Her er en oversikt over forskning på kognitive og emosjonelle problemer som kan ha sammenheng med stoffskiftesykdom.
|Boillet, D., Szoke, A. (1998). Psychiatric manifestations as the only clinical sign of hypothyroidism. Apropos of a case. Encephale: 24(1):65-8.Conclusion: The endocrine investigation has documented, in spite of the absence of any suggestive physical signs, a thyroid insufficiency. After the replacement treatment, all symptoms but the cognitive dysfunction disappeared. The patient’s evolution is presented clinically, also rated on MMSE and MADRS scales, and biologically (TSH and T4 determination) for a 4 months period. The absence of any pathognomonical psychiatric finding, the possibility of the absence of other signs and symptoms (namely physical) in the hypothyroid state, the presence of potentially irreversible cognitive deterioration, as well as the inocuity and sensibility of thyroid hormones examination justify the systematic thyroid evaluation for all new psychiatric patients.|
Carta, MG., Hardoy, MC., Carpiniello, B., Murru, A., Marci, AR., Carbone, F., Deiana, l., Cadeddu, M., Mariotti, S. (2005). A case control study on psychiatric disorders in Hashimoto disease and Euthyroid Goitre: not only depressive but also anxiety disorders are associated with thyroid autoimmunity. Clin Pract Epidemiol Ment Health; 10:1-23. Conclusion: The study seems to confirm that risk for depressive disorders in subjects with thyroiditis is independent of the thyroid function detected by routine tests and indicates that not only mood but also anxiety disorders may be associated with Hashimoto disease.
Davis, A.T. (1989). Psychotic states associated with disorders of thyroid function. Int J Psychiatry Med. 1989;19(1):47-56.
Conclusions: Thyroid-related psychoses continue to pose diagnostic and treatment challenges for clinicians. Two case histories illustrate diverse clinical states associated with hyper- and hypo-thyroidism respectively and highlight the need to consider the possibility of thyroid disorder in all patients presenting with acute psychotic mental disorder. They also demonstrate treatment methods directed at control of psychotic symptoms and restoration of an euthyroid state.
|Gold, M.S., Pottash, A.L., Extein, I. (1982). «Symptomless» autoimmune thyroiditis in depression. Psychiatry Res. 1982 Jun; 6(3):261-9.Conclusion: The magnitude of the thyroid-stimulating hormone (TSH) response induced by thyrotropin-releasing hormone (TRH) helps identify patients whosethyroid is failing. Many of these patients have been found to have Hashimoto’s thyroiditis, symptomless autoimmune thyroiditis (SAT), and subclinical hypothyroidism. While patients with SAT are clinically euthyroid, what might be «symptomless» for the endocrinologist might be a syndrome presenting with psychiatric symptoms to the psychiatrist. As a preliminary test of this hypothesis, we tested 100 consecutive admissions to a psychiatric hospital who complained of depression or lack of energy. Fifteen (15%) of 100 patients were identified from the baseline thyroxin (T4), triiodothyronine (T3) resin uptake (RU), T3 radioimmunoassay (T3RIA), TSH, and TRH test who met criteria for either subclinical, mild, or overt hypothyroidism. Of these 15 patients, 9 (60%) had positive thyroid microsomal antibodies with titers of greater than or equal to 1:10. Our data suggest that SAT is not symptomless and may be an important diagnosis to consider in the evaluation of depressed, anergic, or atypical patients.|
Hage, M.P., Azar, S.T. (2011). The Link between Thyroid Function and Depression. Journal of Thyroid Research; Vol. 2012 (Article ID 590648).
Conclusion: Clinical investigators have long recognized the link between thyroid and depression. While patients with hypothyroidism commonly manifest features of depression, hyperthyroidism presents with a wider spectrum of neuropsychiatric symptoms including both depression and anxiety…Screening patients presenting with depression for thyroid dysfunction seems reasonable particularly those with refractory symptoms. However, the use of thyroid hormones as an adjunct therapy to antidepressants in the absence of subclinical or clinical hypothyroidism should be further investigated. In addition, specifying a particular patient population that might benefit from this combination as determined by individual genetic variants should be addressed.
|Haggerty, J.J., Jr., Evans, D.L., Golden, R.N., Pedersen, C.A., Simon, J.S., Nemeroff, C.B. (1990). The presence of antithyroid antibodies in patients with affective and nonaffective psychiatric disorders. Biol Psychiatry; 27(1):51-60.Conclusions: Our findings confirm earlier reports that thyroid disorders may be particularly common in patients with bipolar affective disorder, even in the absence of lithium exposure. However, as antithyroid antibodies also occurred at a relatively high rate in nonaffective disorders, the possible psychiatric effects of autoimmune thyroiditis do not appear to be limited to affective dysregulation.|
|Hall, R C W, Popkin M, Devaul R, Hall, A K, Gardner E, Beresford T (1982). Psychiatric Manifestations of Hashimoto’s Thyroiditis. Psychosomatics. Volume 23, Issue 4, April 1982, Pages 337-342. Abstract: The mental symptoms associated with Hashimoto’s thyroiditis may precede the full-blown, classic picture of hypothyroidism. The psychiatric symptoms include various mental aberrations, depression, irritability, and confusion. Indeed, patients may be mislabeled as having psychotic depression, paranoid schizophrenia, or the manic phase of a manic depressive disorder. The workup must include a thorough evaluation of thyroid function, including tests for autoantibodies. Patients usually respond favorably to thyroid replacement hormone therapy.|
Hendrick, V., Altshuler, L., Whybrow, P. (1998) Psychoneuroendocrinology of mood disorders. The hypothalamic-pituitary-thyroid axis. Psychiatr Clin North Am. 1998 Jun;21(2):277-92.
Conclusions: Abnormal thyroid functioning can affect mood and influence the course of unipolar and bipolar disorder. Even mild thyroid dysfunction has been associated with changes in mood and cognitive functioning. Thyroid hormone supplementation may have role in the treatment of certain mood disorders, particularly rapid-cycling bipolar disorder. Women are more vulnerable to thyroid dysfunction than men and also respond better to thyroidaugmentation. This article reviews the relationship between thyroid function and mood, and the use of thyroid hormones in the treatment of mood disorders. The impact of gender on these issues is also discussed.
Jackson, I.M. (1998). Thyroid Axis and Depression. Thyroid: 8 (10): 951-6.
Conclusion: It is known that in human depression there is a functional disconnection of the hypothalamus with impairment of the inhibitory glucocorticoid feedback pathway from the hippocampus to the hypothalamus that results in the typical elevated cortisol levels and impaired dexamethasone suppression. It is postulated that a similar situation prevails with regards to the thyroid axis and that the increased T4 in depression, as well as the blunted TSH response to exogenous TRH, reflects glucocorticoid activation of the TRH neuron leading to increased TRH secretion with resultant down regulation of the TRH receptor on the thyrotrope. Normalization of thyroid function after treatment may result in part from an inhibitory response of the TRH neuron to antidepressant medication, although other effects may also be responsible.
|McGaffee, J. Barnes, MA, Lippmann, S. (1981) Psychiatric Presentations of Hypothyroidism. American Family Physician; 23 (5): 129-133.Conclusion: Hypothyroidism can often be misdiagnosed as psychiatric illness. The hypothyroid patient may present with depression, an organic mental disorder, apathy and/or frank psychosis (usually with paranoid symptoms). Psychiatric manifestations of the endocrinopathy will abate with thyroid hormone replacement therapy, unless the disease state has been sufficiently prolonged to cause some irreversible brain damage. This irreversibility mandates prompt diagnosis and specific hormonal replacement therapy. Thus, thyroid function screening is recommended for patients presenting with depression, psychosis or organic mental disorder.|
Placidi, G.P.A., Boldrini M., Patronelli A., Fiore E., Chiovato L., Perugi G., Marazziti D. (1998) Prevalence of Psychiatric Disorders in Thyroid Diseased Patients. Neuropsychobiology; 38:222–225.
Conclusion: The results showed higher rates of panic disorder, simple phobia, obsessive-compulsive disorder, major depressive disorder, bipolar disorder and cyclothymia in thyroid patients than in the general population. These findings would suggest that the co-occurrence of psychiatric and thyroid diseases may be the result of common biochemical abnormalities.
|Rack, S.K., Makela, E.H. (2000) Hypothyroidism and depression: a therapeutic challenge. Ann Pharmacother; 34(10):1142-5.Conclusions: Depressed patients should be screened for hypothyroidism. In hypothyroid patients, depression may be more responsive to a replacement regimen that includes T3 rather than T4 alone. Therefore, inclusion of T3 in the treatment regimen may be warranted after adequate trial with T4 alone.|
Reed K, Bland RC (1977). Masked «myxedema madness». Acta Psychiatr Scand. 1977 Nov;56(5):421-6.
Abstract: Hypothyroidism can present a wide range of psychiatric manifestations, including personality disturbance, neurotic traits and psychotic features. Psychiatric treatment techniques without recognition and correction of the endocrine root of the mental disturbance will result in a failure of treatment. However, severe hypothyroidism can exist with a poverty of classical signs and symptoms such that both internist and psychiatrist may easily overlook endocrine dysfunction as a possible etiology of the mental disorder. A case of long-standing paranoid illness whose etiology was severe myxedema with such a poverty of signs and symptoms is presented.
Rosenthal, L. J., Goldner, W. S., & O’Reardon, J. P. (2011). T3 augmentation in major depressive disorder: safety considerations. American Journal of Psychiatry, 168(10), 1035-1040.
Conclusion: Current textbooks and the 2010 APA guidelines agree that there is good evidence for the use of T3 in depressive syndromes, but largely do not mention monitoring of thyroid functioning. Schatzberg et al. suggest use of T3 in postmenopausal women or atypical depression and tapering augmentation after 60 days.
Wiersinga, W. M., & DeGroot, L. J. (2010). Adult hypothyroidism. Thyroid Disease Manager. Available at: www.thyroidmanager.org/chapter/adulthypothyroidism/#toc-9-2-definition-and-epidemiology-of-hypothyroidismm . Accessed: Nov, 16, 2011. See section 9.5.3 «Nervous System» and Table 9-10 «Incidence of symptoms and signs in hypothyroidism».
|Journal of Aggression, Maltreatment & Trauma, 2013 Emma Fuller-Thomson et al Exploring Gender Differences in the Association Between Childhood Physical Abuse and Thyroid Disorders Abstract This study used a regional subsample (n = 13,070) from the 2005 Canadian Community Health Survey to explore the independent contribution of childhood physical abuse to thyroid conditions in adulthood. Gender-specific logistic regression analyses controlled for age and race, in addition to 5 clusters of variables: childhood stressors, health behaviors, general stress levels, mental health, and socioeconomic status. No significant relationship between childhood abuse and thyroid conditions was found in men; however, childhood physical abuse was associated with higher odds of thyroid conditions among women, independent of a wide range of factors. In a fully adjusted model, abused women had 40% higher odds of thyroid conditions compared to their non abused peers, 95% CI [1.05, 1.87]. Future research on gender differences in the abuse–thyroid relationship is warrantedArtikler om studien: http://www.empr.com/for-women-child-abuse-linked-to-adult-thyroid-conditions/article/306330/|
Saravanan P1, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM. 2002 Psychological well-being in patients on ‘adequate’ doses of l-thyroxine: results of a large, controlled community-based questionnaire study.
Over 1% of the UK population is receiving thyroid hormone replacement with l-thyroxine (T4). However, many patients complain of persistent lethargy and related symptoms on T4 even with normal TSH levels. To date there has been no large study to determine whether this is related to thyroxine replacement or coincidental psychological morbidity. We have therefore attempted to address this issue using a large, community-based study.
This community-based study is the first evidence to indicate that patients on thyroxine replacement even with a normal TSH display significant impairment in psychological well-being compared to controls of similar age and sex. In view of the large numbers of people on thyroxine replacement, we believe that these differences, although not large, could contribute to significant psychological morbidity in a substantial number of individuals.
Markku Linnoila, Bror-Axel Lamberg, William Z. Potter, Philip W. Gold, Frederick K. Goodwin. Psychiatry Research: Received: November 19, 1981; Received in revised form: January 23, 1982 High reverse T3 levels in manic and unipolar depressed women
Abstract A relatively high percentage of patients with affective disorders have abnormalities of thyroid function, and over 60% of endogenously depressed and most manic patients show a blunted thyroid-stimulating hormone (TSH) response to thyroid-releasing hormone (TRH) injections. We now replicate earlier findings concerning relatively high 3,3′,5′-triiodothyronine (reverse T3) levels in unipolar depressives and find similarly high levels in manic women. The significance of the present finding is unknown, but measurement of reverse T3 levels as a potential tool in differential diagnosis of affective disorders and in psychobiological research should be exploded further.
Thyroidea Norge mener: Reverse T3 kan kun tas på Hormonlaboratoriet på Aker, men alle fastleger kan rekvirere denne prøven. rT3 bør i større grad brukes som en indikasjon på flere ting – både for å sammenligne med pasientens kognitive funksjonsnivå, det mentale, og om pasienten klarer å konvertere T4 til T3. Vi mener at rT3 i større grad bør inn som standard test i behandling og overvåkning av stoffskiftepasienter
Review ArticleJournal of Thyroid Research, Volume 2012, Mirella P. Hage and Sami T. Azar, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center The Link between Thyroid Function and Depression
Abstract The relation between thyroid function and depression has long been recognized. Patients with thyroid disorders are more prone to develop depressive symptoms and conversely depression may be accompanied by various subtle thyroid abnormalities. Traditionally, the most commonly documented abnormalities are elevated T4 levels, low T3, elevated rT3, a blunted TSH response to TRH, positive antithyroid antibodies, and elevated CSF TRH concentrations. In addition, thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressant drugs. However, the mechanisms underlying the interaction between thyroid function and depression remain to be further clarified. Recently, advances in biochemical, genetic, and neuroimaging fields have provided new insights into the thyroid-depression relationship.