Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55902, USA.
Medicina (Kaunas). 2021 Jul 15;57(7):714. doi: 10.3390/medicina57070714.
Thyroid disease is a very common condition that influences the entire human body, including cognitive function and mental health. As a result, thyroid disease has been associated with multiple neuropsychiatric conditions. However, the relationship between thyroid dysfunction and suicide is still controversial. We conducted a systematic review and meta-analysis to describe the association of thyroid function with suicidal behavior in adults. We searched four data bases (MEDLINE, EMBASE, PsycINFO, and Scopus) from their inception to 20 July 2018. Studies that reported mean values and standard deviation (SD) of thyroid hormone levels [Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3)] in patients with suicidal behavior compared with controls were included in this meta-analysis. The abstracts and papers retrieved with our search strategies were reviewed independently and in duplicate by four reviewers for assessment of inclusion criteria and data extraction, as well as for evaluation of risk of bias. Random-effects models were used in this meta-analysis to establish the mean difference on thyroid function tests between groups. Overall, 2278 articles were identified, and 13 studies met the inclusion criteria. These studies involved 2807 participants, including 826 participants identified with suicidal behavior. We found that patients with suicide behavior had lower levels of FT3 (-0.20 pg/mL; = 0.02) and TT4 (-0.23 µg/dL; = 0.045) compared to controls. We found no differences in either TSH, FT4, or TT3 levels among groups. With our search strategy, we did not identify studies with a comparison of overt/subclinical thyroid disease prevalence between patients with and without suicide behavior. The studies included in this meta-analysis had a low-to-moderate risk of bias. In the available literature, the evidence regarding the association of thyroid disorders and suicidal behavior is limited. We found that patients with suicidal behavior have significantly lower mean FT3 and TT4 levels when compared to patients without suicidal behavior. The clinical implications and pathophysiologic mechanisms of these differences remain unknown and further research is needed.
甲状腺疾病是一种非常常见的影响全身的疾病，包括认知功能和心理健康。因此，甲状腺疾病与多种神经精神疾病有关。然而，甲状腺功能障碍与自杀之间的关系仍存在争议。我们进行了系统评价和荟萃分析，以描述甲状腺功能与成人自杀行为之间的关系。我们从四个数据库（MEDLINE、EMBASE、PsycINFO 和 Scopus）中检索了从成立到 2018 年 7 月 20 日的数据。本荟萃分析纳入了报告有自杀行为的患者与对照组相比甲状腺激素水平（促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、总甲状腺素（TT4）和总三碘甲状腺原氨酸（TT3））平均值和标准差（SD）的研究。我们的搜索策略检索到的摘要和论文由四位评审员独立和重复审查，以评估纳入标准和数据提取，并评估偏倚风险。本荟萃分析采用随机效应模型确定组间甲状腺功能检查的平均差异。总体而言，共确定了 2278 篇文章，其中 13 项研究符合纳入标准。这些研究共涉及 2807 名参与者，其中 826 名参与者有自杀行为。我们发现，与对照组相比，有自杀行为的患者 FT3 水平较低（-0.20 pg/mL； = 0.02）和 TT4 水平较低（-0.23 µg/dL； = 0.045）。我们没有发现 TSH、FT4 或 TT3 水平在各组之间存在差异。根据我们的搜索策略，我们没有发现有研究比较有自杀行为和无自杀行为的患者中显性/亚临床甲状腺疾病的患病率。本荟萃分析纳入的研究存在低至中度偏倚风险。在现有的文献中，关于甲状腺疾病与自杀行为之间关联的证据有限。我们发现，与无自杀行为的患者相比，有自杀行为的患者的 FT3 和 TT4 平均水平明显较低。这些差异的临床意义和病理生理机制尚不清楚，需要进一步研究。
