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

Abstract

Background Bipolar disorder (BD)-mania symptoms are stimulated by disease of the thyroid. Methods This study included 70 patients diagnosed with first-episode BD-mania and 70 healthy controls (HC) matched for age and sex. We aimed to determine upstream thyroid hormone interactions on the anterior pituitary, and find differences between thyroid-stimulating-hormone (TSH) and Prolactin (PRL) in the patients with first-episode of BD-mania. There were significant changes in triiodothyronine (TT3), total thyroxin (TT4), and free thyroxine (FT4) concentrations between the BD-mania and HC groups (p < 0.0167 with Bonferroni correction). Results After being grouped by sex, higher PRL in the male and female BD-mania subgroup were observed compared to each isosexual HC (p’s < 0.01). Higher FT4 in the male BD-mania group was observed compared to the HC males (p < 0.01) while the female BD-mania group showed lower TT3 and TT4 compared to the HC females (p’s < 0.01). In the female BD-mania group, correlation analysis established an inverse relationship between PRL and TSH (r2 = 0.25, F = 11.11, p < 0.01). Conclusions The findings demonstrate that sex impacts the concentration of hormones secreted by the anterior pituitary of patients with first-episode BD-mania. The increased PRL may be a putative mechanism that underlies the onset in female patients with a moderate inverse relationship between TSH and PRL.

Proteomic Analysis of Plasma Markers in Patients Maintained on Antipsychotics: Comparison to Patients Off Antipsychotics and Normal Controls

“…High PRL levels in patients with SZ or BD are often attributed to APs. Nevertheless, there have been reports of high prolactin levels in drug-naive patients with SZ or other psychotic disorders ( 41 ), as well as in BD ( 42 ). The data on PRL in drug-free or drug-naïve patients are still equivocal ( 43 ).…”

“…However, a meta-analysis of the studies on long-acting injectable (LAI) and second-generation oral antipsychotics reported better clinical outcomes with LAIs but higher PRL level and side effects ( 44 ). Many hypotheses have been proposed, including relationships between PRL and dopamine, links between PRL and stress, effects of the Thyroid Stimulating Hormone ( 4 ) axis on PRL, as well as pro-inflammatory and detrimental cognitive effects of PRL ( 42 , 45 ).…”

Thyroid hormone levels in patients with bipolar disorder: A systematic review and meta- analysis

“…The mean age of patients ranged from 15.9 [40] to 53.3 [52]. The diagnostic criteria for BD included the Diagnostic and Statistical Manual of Mental Disorders (DSM) [27,29,30,33,35,38,41,43,44,[50][51][52], the International Classi cation of Diseases diagnostic Criteria, Edition10(ICD 10) [28, 31,34,36,39,40,42,48], the Chinese Criteria for Classi cation and Diagnosis of Mental Disorders, Edition3(CCCD-3) [32,37,[45][46][47]49], and the Diagnostic Criteria for Functional Psychoses (3rd) [53]. In most studies, euthyroid patients or no history of thyroid disease were required to be included, while two studies [27,30] had no any description of thyroid function.…”

“…In most studies, euthyroid patients or no history of thyroid disease were required to be included, while two studies [27,30] had no any description of thyroid function. Except for 2 studies [36, 47] that didn't mention it, and one study [35] just said it was immunoassay, methods for measuring serum TH included Electrochemiluminescence immunoassay (ECLIA) [28,31,34,[39][40][41][42]44], Chemiluminescence immunoassay (CLIA) [27,29,30,32,33,37,38,45], Radioimmunoassay (RIA) [46,[50][51][52][53], Enzyme linked immunosorbent assay (ELISA) [43,[48][49][50], Immuno uorescence (IF) [50], and most studies show that they were measured in the morning. In terms of drug expression, some studies directly speci ed medication-free [30,31,33,34,42,45], the duration of drug discontinuation in other studies were separately 6 months [27,29,36], 3 months [32, 39], 2 months [43], 1 month [37,40,46,50], and at least 2 weeks [28, 35,38,…”

“…A total of 8 studies [28, 30,39,40,42,43,50,53] reported comparison of BD-mania and HC. Seven studies showed serum TSH level increased signi cantly in BD-mania compared with HC, the difference between groups was statistically signi cant (SMD: 0.20, 95%CI: 0.04 to 0.36, I 2 = 0.00%, P = 0.02, Fig.…”