Association between free thyroxine levels and clinical phenotype in first-episode psychosis: a prospective observational study

Abstract

Aim To determine whether thyroid hormone levels are associated with a specific clinical phenotype in patients with first-episode psychosis (FEP). Methods Ninety-eight inpatients experiencing FEP and with less than 6 weeks of antipsychotic treatment were included in the study and were followed up for one year. Baseline psychiatric evaluation included assessment of prodromal symptoms, positive and negative symptoms, depressive symptoms, stressful life events and cycloid psychosis criteria. Thyroid function (thyroid-stimulating hormone (TSH) and free thyroxin (FT4)) was determined at admission. Partial correlation analysis was conducted to analyse the correlation between levels of TSH/FT4 and symptoms. Logistic regression was performed to explore the association between psychopathological symptoms, 12-month diagnoses and thyroid hormones while adjusting for covariates. Results Patients with prodromal symptomatology showed lower baseline FT4 levels (OR = 0.06; p = 0.018). The duration of untreated psychosis (DUP) was inversely associated with FT4 concentrations (r = − 0.243; p = 0.039). FEP patients with sudden onset of psychotic symptoms (criteria B, cycloid psychosis) showed higher FT4 levels at admission (OR = 10.49; p = 0.040). Patients diagnosed with affective psychotic disorders (BD or MDD) at the 12-month follow-up showed higher FT4 levels at admission than patients diagnosed with nonaffective psychosis (schizophrenia, schizoaffective) (OR = 8.57; p = 0.042). Conclusions Our study suggests that higher free-thyroxine levels are associated with a specific clinical phenotype of FEP patients (fewer prodromal symptoms, shorter DUP duration and sudden onset of psychosis) and with affective psychosis diagnoses at the 12-month follow-up.

Psychosocial stress moderates the relationship between cerebrospinal fluid lactate dehydrogenase and the duration of untreated psychosis in first-episode psychosis

“…Previous studies have established associations of serum biomarkers related to inflammatory ( 50 – 52 ), oxidative stress ( 53 ), immune ( 54 ), neuroendocrine ( 55 ), and metabolic systems ( 56 ) with the DUP. To our knowledge, the current study is the first to report that a CSF biomarker related to brain bioenergetics is correlated with the DUP.…”

Relationship between thyroid-stimulating hormone, BDNF levels, and hippocampal volume in antipsychotic-naïve first-episode psychosis patients

“…Only a few studies have explored the relationship between clinical symptoms and alterations in thyroid hormone levels. Recently, one study in FEP patients ( 33 ) found that high T4 plasma levels (but still within the normal range) were associated with fewer prodromal symptoms, shorter DUP, greater likelihood of sudden onset psychosis, and more affective symptomatology at 1 year of follow-up. A study involving patients with early psychosis found that higher T4 levels were associated with better cognitive performance on the attention domain ( 12 ) and that the presence of antithyroid antibodies was associated with worse negative symptoms ( 9 ).…”