Demartini Benedetta, Ranieri Rebecca, Masu Annamaria, Selle Valerio, Scarone Silvio, Gambini Orsola
Departments of *Psychiatry, and †Internal Medicine, San Paolo Hospital and University of Milan, Milan, Italy.
J Nerv Ment Dis. 2014 Aug;202(8):603-7. doi: 10.1097/NMD.0000000000000168.
The relationship between subclinical hypothyroidism and depression is still controversial. Our objective was to compare the prevalence of depressive symptoms and major depressive disorder in a population of patients affected by subclinical hypothyroidism and a control group without thyroid disease. The authors enrolled 123 consecutive outpatients affected by subclinical hypothyroidism undergoing follow-up at the endocrinology department of San Paolo Hospital in Milan and 123 controls without thyroid disease under the charge of general physicians.All patients and controls underwent an evaluation by means of a psychiatric interview; Hamilton Rating Scale for Depression (HAM-D); Montgomery-Asberg Depression Rating Scale (MADRS); and serum thyroid stimulating hormone, free T4, and free T3 levels. Patients were also screened for thyroid peroxidase antibodies and thyroglobulin antibodies. Patients affected by subclinical hypothyroidism had a prevalence of depressive symptoms of 63.4% at HAM-D and 64.2% at MADRS; 22 patients (17.9%) had a diagnosis of depressive episode (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria). The control group had a prevalence of depressive symptoms of 27.6% at HAM-D and 29.3% at MADRS, and only seven controls had a diagnosis of depressive episode. The prevalence of depressive symptoms between these two groups was statistically different. This study underlines a strong association between subclinical hypothyroidism and depressive symptoms, which could have some important diagnostic and therapeutic implications in the clinical practice.
亚临床甲状腺功能减退与抑郁症之间的关系仍存在争议。我们的目的是比较亚临床甲状腺功能减退患者群体与无甲状腺疾病的对照组中抑郁症状和重度抑郁症的患病率。作者纳入了米兰圣保罗医院内分泌科连续随访的123例亚临床甲状腺功能减退门诊患者以及由普通内科医生负责的123例无甲状腺疾病的对照者。所有患者和对照者均通过精神科访谈、汉密尔顿抑郁量表（HAM-D）、蒙哥马利-阿斯伯格抑郁量表（MADRS）以及血清促甲状腺激素、游离T4和游离T3水平进行评估。患者还接受了甲状腺过氧化物酶抗体和甲状腺球蛋白抗体筛查。亚临床甲状腺功能减退患者中，根据HAM-D评估抑郁症状患病率为63.4%，根据MADRS评估为64.2%；22例患者（17.9%）诊断为抑郁发作（依据《精神疾病诊断与统计手册》第四版修订版标准）。对照组中，根据HAM-D评估抑郁症状患病率为27.6%，根据MADRS评估为29.3%，仅有7例对照者诊断为抑郁发作。两组之间抑郁症状的患病率存在统计学差异。这项研究强调了亚临床甲状腺功能减退与抑郁症状之间的紧密关联，这在临床实践中可能具有一些重要的诊断和治疗意义。
