National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
National Clinical Research Center for Mental Disorders, Department of Psychiatry, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China; Department of Ultrasound Diagnostic, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
J Affect Disord. 2023 Jul 15;333:209-215. doi: 10.1016/j.jad.2023.04.067. Epub 2023 Apr 21.
Thyroid dysfunction is often reported in patients with major depressive disorder (MDD) and may be associated with depression severity and psychotic symptoms. We included young adults with first-episode and untreated MDD to avoid the effect of age and disease duration on thyroid dysfunction and psychotic symptoms.
481 young patients with MDD (aged 18-24 years) were recruited. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Positive and Negative Syndrome Scale (PANSS) positive subscale and Global Impression of Severity Scale (CGIS) were used to assess depression, anxiety, psychotic symptoms and disease severity, respectively.
The prevalence rate of subclinical hypothyroidism (SCH) and thyroid antibody positivity was 56.76 % (273/481) and 26.61 % (128/481) in young MDD, respectively. A higher proportion of MDD patients with SCH displayed psychotic features (14.3 % vs. 5.3 %, OR = 2.985, p = 0.001). TSH was a risk factor for psychotic symptoms in MDD patient with SCH (B = 0.136, p = 0.017, OR = 1.384), with an AUC of 0.709, indicating acceptable discrimination. Multivariate regression analysis also showed that TSH was also independently associated with PANSS positive score (B = 0.339, t = 2.019, p = 0.045).
This cross-sectional study design did not demonstrate a causal relationship. Relying solely on the PANSS positive subscale as psychotic symptoms may cause bias.
Our findings suggest that SCH is common in young patients with first-episode and untreated MDD. MDD patients with higher TSH levels may suffer from more psychotic symptoms. Regular screening of serum thyroid hormones is necessary in patients with MDD.
甲状腺功能障碍在重度抑郁症（MDD）患者中经常被报道，并且可能与抑郁严重程度和精神病症状有关。我们纳入了首发且未经治疗的 MDD 的年轻患者，以避免年龄和疾病持续时间对甲状腺功能障碍和精神病症状的影响。
共纳入 481 例 MDD 年轻患者（年龄 18-24 岁）。使用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、阳性和阴性综合征量表（PANSS）阳性分量表和临床总体印象严重程度量表（CGIS）分别评估抑郁、焦虑、精神病症状和疾病严重程度。
在年轻的 MDD 患者中，亚临床甲状腺功能减退症（SCH）和甲状腺抗体阳性的患病率分别为 56.76%（273/481）和 26.61%（128/481）。SCH 的 MDD 患者中，出现精神病特征的比例更高（14.3% vs. 5.3%，OR=2.985，p=0.001）。TSH 是 SCH 患者 MDD 出现精神病症状的危险因素（B=0.136，p=0.017，OR=1.384），AUC 为 0.709，表明具有可接受的区分度。多变量回归分析还表明，TSH 也与 PANSS 阳性评分独立相关（B=0.339，t=2.019，p=0.045）。
本横断面研究设计并未证明因果关系。仅依赖 PANSS 阳性分量表作为精神病症状可能会导致偏倚。
我们的研究结果表明，SCH 在首发且未经治疗的年轻 MDD 患者中很常见。TSH 水平较高的 MDD 患者可能会出现更多的精神病症状。MDD 患者有必要定期筛查血清甲状腺激素。
