Sinai Cave, Hirvikoski Tatja, Nordström Anna-Lena, Nordström Peter, Nilsonne Asa, Wilczek Alexander, Asberg Marie, Jokinen Jussi
Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
Department of Children's and Women's Health, Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Stockholm, Sweden.
Eur J Psychotraumatol. 2014 May 16;5. doi: 10.3402/ejpt.v5.23911. eCollection 2014.
A relationship between exposure to sexual violence and thyroid hormone alterations has been observed among women with posttraumatic stress disorder (PTSD). Women with borderline personality disorder (BPD) report a high estimate of childhood trauma.
The aim of the present study was to assess relationships between thyroid hormone measures and exposure to violence in childhood in women with BPD.
A total of 92 clinically euthyroid women with BPD (53% with comorbid PTSD) diagnosis and at least two prior suicide attempts were assessed with the Karolinska Interpersonal Violence Scales (KIVS). The KIVS contains four subscales with concrete examples of exposure to violence and expressed violent behavior in childhood (aged 6-14 years) and during adult life (15 years or older). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays. The FT3/FT4 ratio was used to estimate peripheral deiodination. Plasma cortisol was also assessed.
Sixty-seven percent of patients reported medium high or high level of exposure to interpersonal violence as a child. The FT3/FT4 ratio showed a significant negative correlation with exposure to violence as a child. Patients with PTSD had significantly higher plasma cortisol levels. An ad hoc analysis revealed that the correlation between KIVS exposure to interpersonal violence as a child and FT3/FT4 ratio was significant only in patients with comorbid PTSD. Altered thyroid activity, especially FT3/FT4, levels was associated with exposure to violence in childhood in women with BPD.
Severe childhood trauma-related stress may promote lasting altered thyroid levels and/or contribute to the development of psychopathology associated with BPD traits or PTSD.
在患有创伤后应激障碍（PTSD）的女性中，已观察到性暴力暴露与甲状腺激素改变之间存在关联。边缘性人格障碍（BPD）女性报告童年创伤的发生率很高。
本研究的目的是评估BPD女性甲状腺激素指标与童年期暴力暴露之间的关系。
使用卡罗林斯卡人际暴力量表（KIVS）对92名临床甲状腺功能正常、诊断为BPD（53%伴有共病PTSD）且至少有过两次自杀未遂的女性进行评估。KIVS包含四个子量表，有童年期（6至14岁）和成年期（15岁及以上）暴力暴露和暴力行为表现的具体例子。通过免疫测定法测量血浆游离和结合三碘甲状腺原氨酸（FT3和T3）、甲状腺素（FT4和T4）以及促甲状腺激素（TSH）来评估基线甲状腺功能。FT3/FT4比值用于估计外周脱碘情况。还评估了血浆皮质醇。
67%的患者报告童年期人际暴力暴露水平为中高或高。FT3/FT4比值与童年期暴力暴露呈显著负相关。PTSD患者的血浆皮质醇水平显著更高。一项专项分析显示，仅在伴有共病PTSD的患者中，KIVS童年期人际暴力暴露与FT3/FT4比值之间的相关性显著。甲状腺活动改变，尤其是FT3/FT4水平，与BPD女性童年期暴力暴露有关。
严重的童年创伤相关应激可能会促进甲状腺水平的持续改变和/或促成与BPD特质或PTSD相关的精神病理学发展。
