Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil.
Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brasil.
Clin Endocrinol (Oxf). 2021 May;94(5):858-865. doi: 10.1111/cen.14407. Epub 2021 Feb 14.
This study aimed to prospectively evaluate whether TSH levels at baseline were associated with incident depression after four years of follow-up in a cohort of middle-aged adults, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
TSH and free-thyroxine (FT4) levels were evaluated at baseline. Depression diagnoses were performed using the Clinical Interview Schedule-Revised (CIS-R) at baseline and after a 4-year follow-up. Poisson regression models (95% Confidence Intervals) were built to evaluate the association between TSH quintiles at baseline and incident depression. All analyses were stratified by sex. Models were presented crude, adjusted for age and sex; and further adjusted for race, education, BMI, smoking, alcohol consumption, use of antidepressants/benzodiazepines, kidney function and comorbidities.
Mean age was 51.5 years, and 51.2% were women. Overall, low TSH levels (1 quintile) were associated with incident depression (adjusted RR = 1.36, 95% CI 1.02-1.81), remaining significant for women (adjusted RR = 1.64, 95% CI 1.15-2.33), but not for men. The same results were found when restricting analysis to euthyroid participants (adjusted RR = 1.46, 95% CI 1.08-1.99), also significant for women only (adjusted RR = 1.63, 95% CI 1.12-2.38).
Our results showed that low TSH levels were positively associated with incident depression, particularly among women. Similar results were found when restricting the analysis to euthyroid participants. In contrast, high TSH levels were inversely associated with incident depression, also among women.
本研究旨在前瞻性评估中年成年人队列中，基线 TSH 水平与四年随访后新发抑郁之间的关系，该队列为巴西成人健康纵向研究（ELSA-Brasil）。
基线时评估 TSH 和游离甲状腺素（FT4）水平。基线和四年随访后使用临床访谈表修订版（CIS-R）进行抑郁诊断。构建泊松回归模型（95%置信区间），以评估基线 TSH 五分位数与新发抑郁之间的关系。所有分析均按性别分层。模型呈现未经调整、调整年龄和性别；以及进一步调整种族、教育程度、BMI、吸烟、饮酒、使用抗抑郁药/苯二氮䓬类药物、肾功能和合并症。
平均年龄为 51.5 岁，51.2%为女性。总体而言，低 TSH 水平（第 1 五分位数）与新发抑郁相关（调整 RR=1.36，95%CI 1.02-1.81），女性仍然显著（调整 RR=1.64，95%CI 1.15-2.33），但男性则不然。当将分析限制在甲状腺功能正常的参与者时，也得到了相同的结果（调整 RR=1.46，95%CI 1.08-1.99），仅在女性中仍然显著（调整 RR=1.63，95%CI 1.12-2.38）。
我们的结果表明，低 TSH 水平与新发抑郁呈正相关，尤其是在女性中。当将分析限制在甲状腺功能正常的参与者时，也得到了相似的结果。相比之下，高 TSH 水平与新发抑郁呈负相关，同样在女性中。
