The Association Between Thyroid Stimulating Hormone and Depression: A Historical Cohort Study

Association of Thyroid Function With Depression: A Historical Cohort Study

BACKGROUND

There is inconsistent evidence concerning the association between thyroid dysfunctions and depression. Therefore, we conducted this population-based study to investigate the relationship between thyroid-stimulating hormone (TSH) and depression using the Patient Health Questionnaire-9 (PHQ-9).

METHOD

We included patients (≥18 y) who received care at the Marshfield Clinic Health System and completed a TSH level and a PHQ-9 within 2 weeks, between 2015 and 2020. We used a logistic regression model adjusted for covariates to estimate the effect of TSH level on clinically relevant depression (PHQ-9 score ≥10).

RESULTS

Our cohort included 31,099 patients, mean age 50.9±19.5 years, 73.5% females, and 96.3% White, 39.7% of whom had clinically relevant depression. The patients with clinically relevant depression had higher TSH levels compared with those without such depression (P=0.01). In this cohort, we found that low TSH levels (<0.5 mIU/L) and very elevated TSH levels (≥10 mIU/L) both had increased odds of being associated with clinically relevant depression: [1.30 (95% CI: 1.15-1.46) and OR 1.50 (95% CI: 1.25-1.81), respectively]. Subgroup analysis showed similar findings in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. In males, only low TSH was associated with clinically relevant depression, whereas in patients with treated thyroid disorders, only very elevated TSH was associated with clinically relevant depression.

CONCLUSIONS

In this large cross-sectional study, we found that low TSH and very elevated TSH levels were both associated with higher odds of depression. Similar trends were observed in patients with mood disorders, females, younger adults (<65 y), and those with untreated thyroid disorders. Large prospective population-based studies are needed to further investigate the relationship between TSH levels and clinical depression.

The Association Between Thyrotropin and Clinically Relevant Depression: A Retrospective Cross-Sectional Study

Introduction: Thyroid dysfunction and mood disorders are chronic health conditions with a significant impact on quality of life. This study aimed to investigate the association between thyrotropin (TSH) and clinically relevant depression (CRD) in patients with and without mood disorders, in a population-based sample. Methods: This retrospective cross-sectional study included all consecutive adults (≥18 years) who had TSH and completed the Patient Health Questionnaire (PHQ-9) within 6 months of the index visit, between October 2016 and May 2021, at the University of Utah Health. Data on demographics, hypothyroidism diagnoses, TSH, thyroid hormone replacement (THR), PHQ-9, antidepressant (AD) medications, and mood disorder diagnoses (using the International Classification of Diseases, 10th Revision, Clinical Modification codes; Major depressive disorder single episode-F32, recurrent-F33, persistent mood disorder-F34, bipolar disorder-F30+F31, and mood disorder not otherwise specified-F39) were extracted electronically. CRD was defined as PHQ-9 ≥ 10. t-Test and chi-square test were used to compare continuous and categorical variables, respectively. Logistic regression models were formulated to evaluate the association between TSH and CRD, after adjusting for covariates. Results: The cohort included 33,138 patients, mean age 42.41 ± 16.10 years, 80.67% Caucasian, 69.10% females, and mean PHQ-9 score 10.11 ± 6.94. A total of 45.23% (n = 14,989) patients had a diagnosis of mood disorders, and 49.70% had CRD. Patients with mood disorders were more likely to be female, Caucasian, non-Hispanic/Latino, on AD, had hypothyroidism diagnoses, on thyroid medications, had higher mean PHQ-9 scores, and had CRD. TSH level was associated with an increased odds of CRD (odds ratio [OR] = 1.01, confidence interval [CI], 1.01-1.02, p < 0.009) after adjusting for age, sex, body mass index, Charlson Comorbidity Index, and use of THR and AD. Both the low TSH and high TSH groups showed increased odds of CRD, with respective ORs of 1.19 (CI: 1.04-1.37) and 1.26 (CI: 1.13-1.40). Conclusions: Thyroid dysfunction is associated with an increase in the odds of depression. Future longitudinal cohort studies are recommended to investigate the association between thyroid function and incident depression.

Sex-modulated association between thyroid stimulating hormone and informant-perceived anxiety in non-depressed older adults: Prediction models and relevant cutoff value

The aim of this study was to assess the association between thyroid function and perceived anxiety in non-depressed older adults. Non-depressed Alzheimer's Disease Neuroimaging Initiative (ADNI) participants with complete Thyroid Stimulating Hormone (TSH) and neuropsychiatric inventory (NPI/NPI-Q) were included. The association between anxiety and thyroid function was assessed by logistic regression and sex stratification. Restricted cubic splines were applied to evaluate non-linearity in the association. The median age of 2,114 eligible participants was 73 years (68-78), 1,117 (52.84%) were males, and the median TSH was 1.69 µIU/mL. There was a significant association between TSH and informant-perceived anxiety in the total study population (ORModel1 = 0.86, 95%CI 0.76-0.97, p = 0.011), even after adjusting for bio-demographical (adj.ORModel2 = 0.85, 95%CI 0.75-0.96, p = 0.007), and socio-cognitive confounders (adj.ORModel3 = 0.84, 95%CI 0.73-0.96, p = 0.009). Sex-stratification showed similar significant results in all male-specific models (ORModel1-male = 0.71, 95%CI: 0.58-0.85, pModel1-male < 0.001). In the general population and males, a TSH value of 2.4 µIU/dL was a significant cutoff under which anxiety odds were significantly high, even after adjusting for confounders. The sex-dependent association between TSH levels and perceived anxiety in non-depressed older adults is a novel finding that has to be further explored for a better understanding of the underlying neurobehavioral biology.

The Quartile Levels of Thyroid-stimulating Hormone at Newborn Screening Stratified Risks of Neurodevelopmental Impairment in Extremely Preterm Infants: A Population Cohort Study

BACKGROUND

To evaluate whether thyroid-stimulating hormone (TSH) measured during newborn screening (NBS) at birth and at discharge can be surrogate markers for neurodevelopmental impairment (NDI) in extremely preterm infants.

METHODS

The population cohort enrolled infants born <29 weeks' gestation in 2008-2020 in southern Taiwan. Infants with a maternal history of thyroid disorders and infants who required thyroxine supplementation during hospitalization were excluded. TSH levels measured during NBS at birth and at term-equivalent age (TEA)/discharge were respectively categorized into the lowest quartile, the interquartile range, and the highest quartile, which were correlated to NDI outcomes.

RESULTS

Among 392 patients with paired TSH data, 358 (91%) were prospectively followed until a corrected age of 24 months. At birth, infants with lowest-quartile TSH had higher NDI risks (odds ratio [OR] 2.3; 95% confidence interval [CI], 1.3-4.1, P = 0.004) compared to infants with interquartile-range TSH. Conversely, by TEA/discharge, infants with highest-quartile TSH had increased NDI (OR 1.9; 95% CI, 1.0-3.4, P = 0.03). By paired TSH categories, infants persistently in the lowest TSH quartile (48%; aOR 4.4; 95% CI, 1.4-14.5, P = 0.01) and those with a shift from interquartile range to the highest quartile (32%; aOR 2.7; 95% CI, 1.0-7.4, P = 0.046) had increased NDI risks compared with the reference with consistent interquartile-range TSH.

CONCLUSION

Extremely preterm infants persistently in the lowest-quartile TSH level at birth and at discharge had the highest NDI risk. TSH quartile levels measured during NBS may serve as a population surrogate biomarker for assessing NDI risks in infants born extremely preterm.

The contribution of alexithymia, childhood maltreatment, impulsivity, C-reactive protein, lipid profile, and thyroid hormones to aggression and psychological distress (depression and anxiety) in schizophrenia

There are individual effects of alexithymia, childhood maltreatment, impulsivity, and some biological markers on aggression and psychological distress in schizophrenia. However, the combined effects of these psychological and biological markers have not yet been fully studied. This study therefore aimed to investigate the influence of these psychological and biological markers on aggression and psychological distress (e.g., depression and anxiety) in inpatients with schizophrenia (n = 355). Participants completed self-report and clinician-rated scales, and blood samples were collected. There were no significant differences between patients with and without alexithymia regarding biological markers. Patients with childhood maltreatment exhibited higher levels of free triiodothyronine (FT3) and C-reactive protein (CRP), as well as lower total cholesterol (TC) levels, compared to non-traumatized individuals. Aggression was positively predicted by psychological distress, alexithymia, childhood maltreatment, impulsivity, CRP, and FT3, and negatively by TC and low-density lipoprotein cholesterol. Negative symptoms, childhood maltreatment, alexithymia, aggression, and CRP positively, and high-density lipoprotein cholesterol negatively emerged as predictors of psychological distress. The study highlights the connections between childhood maltreatment, alexithymia, impulsivity, and potentially related biological dysregulation in explaining aggression and negative mood states as a bio-psychological model of aggression and mood in schizophrenia.

Association of exposure to a mixture of phenols, parabens, and phthalates with altered serum thyroid hormone levels and the roles of iodine status and thyroid autoantibody status: A study among American adults

BACKGROUND

Toxicological and epidemiological studies have shown that environmental endocrine disruptors interfere with hormonal homeostasis. However, there is limited research on the effects of mixed exposure to nonpersistent endocrine disruptors on thyroid hormones and the factors (e.g., presence status of thyroid autoantibodies or nutritional status of organismal iodine) that may influence this association.

METHODS

Data were collected from the National Health and Nutrition Examination Survey (NHANES) 2007-2008 and 2011-2012. Relationships between single pollutants and thyroid hormone and thyroid autoantibody levels were assessed using generalized linear (GLM) and restricted cubic spline (RCS) regression models. Weighted quantile sum regression (WQS), group-weighted quantile sum regression (GWQS), quantile-based g-computation (qgcomp), and adaptive elasticity network (AENET) were applied to assess the mixed exposure effect. Next, subgroup analyses were performed on the basis of the urinary iodine concentration or thyroid autoantibody status to assess the modifying role of urinary iodine and thyroid autoantibodies.

RESULTS

A total of 2385 study participants were included in this study. Both the single-pollutant model and the multipollutant mixed model revealed that parabens and bis(2-ethylhexyl) phthalate (DEHP) metabolites were significantly and negatively associated with serum thyroxine (T4) levels. However, no associations were found between the target pollutants and thyroid autoantibodies (thyroglobulin antibodies (TgAb) and thyroid peroxidase antibodies (TPOAb)). In addition, this study revealed that urinary iodine or thyroid autoantibody status altered the associations of some of the target pollutants with thyroid hormones. WQS and qgcomp analyses, revealed that the associations of mixed pollutants with hormones differed depending on the urinary iodine or antibody status, especially T4 and thyroid-stimulating hormone (TSH).

CONCLUSION

Significant associations were found between phenols, parabens, and phthalates and serum thyroid hormone levels, with parabens and DEHP metabolites playing major roles. Urinary iodine and thyroid autoantibody status act as modifiers between environmental endocrine-disrupting pollutants and thyroid hormones.

The association between depression and thyroid function

Background

Emerging evidence indicated that depression is currently one of the most burdensome diseases worldwide, and it can lead to a variety of functional physical impairments. However, the studies estimated the association between depression and thyroid function remain sparse. We aimed to investigate the association between depression and thyroid function in the American population.

Methods

A cross-sectional analysis was performed using the data from the National Health and Nutrition Examination Survey conducted from 2007 to 2012. In the 12,502 adults aged 20-80 years, weighted linear regression models and multiple logistic regression models were applied to evaluate the association between depression and thyroid function indicators. The thyroid indicators investigated were mainly free thyroxine (FT4), total T4 (TT4), free triiodothyronine (FT3), total T3 (TT3), thyroid-stimulating hormone (TSH), and antithyroperoxidase antibody (TPOAb), thyroglobulin (Tg) and antithyroglobulin antibody (TgAb).

Results

The final results were reached after adjusting for various confounding factors. In the stratification analysis of subgroups divided by age, depression was significantly negatively correlated with FT4, FT3, and TT3 in both younger adults (p = 0.00122, p < 0.00001, and p = 0.00003) and older adults (p = 0.00001, p = 0.00004, and p < 0.00001). In contrast, depression was significantly negatively correlated with TT4 and Tg in older adults (p = 0.00054, p = 0.00695) and positively correlated in younger adults (p = 0.01352, p < 0.00001). The subgroup analysis by gender revealed that depression was significantly negatively correlated with FT4, FT3, and TT3 in both adult males (p = 0.0164, p = 0.0204, and p = 0.0050) and adult females (p ≤ 0.0001, p < 0.0001, and p < 0.0001), which was more prominent in females. The positive correlation between depression symptoms and TPOAb was only found in adult females (p = 0.0282) and younger adults (p = 0.00488).

Conclusion

This study confirmed a significant correlation between depressive and thyroid function and it varied among different genders or age. In the future, more prospective studies are needed to reveal these findings and confirm a causal relationship between them.

Risk Factors for Post-Stroke Depression Following the Lifting of COVID-19 Restrictions

Purpose

Research on post-stroke depression (PSD) following the lifting of coronavirus disease 2019 (COVID-19) restrictions remains sparse. This study aimed to investigate the factors associated with PSD after the easing of COVID-19 restriction measures.

Patients and Methods

This cross-sectional study was conducted with 947 stroke patients (cerebral hemorrhage and cerebral infarction) meeting the inclusion criteria. Participants completed a demographic questionnaire and the Patient Health Questionnaire-9 (PHQ-9). Additionally, data were collected on C-reactive protein (CRP), homocysteine (Hcy), modified Rankin Scale (mRS), stroke site, National Institutes of Health Stroke Scale (NIHSS), thyroid-stimulating hormone (TSH), and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. This study assessed correlations between these indices and PSD.

Results

Stroke patients with a PHQ-9 score ≥5 were identified as having PSD, with a prevalence rate of 14.15%. No significant correlation was found between previous COVID-19 infection and PSD. However, multiple regression analysis revealed associations between PSD and the following factors: TSH (OR: 0.87, 95% CI: 0.76-1), CRP levels (OR: 1.01, 95% CI: 1-1.02), family history of stroke (OR: 4.25, 95% CI: 1.66-10.88), migraine history (OR: 8.63, 95% CI: 2.49-29.85), and shorter sleep duration (OR: 0.6, 95% CI: 0.51-0.71) (all P < 0.05).

Conclusion

CRP, family history of stroke, migraine, sleep duration, and TSH are identified as independent risk factors for PSD following the lifting of COVID-19 restrictions.

Depression Is Associated with a Higher Risk of Mortality among Breast Cancer Survivors: Results from the National Health and Nutrition Examination Survey-National Death Index Linked Study

Breast cancer (BC) and depression are globally prevalent problems. Numerous reviews have indicated the high prevalence of depression among BC survivors. However, the long-term impact of depression on survival among BC survivors has not been well explored. For this investigation, we aimed to explore the relationship between BC, depression, and mortality from a national random sample of adult American women. Data from the U.S. National Health and Nutrition Examination Survey (years 2005-2010) were linked with mortality data from the National Death Index up to December 31st, 2019. A total of 4719 adult women (ages 45 years and older) were included in the study sample with 5.1% having breast cancer and more than a tenth (12.7%) having depression. The adjusted hazard ratio (HR) for all-cause mortality risk among those with BC was 1.50 (95% CI = 1.05-2.13) compared to those without BC. In the adjusted analysis, the risk of all-cause mortality was highest among women with both depression and BC (HR = 3.04; 95% CI = 1.15-8.05) compared to those without BC or depression. The relationship between BC and mortality was moderated by cardiovascular diseases, anemia, smoking, age, PIR, and marital status. Our analysis provides vital information on factors that could be helpful for interventions to reduce mortality risk among those with BC and depression. In addition, given the higher risk of mortality with co-occurring BC and depression, collaborative healthcare practices should help with widespread screening for and treatment of depression among BC survivors.

The Association between Depression, Anxiety, and Thyroid Disease: A UK Biobank Prospective Cohort Study

Background

There is a lack of comprehensive data regarding the association of depression and anxiety for the subsequent risk of thyroid disease.

Aim

To examine this prospective association between depression and anxiety and the risk of potential thyroid diseases, a large prospective study was conducted using data from UK Biobank.

Materials and Methods

Depression and anxiety were measured through self-reported Patient Health Questionnaire-4 (PHQ-4) at baseline, thyroid disease was diagnosed by corresponding hospital data documented through International Classification of Diseases (ICD)-10 codes. Cox proportional hazard models and restricted cubic splines were employed to analyze the associations.

Results

In a 13-year follow-up cohort study involving 349,993 participants, 9,877 (2.82%) individuals developed thyroid disease. Significant associations were observed between depression, anxiety, and risk of both hypothyroidism and hyperthyroidism among all participants, the adjusted hazard ratios (HRs) for PHQ scores were as follows: mild 1.27 (95% CI, 1.20-1.36), moderate 1.33 (95% CI, 1.17-1.51), and severe 1.56 (95% CI, 1.31-1.85). For hyperthyroidism, the HRs were mild 1.19 (95% CI, 1.03-1.38), moderate 1.43 (95% CI, 1.08-1.90), and severe 1.84 (95% CI, 1.28-2.66). The adjusted HRs indicating the association between depression, anxiety, and hypothyroidism remained significant for both males and females. The relationship between PHQ score and the risk of thyroid disease shows linear in restricted cubic spline.

Conclusion

Depression and anxiety exposure is associated with subsequent risk of thyroid diseases, the more severe the depression and anxiety, the greater the associated risk. Therefore, any level of depression and anxiety should be taken into consideration in thyroid disease risk prediction and prevention.

Association between hypothyroidism subtypes and major depression: A two-sample Mendelian randomization study

BACKGROUND

The causal relationship between different hypothyroidism subtypes and the risk of major depression (MD) is yet to be fully elucidated. This study aimed to determine if there's a causal relationship between various hypothyroidism subtypes (and related factors) and the risk of MD.

METHODS

This genetic association study utilized a two-sample Mendelian Randomization (MR) approach to explore the causal relationships between various hypothyroidism subtypes and MD risk. Genome-Wide Association Study (GWAS) summary statistics were obtained from the FinnGen and the UK Biobank. Instrumental variables (IVs) were chosen based on single nucleotide polymorphisms (SNPs).

RESULTS

Among the analyzed hypothyroidism subtypes and related factors, "Hypothyroidism, strict autoimmune" (HTCBSA) and "Hypothyroidism, levothyroxin purchases" (HT/LP) demonstrated a statistically significant positive causal relationship with MD, with odds ratios of 1.020 (95 % CI: 1.004-1.037) and 1.022 (95 % CI: 1.005-1.040), respectively. The sensitivity analysis supported the robustness of these findings, showing no significant horizontal pleiotropy and confirming the stability of results when individual SNPs were removed. "Congenital iodine-deficiency syndrome/hypothyroidism" (CIDS/HT), "Postinfectious hypothyroidism" (PHT), "Hypothyroidism due to medicaments and other exogenous substances" (HDTDM and OES), "Thyroid Stimulating Hormone" (TSH), "Thyrotropin-releasing hormone" (THRH), and "Hypothyroidism, strict autoimmune, 3 medication purchases required" (HTCBSA/3MPR) showed no significant causal relationship with MD.

LIMITATIONS

The study population was limited to individuals of European ancestry, and there may be certain genetic differences between different ethnic groups.

CONCLUSIONS

This MR study suggests a potential causal relationship between certain hypothyroidism subtypes (specifically HTCBSA and HT/LP) and an increased risk of MD.

Treatment-resistant depression patients with baseline suicidal ideation required more treatments to achieve therapeutic response with ketamine/esketamine

BACKGROUND

There is an urgent need to identify interventions to reduce suicidality. We investigated the antisuicidal effects of intravenous (IV) ketamine and intranasal (IN) esketamine among patients with treatment-resistant depression (TRD) in a historical cohort study.

METHODS

The Quick Inventory of Depressive Symptomatology self-report (QIDS-SR) question 12 was used to measure suicidal ideation (SI). Cox proportional hazards models were used to evaluate associations between the number of treatments to response and baseline SI (yes, Q12 > 0 versus no, Q12 = 0), adjusting for covariates and modified baseline QIDS-SR score. We evaluated associations between the number of treatments to a 50 % reduction in SI score between IV and IN treatment.

RESULTS

Fifty-two adults (62.5 % female, median age 49.1 years) received IV ketamine (71 %, n = 37) or IN esketamine (29 %, n = 15). Eighty-one percent of patients reported SI at baseline. Among those with baseline SI, 60 % had improved SI scores while 38 % did not change, and among those with no SI, 80 % did not change. After adjusting for covariates, the hazard ratios (HR) of response were significantly lower among those with baseline SI (HR = 0.36, 95 % CI, 0.14-0.92, p = 0.03). The number of treatments to achieve a 50 % reduction in SI score did not depend on group (IN esketamine vs. IV ketamine HR = 0.74 [95 % CI, 0.27-2.05]; p = 0.57).

LIMITATIONS

Small sample size and lack of a placebo group.

CONCLUSIONS

This study suggests that patients with baseline suicidal ideation require more treatments to achieve a response with ketamine or esketamine. The antisuicidal response seemed similar between IV ketamine and IN esketamine.

Prevalence of self-reported thyroid disease among adults with depression

BACKGROUND

Thyroid disorders are a common comorbidity in patients with depression, yet there is limited information available about the clinical epidemiology of thyroid diseases in this specific population. This study aims to describe the prevalence of thyroid disease among US adults with depression from 2007 to 2018.

METHODS

This cross-sectional study used nationally representative data collected through the National Health and Nutrition Examination Survey (NHANES) between January 1, 2007, to December 31, 2018. Age-standardized prevalence of thyroid disease among depressed patients was calculated within 4-year survey periods (2007-2010, 2011-2014, and 2015-2018), and adjusted to the 2000 U.S. standard population.

RESULTS

In our weighed sample, 6.1% of depressed individuals and 4.3% of non-depressed individuals reported thyroid disease between 2007 and 2018 (P < 0.0001). The age-standardized prevalence of thyroid disease in patients with depression increased over time, from 5.4% (95%CI, 4.6%-6.2%) in 2007-2010 to 6.8% (95%CI, 5.8%-8.0%) in 2015-2018 (P for trend = 0.0270). Furthermore, thyroid disease prevalence was highest in non-Hispanic white individuals, increased with age, and tended to be higher in women. Mean depression scores in patients with thyroid disease (9.1; 95%CI, 8.7-9.5) did not significantly different from those without thyroid disease (9.1; 95%CI, 9.0-9.3) (P = 0.96).

CONCLUSION

The age-standardized prevalence of thyroid disease among US adults with depression exhibited a consistent increase from 2007 to 2018, with the highest rate occurring in older, non-Hispanic white individuals, and women.