Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
School of Information and Electronics Technology, Jiamusi University, Jiamusi, China.
Front Endocrinol (Lausanne). 2021 Mar 11;12:595933. doi: 10.3389/fendo.2021.595933. eCollection 2021.
There is no doubt that thyroid dysfunction is associated with psychiatric disorders. A large amount of thyroid carcinoma patients displayed mood disorders after the withdrawal of levothyroxine (LT4). However, it is unclear whether the disorders are related to the transient withdrawal of LT4, and if yes, what the possible underlying mechanism is. This study aims to investigate the abnormal regional cerebral glucose metabolism (rCMRglu) in a group of papillary thyroid cancer (PTC) patients without LT4 for 4 weeks and prove the relationship between the abnormal rCMRglu with depression and anxiety.
Brain F-FDG PET/CT data of 38 consecutive PTC patients with high/intermediate-risk from June 2016 to December 2017 have been analyzed. Of the 38 patients, 23 are in the LT4 withdrawal group (WG) and 15 in the LT4 replacement group (RG). These patients were also evaluated for depressive and anxiety symptoms within 24 h after the scans based on the Hamilton Depression Rating Scale (17 items, HRDS-17) and the Hamilton Anxiety Rating Scale (HAMA) respectively.
Thirty-eight patients (12 men, 26 women; age range, 25-69 years; mean age, 45.8 years) were selected in the study. Compared with the RG, patients in WG showed depression and anxiety with higher total scores of HRDS-17 and HAMA (14.7 ± 5.8 3.8 ± 5.5, t = -5.74, p = 0.00; 9.3 ± 4.3 2.7 ± 4.1, t = -4.74, p = 0.00, respectively). In the brain glucose metabolism analysis, the WG patients showed lower rCMRglu in Occipital_Mid_R and Postcentral_L. On the other hand, data illustrated significant rCMRglu increases in the Frontal_Sup_Orb_L. Compared with the healthy group (HG), the rCMRglu of the Postcentral_L and Precuneus_L showed hypoactivity, but the Hippocampus_R and the Temporal_Inf_L showed hyperactivity. This analysis yielded a significant correlation between abnormal rCMRglu with the free thyroxine level, the serum thyroid-stimulating hormone level, HRDS-17, and HAMA scores.
The findings showed that more PTC patients exhibited depression and anxiety after LT4 withdrawal for 4 weeks. More attention should be paid to these hypothyroid patients while they were in the hospital. Such a short-term LT4 withdrawal also likely induced abnormal rCMRglu. Our study attempts to explain the possible mechanism of mood disorders related to transient hypothyroidism.
甲状腺功能障碍与精神疾病的关系无疑是明确的。大量甲状腺癌患者在停用左旋甲状腺素（LT4）后出现情绪障碍。然而，目前尚不清楚这些障碍是否与 LT4 的短暂停药有关，如果是，可能的潜在机制是什么。本研究旨在调查一组无 LT4 治疗 4 周的甲状腺乳头状癌（PTC）患者的异常区域性脑葡萄糖代谢（rCMRglu），并证明异常 rCMRglu 与抑郁和焦虑之间的关系。
分析了 2016 年 6 月至 2017 年 12 月期间 38 例高/中危 PTC 患者的脑 F-FDG PET/CT 数据。在这 38 名患者中，23 名患者处于 LT4 停药组（WG），15 名患者处于 LT4 替代组（RG）。在扫描后 24 小时内，这些患者还根据汉密尔顿抑郁评定量表（17 项，HRDS-17）和汉密尔顿焦虑评定量表（HAMA）分别对抑郁和焦虑症状进行了评估。
本研究共纳入 38 例患者（男 12 例，女 26 例；年龄 25-69 岁，平均年龄 45.8 岁）。与 RG 相比，WG 患者的 HRDS-17 和 HAMA 总分更高，表现出抑郁和焦虑（14.7±5.8 vs. 3.8±5.5，t=-5.74，p=0.00；9.3±4.3 vs. 2.7±4.1，t=-4.74，p=0.00，分别）。在脑葡萄糖代谢分析中，WG 患者的枕中回和后中央回的 rCMRglu 降低。另一方面，额叶上眶回的 rCMRglu 数据显示出显著的增加。与健康组（HG）相比，后中央回和楔前叶的 rCMRglu 活性降低，而海马回和颞下回的 rCMRglu 活性增加。该分析表明，异常 rCMRglu 与游离甲状腺素水平、血清促甲状腺激素水平、HRDS-17 和 HAMA 评分之间存在显著相关性。
研究结果表明，更多的 PTC 患者在 LT4 停药 4 周后出现抑郁和焦虑。在这些患者住院期间，应更加关注这些甲状腺功能减退症患者。这种短期 LT4 停药也可能导致异常 rCMRglu。本研究试图解释与短暂性甲状腺功能减退相关的情绪障碍的可能机制。
