FT4 and TSH, relation to diagnoses in an unselected psychiatric acute-ward population, and change during acute psychiatric admission

Abstract

BackgroundAlteration in thyroid activity is a well-known cause of symptoms mimicking psychiatric disorders. There are reports on altered levels of thyroid hormones in patients with certain psychiatric disorders compared to healthy controls; still, the magnitude and importance of the phenomenon is not known. We wanted to explore the level of thyroid hormones in different diagnostic groups in an acute-psychiatric population. We also wanted to follow any change during their stay.MethodsPatients aged 18 years and older admitted to a closed, psychiatric inpatient ward were eligible if giving informed consent. For 539 patients representing all main psychiatric diagnostic groups and with equal gender distribution, data for FT4 were available for 539 patients, and data for TSH were available from 538 patients at admittance. For 239 patients, data for FT4 were available at both admittance and discharge, and the corresponding number for TSH was 236 patients.ResultsA significantly higher share of patients had higher levels of FT4 and TSH at admittance than expected for healthy individuals. No significant effect of gender or most diagnostic groups was seen.For female patients with substance-use disorder (SUD), the level of TSH was significantly lower than that for all other diagnostic groups. No other difference in the levels of FT4 and TSH was seen between the main diagnostic groups, and the effect in SUD was not seen in males.For the population with available markers at both admittance and discharge, in total, there was a significant reduction of FT4 from admittance to discharge, not followed by any change in TSH.ConclusionsIn acutely admitted psychiatric patients there seems to be an increased FT4 and TSH. FT4 is normalized during the inpatient stay independently of TSH. This indicates somatic effects of psychiatric stress that may be of clinical importance and the phenomenon should be further explored. Mainly different diagnostic groups did not differ in level of FT4 and TSH. Thus future studies on thyroid activity in psychiatric patients should focus on function and level of stress and suffering rather than diagnostic groups.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1819-3) contains supplementary material, which is available to authorized users.

Functional Status of Hypothalamic-pituitary-thyroid axis and Prolactin level in Patients with First-episode of Bipolar Disorder in Mania State

“…Male patients had higher FT4 levels, while female patients had lower TT3 and TT4. The increase in peripheral secreted THs leads to high risk of hyperthymia, irritability, and distractibility, thus, the increase of FT4 in the male BD-mania group was consistent with symptoms of a mania-like state [25]. The hypothyroidism theory in BD is usually explained by the compensatory mechanism of the thyroid [26].…”

“…A previous study found that the compensatory feedback of the HPTA may decline with chronic deferment of the disease. Thus, increased FT4 and TSH becomes a comparatively steady state under chronic psychiatric stress, and the sex differences may disappear [25].…”

Prevalence and clinical profile of abnormal glucose in first-episode and drug-naïve patients with major depressive disorder with comorbid abnormal thyroid function: a large-scale cross-sectional study

“…Fortunately, our patients of first episode MDD patients were young, and we found that only a few patients had previous diabetes or thyroid disorder, which may not have significantly affected the results of this study. Fifth, it is known that many comorbid medical and mental illnesses may affect thyroid levels, such as Alzheimer’s Disease, brain injury, and unselected populations with acute episodes of psychosis [ 46 – 48 ]. However, not all of these diseases were specified in the exclusion criteria, which should be remedied in future studies.…”

A retrospective study of pituitary-thyroid interaction in patients with first-episode of bipolar disorder type I in Mania State

“…The increase in peripheral secreted THs leads to high risk of hyperthymia, irritability, and distractibility, thus, the increase of FT4 in the male BD-mania group was consistent with symptoms of a mania-like state. [ 28 ] The hypothyroidism theory in BD is usually explained by the compensatory mechanism of the thyroid. [ 29 ] It is important to note that the results of the female BD-mania group were inconsistent with the biological peripheral roles of T3 and T4.…”