phase immunoradiometric assay for anti-thyroglobulin autoantibody. J. Endocrinol. Invest. 5: 227, 1982.
Scherbaum W.A., Blaschek M., Berg P.A., Doniach D., Bottazzo G.F. Spectrum and profiles of non-organ-specific autoantibodies in autoimmune disease in immunocyto-chemistry: modern methods and applications. In: Polak J.M., Van Norden S. (Eds.), J. Wright, Brisol, 1986, p. 477.
Roy A., Karoum F., Linnoila M., Pickar D. Thyrotropin releasing hormone test in unipolar depressed patients and controls: relationship to clinical and biologic variables. Acta Psychiatr. Scand. 77: 151, 1988.
Weeke A., Weeke J. The 24-hour pattern of serum TSH in patients with endogenous depression. Acta Psychiatr. Scand. 62: 69, 1980.
Bartalena L., Placidi G.F., Martino E., Falcone M., Pellegrini L., Dell’Osso L., Pacchiarotti A., Pinchera A. Nocturnal serum thyrotropin (TSH) surge and TSH response to TRH-releasing hormone: dissociated behaviour in untreated depressives. J. Clin. Endocrinol. Metab. 71: 650, 1990.
Pinchera A., Fenzi G.F., Vitti P., Chiovato L., Bartalena L., Macchia E., Mariotti S. Significance of thyroid autoantibodies in autoimmune thyroid disease. In: Wallfish P.G., Wall J.R., Volpé R. (Eds.), Autoimmunity and the thyroid. Academic Press, New York, 1985, p. 139.
Ruf J., Czarnocka B., De Micco C., Dutoit C., Ferrand M., Carayon P. Thyroid peroxidase is the organ-specific “microsomal” autoantigen involved in thyroid autoimmunity. Acta Endocrinol. (Copenh.) (Suppl) 281: 49, 1987.
Gold M.S., Pottash A.L.C., Extein I. Hypothyroidism and depression: evidence from complete thyroid evaluation. JAMA 245: 1919, 1981.
Hall R.C.W. Psychiatric effects of thyroid hormone disturbance. Psychosomatics 24: 7, 1983.
Haggerty J.J., Stern R.A., Mason G.A., Beckwith J., Morey C.E., Prange A.J. Subclinical hypothyroidism: a modifiable risk factor for depression? Am. J. Psychiatry 150: 508, 1993.
Kirkegaard C., Faber J. Free thyroixine and 3,3’, 5’-triiodothyronine levels in cerebrospinal fluid in patients with endogenous depression. Acta Endocrinol. (Copenh.) 124: 166, 1991.
Calabrese J.R., Kling M.A., Gold P.W. Alterations in immunocompetence during stress, bereavement, and depression, focus on neuroendocrine regulation. Am. J. Psychiatry 144: 1123, 1987.
Perez M., Farrant J. Immune reactions and mental disorders. Psychol. Med. 18: 11, 1988.
Schleifer S.J., Keller S.E., Bond R.N., Cohen J., Stein M. Major depressive disorder and immunity. Arch. Gen. Psychiatry 46: 81, 1989.
Targum S.D., Greenberg R.D., Harmon R.L., Kessler K., Salerian A.J., Fram D.H. Thyroid hormone and the TRH stimulation test in refractory depression. J. Clin. Psychiatry 45: 345, 1984.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Custro, N., Scafidi, V., Lo Baido, R. et al. Subclinical hypothyroidism resulting from autoimmune thyroiditis in female patients with endogenous depression. J Endocrinol Invest 17, 641–646 (1994). https://doi.org/10.1007/BF03349679
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03349679