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Fraile-Martinez O, García-Montero C, Álvarez-Mon MÁ, Casanova-Martín C, Fernández-Faber D, Presa M, Lahera G, Lopez-Gonzalez L, Díaz-Pedrero R, Saz JV, Álvarez-Mon M, Sáez MA, Ortega MA. Grasping Posttraumatic Stress Disorder From the Perspective of Psychoneuroimmunoendocrinology: Etiopathogenic Mechanisms and Relevance for Integrative Management. Biol Psychiatry 2025:S0006-3223(25)00056-3. [PMID: 39864788 DOI: 10.1016/j.biopsych.2025.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 12/25/2024] [Accepted: 01/16/2025] [Indexed: 01/28/2025]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition caused by exposure to traumatic events that affects 5% to 10% of the population, with increased prevalence among women and individuals in war zones. Beyond psychological symptoms, PTSD induces significant physiological changes across systems. Psychoneuroimmunoendocrinology (PNIE) offers a framework to explore these complex interactions between the psyche and the nervous, immune, and endocrine systems. Studies have revealed that PTSD entails disruptions in the central and autonomic nervous, immune, and endocrine systems, including gut microbiota imbalances, which impair organ function. Integrative pathways that connect these parts include the microbiota-gut-brain axis, heart-brain axis, neuroinflammation, and hypothalamic-pituitary dysregulation, highlighting bidirectional links between mental and physical health. Viewing PTSD as an entity comprising both psychological and physiological challenges underscores the importance of integrative care strategies that combine pharmacological treatments, psychotherapy, and lifestyle interventions. These approaches are consistent with PNIE principles, which may help identify biomarkers for treatment efficacy. In this review, we discuss the pathophysiology of PTSD through a PNIE lens and its implications for improving patient care, advocating for personalized, multidisciplinary interventions in mental health.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Miguel Ángel Álvarez-Mon
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Carlos Casanova-Martín
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Daniel Fernández-Faber
- Psychiatry and Mental Health Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Marta Presa
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Psychiatry and Mental Health Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Psychiatry Service, Center for Biomedical Research in the Mental Health Network, CIBERSAM, University Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Laura Lopez-Gonzalez
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Raúl Díaz-Pedrero
- Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - José V Saz
- Department of Biomedicine and Biotechnology, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Príncipe de Asturias, CIBEREHD, Alcalá de Henares, Spain
| | - Miguel A Sáez
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain; Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, CIBEREHD, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Ramón y Cajal Institute of Sanitary Research, Madrid, Spain.
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2
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Khosravani V, Sharifibastan F, Aghaeimazraji M, Berk M, Samimi Ardestani SM. 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. Psychoneuroendocrinology 2024; 167:107087. [PMID: 38820716 DOI: 10.1016/j.psyneuen.2024.107087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/02/2024]
Abstract
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.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farangis Sharifibastan
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Psychosocial Science, University of Bergen, Norway
| | - Morteza Aghaeimazraji
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Victoria, Australia; University of Melbourne, Florey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia; University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Maihofer AX, Ratanatharathorn A, Hemmings SMJ, Costenbader KH, Michopoulos V, Polimanti R, Rothbaum AO, Seedat S, Mikita EA, Smith AK, Salem RM, Shaffer RA, Wu T, Sebat J, Ressler KJ, Stein MB, Koenen KC, Wolf EJ, Sumner JA, Nievergelt CM. Effects of genetically predicted posttraumatic stress disorder on autoimmune phenotypes. Transl Psychiatry 2024; 14:172. [PMID: 38561342 PMCID: PMC10984931 DOI: 10.1038/s41398-024-02869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Observational studies suggest that posttraumatic stress disorder (PTSD) increases risk for various autoimmune diseases. Insights into shared biology and causal relationships between these diseases may inform intervention approaches to PTSD and co-morbid autoimmune conditions. We investigated the shared genetic contributions and causal relationships between PTSD, 18 autoimmune diseases, and 3 immune/inflammatory biomarkers. Univariate MiXeR was used to contrast the genetic architectures of phenotypes. Genetic correlations were estimated using linkage disequilibrium score regression. Bi-directional, two-sample Mendelian randomization (MR) was performed using independent, genome-wide significant single nucleotide polymorphisms; inverse variance weighted and weighted median MR estimates were evaluated. Sensitivity analyses for uncorrelated (MR PRESSO) and correlated horizontal pleiotropy (CAUSE) were also performed. PTSD was considerably more polygenic (10,863 influential variants) than autoimmune diseases (median 255 influential variants). However, PTSD evidenced significant genetic correlation with nine autoimmune diseases and three inflammatory biomarkers. PTSD had putative causal effects on autoimmune thyroid disease (p = 0.00009) and C-reactive protein (CRP) (p = 4.3 × 10-7). Inferences were not substantially altered by sensitivity analyses. Additionally, the PTSD-autoimmune thyroid disease association remained significant in multivariable MR analysis adjusted for genetically predicted inflammatory biomarkers as potential mechanistic pathway variables. No autoimmune disease had a significant causal effect on PTSD (all p values > 0.05). Although causal effect models were supported for associations of PTSD with CRP, shared pleiotropy was adequate to explain a putative causal effect of CRP on PTSD (p = 0.18). In summary, our results suggest a significant genetic overlap between PTSD, autoimmune diseases, and biomarkers of inflammation. PTSD has a putative causal effect on autoimmune thyroid disease, consistent with existing epidemiologic evidence. A previously reported causal effect of CRP on PTSD is potentially confounded by shared genetics. Together, results highlight the nuanced links between PTSD, autoimmune disorders, and associated inflammatory signatures, and suggest the importance of targeting related pathways to protect against disease and disability.
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Affiliation(s)
- Adam X Maihofer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA.
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- South African Medical Research Council/Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Renato Polimanti
- VA Connecticut Healthcare Center, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Alex O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Research and Outcomes, Skyland Trail, Atlanta, GA, USA
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
- South African Medical Research Council/Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elizabeth A Mikita
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Alicia K Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Rany M Salem
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Richard A Shaffer
- Department of Epidemiology and Health Sciences, Naval Health Research Center, San Diego, CA, USA
| | - Tianying Wu
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
| | - Jonathan Sebat
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Erika J Wolf
- VA Boston Healthcare System, National Center for PTSD, Boston, MA, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Caroline M Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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Döring M, Dette AK, Werle D, Jendritza R, Malaval C, Thiel S, Michaelis S, Schlösser M, Lang P, Handgretinger R, Svaldi J, Cabanillas Stanchi KM. Screening for distress and quality of life in pediatric patients after allogeneic or autologous hematopoietic stem cell transplantation using a self-reporting instrument, blood stress biomarkers and an expert rating scale (PO-Bado). J Psychosom Res 2023; 170:111358. [PMID: 37196587 DOI: 10.1016/j.jpsychores.2023.111358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Hematopoietic stem cell transplantation (HSCT) is highly distressing and potentially traumatizing for pediatric and young adult patients (PYAP). At present, there is little evidence on their individual burdens. METHODS In this prospective cohort study, the course of the psychological and somatic distress was investigated on eight observation days (day -8/-12, -5, 0 (day of HSCT), +10, +20, and + 30 before/after HSCT), using the PO-Bado external rating scale and the EORTC-QLQ-C15-PAL self-assessment questionnaire. Stress-associated blood parameters were determined and correlated with the results of the questionnaires. RESULTS A total of 64 PYAP with a median age of 9.1 years (range 0-26 years) who underwent autologous (n = 20; 31%; autoHSCT) or allogeneic (n = 44; 69%; alloHSCT) HSCT were analyzed. Both were associated with a significant reduction in QOL. The reduction in self-assessed QOL correlated with somatic and psychological distress as assessed by medical staff. While somatic distress was similar in both groups with a maximum around day+10 (alloHSCT 8.9 ± 2.4 vs. autoHSCT 9.1 ± 2.6; p = 0.69), a significantly higher level of psychological distress was seen during alloHSCT (e.g. day0 alloHSCT 5.3 ± 2.6 vs. day0 autoHSCT 3.2 ± 1.0; p < 0.0001). CONCLUSIONS The maximum of psychological and somatic distress, as well as the lowest quality of life, ranges between day 0 and + 10 after both allogeneic and autologous pediatric HSCT. While somatic distress is similar during autologous and allogeneic HSCT, the allogeneic group seems to be affected by higher psychological distress. Larger prospective studies are needed to evaluate this observation.
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Affiliation(s)
- Michaela Döring
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Anna Karina Dette
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Dustin Werle
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076 Tübingen, Germany.
| | - Ricarda Jendritza
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Carmen Malaval
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Stefanie Thiel
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Sebastian Michaelis
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Manuel Schlösser
- University Children's Hospital Tübingen, Psychosocial-therapeutic service, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany
| | - Peter Lang
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Rupert Handgretinger
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstr. 4, 72076 Tübingen, Germany.
| | - Karin Melanie Cabanillas Stanchi
- University Children's Hospital Tübingen, General Pediatrics, Hematology and Oncology, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
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Joseph B, Nunez NA, Pazdernik V, Kumar R, Pahwa M, Ercis M, Ozerdem A, Cuellar-Barboza AB, Romo-Nava F, McElroy SL, Coombes BJ, Biernacka JM, Stan MN, Frye MA, Singh B. Long-Term Lithium Therapy and Thyroid Disorders in Bipolar Disorder: A Historical Cohort Study. Brain Sci 2023; 13:133. [PMID: 36672114 PMCID: PMC9856846 DOI: 10.3390/brainsci13010133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Lithium has been a cornerstone treatment for bipolar disorder (BD). Despite descriptions in the literature regarding associations between long-term lithium therapy (LTLT) and development of a thyroid disorder (overt/subclinical hypo/hyperthyroidism, thyroid nodule, and goiter) in BD, factors such as time to onset of thyroid abnormalities and impact on clinical outcomes in the course of illness have not been fully characterized. In this study we aimed to compare clinical characteristics of adult BD patients with and without thyroid disorders who were on LTLT. We aimed to identify the incidence of thyroid disorders in patients with BD on LTLT and response to lithium between patients with and without thyroid disorders in BD. The Cox proportional model was used to find the median time to the development of a thyroid disorder. Our results showed that up to 32% of patients with BD on LTLT developed a thyroid disorder, of which 79% developed hypothyroidism, which was corrected with thyroid hormone replacement. We did not find significant differences in lithium response between patients with or without thyroid disorders in BD. Findings from this study suggest that patients with BD and comorbid thyroid disorders when adequately treated have a response to lithium similar to patients with BD and no thyroid disorders.
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Affiliation(s)
- Boney Joseph
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicolas A. Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Vanessa Pazdernik
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Rakesh Kumar
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mehak Pahwa
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mete Ercis
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Francisco Romo-Nava
- Lindner Center of HOPE, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati, Cincinnati, OH 45040, USA
| | - Susan L. McElroy
- Lindner Center of HOPE, Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati, Cincinnati, OH 45040, USA
| | - Brandon J. Coombes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Joanna M. Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Marius N. Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN 55905, USA
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Bokulić A, Zec I, Goreta S, Nikolac Gabaj N, Kocijančić M, Serdar Hiršl T, Đuras A, Troha M, Stanišić L, Šupe-Domić D, Ćosić SJ, Đurić K, Marijančević D, Siter Kuprešanin M, Lukić I, Pezo A, Leniček Krleža J. Laboratory policies and practices for thyroid function tests in Croatia: survey on behalf of Working Group for Laboratory Endocrinology of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2022; 32:030702. [PMID: 35966262 PMCID: PMC9344866 DOI: 10.11613/bm.2022.030702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/11/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Laboratory plays important part in screening, diagnosis, and management of thyroid disorders. The aim of this study was to estimate current laboratory preanalytical, analytical and postanalytical practices and policies in Croatia. Materials and methods Working Group for Laboratory Endocrinology of the Croatian Society of Medical Biochemistry and Laboratory Medicine designed a questionnaire with 27 questions and statements regarding practices and protocols in measuring thyroid function tests. The survey was sent to 111 medical biochemistry laboratories participating in external quality assurance scheme for thyroid hormones organized by Croatian Centre for Quality Assessment in Laboratory Medicine. Data is presented as absolute numbers and proportions. Results Fifty-three participants returned the questionnaire. Response rate varied depending on question, yielding a total survey response rate of 46-48%. All respondents perform thyroid stimulating hormone (TSH). From all other thyroid tests, most performed is free thyroxine (37/53) and least TSH-stimulating immunoglobulin (1/53). Laboratories are using nine different immunoassay methods. One tenth of laboratories is verifying manufacturer’s declared limit of quantification for TSH and one third is verifying implemented reference intervals for all performed tests. Most of laboratories (91%) adopt the manufacturer’s reference interval for adult population. Reference intervals for TSH are reported with different percentiles (90, 95 or 99 percentiles). Conclusion This survey showed current practices and policies in Croatian laboratories regarding thyroid testing. The results identified some critical spots and will serve as a foundation in creating national guidelines in order to harmonize laboratory procedures in thyroid testing in Croatia.
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Affiliation(s)
- Adriana Bokulić
- Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- Corresponding author:
| | - Ivana Zec
- Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sanja Goreta
- Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nora Nikolac Gabaj
- University Department of Chemistry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Marija Kocijančić
- Central Laboratory, University Hospital Halle, Halle (Saale), Germany
| | - Tihana Serdar Hiršl
- Medical Biochemistry Laboratory, Synlab Hrvatska-Polyclinic for Medical Laboratory Diagnostics, Zagreb, Croatia
| | - Anamarija Đuras
- Department of Medical Biochemistry Laboratory, General Hospital Varaždin, Varaždin, Croatia
| | - Mateja Troha
- Department of Laboratory Diagnostics, General Hospital Dr. Josip Benčević, Slavonski Brod, Croatia
| | - Lada Stanišić
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Split, Croatia
| | - Daniela Šupe-Domić
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Split, Croatia
- Department of Health Studies, University of Split, Split, Croatia
| | - Sanda Jelisavac Ćosić
- Department of Nuclear Medicine and Radiation Protection, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Koraljka Đurić
- Medical Biochemistry Laboratory, Special Hospital AGRAM, Zagreb, Croatia
| | - Domagoj Marijančević
- Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marija Siter Kuprešanin
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | - Iva Lukić
- Department for Clinical Laboratory Diagnostics, University Hospital Centre Osijek, Osijek, Croatia
| | - Alenka Pezo
- Medical Biochemistry Laboratory, Primary Health Care Centre Zagreb - East, Zagreb, Croatia
| | - Jasna Leniček Krleža
- Croatian Society of Medical Biochemistry and Laboratory Medicine (CROQALM), Zagreb, Croatia
- Department of Laboratory Diagnostics, Children’s Hospital Zagreb, Zagreb, Croatia
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Weiwei D, Bei W, Hong W, Cailan W, Hailin S, Donghong X, Xiaolai W, Zhaohu H, Shijun L, Jian T, Qiang J. Thyroid Hormone Changes in the Northern Area of Tianjin during the COVID-19 Pandemic. Int J Endocrinol 2022; 2022:5720875. [PMID: 35013681 PMCID: PMC8742148 DOI: 10.1155/2022/5720875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to determine whether and how stress-induced thyroid hormone changes occur during the COVID-19 pandemic in the northern area of Tianjin. METHODS This study comprised two groups of study subjects in Tianjin: before (2019) and during (2020) the COVID-19 outbreak. Subjects were included if they had FT3, FT4, and TSH concentrations and thyroid TPOAb or TgAb information available. People who were pregnant, were lactating, or had mental illness were excluded. We used propensity score matching to form a cohort in which patients had similar baseline characteristics, and their anxiety level was measured by the Hamilton Anxiety Rating Scale (HAMA). RESULTS Among the 1395 eligible people, 224 in Group A and 224 in Group B had similar propensity scores and were included in the analyses. The detection rate of abnormal thyroid function was decreased in pandemic Group B (69.2% vs. 93.3%, χ 2 = 42.725, p < 0.01), especially for hypothyroidism (14.29% vs. 35.71%, χ 2 = 27.429, p < 0.01) and isolated thyroid-related antibodies (25.89% vs. 38.39%, χ 2 = 8.023, p < 0.01). The level of FT4 (z = -2.821, p < 0.01) and HAMA score (7.63 ± 2.07 vs. 5.40 ± 1.65, t = 16.873, p < 0.01) went up in Group B; however, TSH (z = -5.238, p < 0.01), FT3 (z = -3.089, p=0.002), TgAb (z = -11.814, p < 0.01), and TPOAb (z = -9.299, p < 0.01) were lower, and HAMA was positive with FT3 (r = 0.208, p < 0.01) and FT4 (r = 0.247, p < 0.01). CONCLUSION People in the northern area of Tianjin during the COVID-19 outbreak were at an increased risk of higher FT4, lower FT3, and lower TSH. The HAMA scores increased in emergency situations and were positively correlated with the levels of FT3 and FT4.
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Affiliation(s)
- Dong Weiwei
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
| | - Wu Bei
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
- Department of Nuclear Medicine, Tianjin Hospital, Tianjin 300211, China
| | - Wang Hong
- Rehabilitation Medical Department, Tianjin Union Medical Center, Tianjin 300121, China
| | - Wu Cailan
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Shao Hailin
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Xu Donghong
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Wang Xiaolai
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Hao Zhaohu
- Department of Endocrinology Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Li Shijun
- Department of Hematology, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Tan Jian
- Department of Nuclear Medicine, Tianjin Fourth Central Hospital, The Fourth Central Clinical School, Tianjin Medical University, Tianjin 300140, China
| | - Jia Qiang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin 300052, China
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A prospective, observational clinical trial on the impact of COVID-19-related national lockdown on thyroid hormone in young males. Sci Rep 2021; 11:7075. [PMID: 33782499 PMCID: PMC8007755 DOI: 10.1038/s41598-021-86670-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/17/2021] [Indexed: 11/08/2022] Open
Abstract
Trying to manage the dramatic coronavirus disease 2019 (COVID-19) infection spread, many countries imposed national lockdown, radically changing the routinely life of humans worldwide. We hypothesized that both the pandemic per se and the consequent socio-psychological sequelae could constitute stressors for Italian population, potentially affecting the endocrine system. This study was designed to describe the effect of lockdown-related stress on the hypothalamic-pituitary-thyroid (HPT) axis in a cohort of young men. A prospective, observational clinical trial was carried out, including patients attending the male infertility outpatient clinic before and after the national lockdown for COVID-19 pandemic. The study provided a baseline visit performed before and a follow-up visit after the lockdown in 2020. During the follow-up visit, hormonal measurements, lifestyle habits and work management were recorded. Thirty-one male subjects were enrolled (mean age: 31.6 ± 6.0 years). TSH significantly decreased after lockdown (p = 0.015), whereas no significant changes were observed in the testosterone, luteinising hormone, follicle-stimulating hormone, estradiol and prolactin serum levels. No patient showed TSH serum levels above or below reference ranges, neither before nor after lockdown. Interestingly, TSH variation after lockdown was dependent on the working habit change during lockdown (p = 0.042). We described for the first time a TSH reduction after a stressful event in a prospective way, evaluating the HPT axis in the same population, before and after the national lockdown. This result reinforces the possible interconnection between psychological consequences of a stressful event and the endocrine regulation.
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