Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati and Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Genetic Counseling Program, University of Cincinnati, Cincinnati, Ohio, USA.
J Clin Psychiatry. 2019 Aug 6;80(5):18m12626. doi: 10.4088/JCP.18m12626.
To determine the prevalence of abnormal thyroid-stimulating hormone (TSH) measures in youth with severe mood and anxiety disorders and to examine clinical and demographic predictors of abnormal TSH measures.
We retrospectively examined screening TSH concentrations in psychiatrically hospitalized children and adolescents (3-19 years) with mood/anxiety disorders (DSM-IV and DSM-5 criteria) at a large, urban, pediatric hospital between September 2013 and April 2017. Symptoms were extracted from the medical record using adaptive natural language processing algorithms, and the utility of demographic, clinical, and treatment variables as predictors of abnormal TSH measures was evaluated using logistic regression.
In this sample (N = 1,017, mean ± SD age = 14.7 ± 2.24 years), 62 patients had a TSH concentration > 3.74 μIU/mL (5.3% [n = 6] of patients < 12 years of age and 6.2% [n = 56] of patients ≥ 12 years of age), and 7 patients had a TSH concentration < 0.36 μIU/mL. Elevated TSH concentrations were associated with a recent weight gain (odds ratio [OR] = 3.60; 95% CI, 1.13-9.61; P = .017), a history of thyroid disease (OR = 6.88; 95% CI, 2.37-10.7; P ≤ .0001), abnormal menstrual bleeding/menometrorrhagia (OR = 2.03; CI, 1.04-3.63; P = .024), and benzodiazepine treatment (OR = 2.29; 95% CI, 1.07-4.52; P = .02). No association was observed for sex, age, or body mass index z score. Among patients with elevated TSH measures, 12.9% (n = 8, mean ± SD age = 16.5 ± 1.5 years, 87.5% female) had an abnormal free/total thyroxine (T₄) level or other biochemical findings consistent with thyroid disease. Patients with thyroid disease (compared to those patients with elevated TSH and normal active thyroid hormone concentrations) were older (16.5 ± 1.5 vs 14.6 ± 2.3 years, P = .020) but did not differ in sex distribution (87.5% vs 63.6% female, P = .444).
TSH concentrations are abnormal in approximately 6% of psychiatrically hospitalized youth, although thyroid disease was present in < 1% of the total sample. Targeted screening should focus on patients with recent weight gain, those treated with benzodiazepines, and girls with a history of abnormal uterine bleeding/menometrorrhagia.
确定患有严重情绪和焦虑障碍的青少年中促甲状腺激素（TSH）异常的发生率，并探讨异常 TSH 测量的临床和人口统计学预测因子。
我们回顾性地检查了 2013 年 9 月至 2017 年 4 月期间在一家大型城市儿科医院住院的患有心境/焦虑障碍（DSM-IV 和 DSM-5 标准）的儿童和青少年（3-19 岁）的筛查 TSH 浓度。使用自适应自然语言处理算法从病历中提取症状，使用逻辑回归评估人口统计学，临床和治疗变量作为异常 TSH 测量的预测因子的效用。
在该样本（N = 1017，平均年龄±标准差为 14.7 ± 2.24 岁）中，有 62 例患者的 TSH 浓度> 3.74 μIU/mL（< 12 岁的患者中占 6%[n = 6]，而≥ 12 岁的患者中占 6.2%[n = 56]），有 7 例患者的 TSH 浓度< 0.36 μIU/mL。TSH 浓度升高与近期体重增加有关（比值比[OR] = 3.60；95%置信区间，1.13-9.61；P =.017），有甲状腺疾病史（OR = 6.88；95%置信区间，2.37-10.7；P ≤.0001），异常月经出血/月经过多（OR = 2.03；CI，1.04-3.63；P =.024）和苯二氮䓬类药物治疗（OR = 2.29；95%置信区间，1.07-4.52；P =.02）。性别，年龄或体重指数 z 得分与 TSH 无关联。在 TSH 升高的患者中，有 12.9%（n = 8，平均年龄±标准差为 16.5 ± 1.5 岁，87.5%为女性）的游离/总甲状腺素（T₄）水平或其他生化发现异常，与甲状腺疾病一致。患有甲状腺疾病的患者（与 TSH 升高且甲状腺激素活性正常的患者相比）年龄较大（16.5 ± 1.5 岁比 14.6 ± 2.3 岁，P =.020），但性别分布无差异（87.5%比 63.6%为女性，P =.444）。
约有 6%的精神病住院的青少年 TSH 浓度异常，尽管在总样本中不到 1%的患者患有甲状腺疾病。有针对性的筛查应集中在近期体重增加，接受苯二氮䓬类药物治疗的患者以及有异常子宫出血/月经过多病史的女孩。
