Evaluation Depressive Symptoms in Patients with Euthyroid Hashimoto’s Thyroiditis and Patients with Subclinical Hypothyroidism

Yıl 2019, , 106 - 108, 06.09.2019

Özge Telci Çaklılı

https://doi.org/10.30934/kusbed.600302

Öz

Objective: Hypothyroidism is a common endocrine disorder in general population. This study aims to compare depressive symptoms of patients with euthyroid Hashimoto hypothyroidism, patients with new onset subclinical hypothyroidism and healthy controls.

Methods: Study was conducted at Kocaeli State Hospital Internal Medicine Clinic between 2017-2019. Patients who were treated for hypothyroidism at Kocaeli State Hospital Internal Medicine Clinic were screened and eligible patients were divided into two groups: patients with euthyroid Hashimoto thyroiditis and patients with subclinical hypothyroidism. Beck depression inventory was applied to the groups. Also, a control group was generated and applied the same inventory.

Results: Forty-three patients and 31 healthy controls were recruited; 32 had euthyroid Hashimoto thyroiditis whereas 11 had subclinical hypothyroidism. Mean thyroid stimulating hormone (TSH) level of patients was 2.3±0.9 mU/L and 8.2±2.7 mU/L, respectively. Mean Beck depression inventory score of the patients was 14.1±8.9. Mean score of the control group was 6.4±5.2. Although there was no difference between scores of controls and subclinical hypothyroid patients, there was statistically significant difference between controls and euthyroid patients (p<0.01). There was no statistically significant difference between subclinical hypothyroid patients and euthyroid patients. Fifteen patients had score ≥17. Thirty four percent of the euthyroid patients (n=11) and 36% of subclinical hypothyroid patients (n=4) had moderate and high depressive symptoms.

Conclusion: Depression is not uncommon in patients with hypothyroidism. It should be investigated when necessary.

Anahtar Kelimeler

Hashimoto thyroiditis, subclinic hypothyroidism, depression

Ötiroid Hashimoto Tiroiditi ve Subklinik Hipotiroidisi Olan Hastalarda Depresif Semptomların Değerlendirilmesi

Öz

Amaç: Hipotiroidi toplumda en sık görülen endokrinolojik hastalıklardan birisidir. Bu çalışmada, Hashimoto hipotiroiditine bağlı tedavi atında ötiroid olan hastalar ile subklinik hipotirodi tanısı alan hastalarda depresif semptom varlığı araştırılarak sağlıklı kontroller ile karşılaştırıldı.

Yöntem: Bu çalışma Kocaeli Devlet Hastanesi İç Hastalıkları Kliniği’nde 2017-2019 yılları arasında yürütüldü. Kocaeli Devlet Hastanesi İç Hastalıkları Kliniği’nde tiroid hastalığı nedeni ile takip edilen hastalar, tiroid fonksiyon testi sonuçlarına göre tedavi altında ötiroid olan Hashimoto tiroiditi olanlar ve subklinik hipotiroidisi olanlar şeklinde ikiye ayrıldı. Her iki gruba da Beck depresyon ölçeği uygulandı. Ayrıca bir kontrol grubu oluşturularak aynı ölçek uygulandı.

Bulgular: Çalışmaya toplam 43 hasta ve 31 kontrol alındı. Bunlardan 32’si ötiroid seyreden Hashimoto tiroiditi olan, 11’i de subklinik hipotiroidisi olan hastalardı. Ötiroid hastaların ortalama tiroid stimulan hormon (TSH) düzeyi 2,3±0,9 mU/L iken subklinik hipotiroidisi olan hastalarınki 8,2±2,7 mU/L idi. Hastaların ortalama Beck depresyon skoru 14,1±8,9 idi. Kontrol grubunun ortalama Beck depresyon skoru 6,4±5,2 olarak saptandı. Kontrol grubu ile ötiroid Hashimoto grubu arasında Beck depresyon skoru açısından anlamlı fark saptanırken (p<0,01), ötiroid Hashimotolu hastalar ile subklinik hipotiroidisi olanlar arasındaki fark anlamlılık arz etmedi. Toplam 15 hastanın (%35) depresyon skoru ≥17 olarak saptandı. Ötiroid hastaların %34’ünde (n=11), subklinik hipotiroidisi olan hastaların %36’sında (n=4) orta ve yüksek seviyede depresif semptomlar görüldü.

Sonuç: Depresyon hipotiroidi hastalarında nadir görülen bir durum değildir. Gerekli durumlarda araştırılmalıdır.

Anahtar Kelimeler

Hashimoto tiroiditi, subklinik hipotiroidizm, depresyon

Kaynakça

• Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301. doi:10.1038/nrendo.2018.18
• Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489-499. doi:10.1210/jcem.87.2.8182
• Türk Endokrinoloji ve Metabolizma Derneği Tiroid Kılavuzu available at http://temd.org.tr/admin/uploads/tbl_kilavuz/20190426165340-2019tbl_kilavuze72e4ddf38.pdf Haziran 2019’da erişildi.
• Duntas LH, Maillis A. Hypothyroidism and depression: salient aspects of pathogenesis and management. Minerva Endocrinol. 2013(1);38(4):365-77.
• Chueire VB, Romaldini JH, Ward LS. Subclinical hypothyroidism increases the risk for depression in the elderly. Arch Gerontol Geriatr. 2007;44(1):21-28. doi:10.1016/j.archger.2006.02.001
• Gulseren S, Gulseren L, Hekimsoy Z, Cetinay P, Ozen C, Tokatlioglu, B. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res. 2006;37(1):133-139. doi:10.1016/j.arcmed.2005.05.008
• Demartini B, Masu A, Scarone S, Pontiroli AE, Gambini O. Prevalence of depression in patients affected by subclinical hypothyroidism. Panminerva Med. 2010;52(4):277-282.
• Sawka AM, Gerstein HC, Marriott MJ, MacQueen GM, Joffe RT. Does a combination regimen of thyroxine (T4) and 3, 5, 3′-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J Clin Endocrinol Metab. 2003;88(10):4551-4555. doi:10.1210/jc.2003-030139
• Kirim S, Keskek SÖ, Köksal F, Haydardedeoglu FE, Bozkirli E, Toledano Y. Depression in patients with euthyroid chronic autoimmune thyroiditis. Endocr J. 2012;59(8):705-708. doi:10.1507/endocrj.EJ12-0035
• Yalcin MM, Altinova AE, Cavnar B, et al. Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto’s thyroiditis? Endocr J. 2017;64(4):425-429. doi:10.1001/jamapsychiatry.2018.0190
• Hisli N. Beck Depresyon Envanterinin Üniversite Öğrencileri için Geçerliği, Güvenirliği. Turk Psikol Derg. 1998;7(23):3-13
• Öner N. Güvenirliği ve/veya Geçerliği Sınanmış Psikolojik Testler. Turk Psikol Derg. 1994;9(33):9-18
• Ayhan MG, Uguz F, Askin R, Gonen, MS. The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto’s thyroiditis: A comparative study. Gen Hosp Psychiatry. 2014;36(1):95-98. doi:10.1016/j.genhosppsych.2013.10.002
• Krysiak R, Drosdzol Cop A, Skrzypulec Plinta V, Okopien B. Sexual function and depressive symptoms in young women with thyroid autoimmunity and subclinical hypothyroidism. Clin Endocrinol. 2016;84(6):925-931. doi:10.1111/cen.12956
• Siegmann EM, Müller HH, Luecke C, Philipsen A, Kornhuber J, Grömer TW. Association of depression and anxiety disorders with autoimmune thyroiditis: a systematic review and meta-analysis. JAMA Psychiatry. 2018;75(6):577-584. doi:10.1001/jamapsychiatry.2018.0190
• Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull. 2011;99(1). doi:10.1093/bmb/ldr030
• Parker G, Brotchie, H. Gender differences in depression. Int Rev Psychiatry, 2010;22(5):429-436. doi:10.3109/09540261.2010.492391
• Kiecolt-Glaser JK, Glaser R. Depression and immune function: central pathways to morbidity and mortality. J Psychosom Res. 2002;53(4):873-876. doi:10.1016/S0022-3999(02)00309-4
• Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology.13th ed. New York. 2015. Elsevier Health Sciences.
• Jackson IM. The thyroid axis and depression. Thyroid. 1998;8(10):951-956. doi:10.1089/thy.1998.8.951