Chen Junhao, Ge Hongmin, Liu Nannan, Li Yanzhe, Dong Yeqing, Wang Xinxu, Xun Zhiyuan, Li Shen
Department of Psychiatry, Tianjin Anding Hospital, Mental health center of Tianjin Medical University, Tianjin 300222, China; Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China.
Department of Psychiatry, Tianjin Anding Hospital, Mental health center of Tianjin Medical University, Tianjin 300222, China.
Psychoneuroendocrinology. 2025 Feb;172:107249. doi: 10.1016/j.psyneuen.2024.107249. Epub 2024 Nov 22.
Sex differences in thyroid hormones, cognitive function, and psychiatric symptoms in schizophrenia remain underexplored. The study aimed to investigate the cross-sectional relationships between thyroid hormone levels, cognitive impairments, and clinical symptoms in people with chronic schizophrenia, with a focus on sex differences.
We included 1007 people with schizophrenia (602 males and 405 females), and 326 healthy controls (193 males and 133 females). Cognitive function and psychiatric symptoms were assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Positive and Negative Syndrome Scale (PANSS), respectively. Blood samples were collected to measure serum total thyroxine (TT4), total triiodothyronine (TT3), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Analysis of variance (ANOVA) and two-way ANOVA were used to compare clinical characteristics and sex differences. Pearson correlation and hierarchical linear regression were conducted to assess the relationships between thyroid hormone levels, cognitive impairments, and clinical symptoms.
People with schizophrenia exhibited lower levels of thyroid hormones compared to the healthy control group (both P < 0.01). Male patients had higher TT3 and FT3 levels than female patients (both P < 0.01). The cognitive scores of the healthy controls were generally higher than those of people with schizophrenia (P < 0.001). Additionally, there were significant sex differences in visuospatial/constructive abilities and language (both P < 0.01) among people with schizophrenia, with males scoring higher than females. The linear regression found that in the cognitive domain, TT4 was negatively associated with Visuospatial/Constructive abilities and RBANS total scores in male patients (both P < 0.05), whereas TT4 was positively associated with these abilities and attention in female patients (all P < 0.05). Additionally, in male patients, TT3 was negatively associated with most of PANSS scale (all P < 0.05). In female, TT3 was only negatively associated with the PANSS Negative scale (P < 0.05).
Sex differences exist in thyroid hormone T3 levels in people with schizophrenia. The association between thyroid hormones and cognitive performance varies by sex in chronic schizophrenia.
精神分裂症患者甲状腺激素、认知功能及精神症状方面的性别差异仍未得到充分研究。本研究旨在调查慢性精神分裂症患者甲状腺激素水平、认知障碍及临床症状之间的横断面关系，重点关注性别差异。
我们纳入了1007例精神分裂症患者（男性602例，女性405例）和326例健康对照者（男性193例，女性133例）。分别使用可重复性神经心理状态评估量表（RBANS）和阳性与阴性症状量表（PANSS）评估认知功能和精神症状。采集血样以测定血清总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）、促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）。采用方差分析（ANOVA）和双向ANOVA比较临床特征及性别差异。进行Pearson相关分析和分层线性回归以评估甲状腺激素水平、认知障碍及临床症状之间的关系。
与健康对照组相比，精神分裂症患者的甲状腺激素水平较低（均P < 0.01）。男性患者的TT3和FT3水平高于女性患者（均P < 0.01）。健康对照者的认知得分总体高于精神分裂症患者（P < 0.001）。此外，精神分裂症患者在视觉空间/构建能力和语言方面存在显著的性别差异（均P < 0.01），男性得分高于女性。线性回归发现，在认知领域，TT4与男性患者的视觉空间/构建能力及RBANS总分呈负相关（均P < 0.05），而TT4与女性患者的这些能力及注意力呈正相关（均P < 0.05）。此外，在男性患者中，TT3与大多数PANSS量表呈负相关（均P < 0.05）。在女性患者中，TT3仅与PANSS阴性量表呈负相关（P < 0.05）。
精神分裂症患者甲状腺激素T3水平存在性别差异。在慢性精神分裂症中，甲状腺激素与认知表现的关联因性别而异。
