Gatta Elisa, Maltese Virginia, Ugoccioni Massimiliano, Silvestrini Irene, Corvaglia Sara, Vetrugno Simone, Ceraso Anna, Vita Antonio, Rotondi Mario, Cappelli Carlo
Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, ASST Spedali Civili, Brescia, Italy.
Centro per la Diagnosi e Cura delle Neoplasie Endocrine e delle Malattie della Tiroide, University of Brescia, Brescia, Italy.
J Endocrinol Invest. 2025 Aug 19. doi: 10.1007/s40618-025-02687-1.
Aim of this systematic review is to evaluate if and how thyrotropin (TSH) serum level levels may influence major depressive disorders (MDD) in drug naïve patients, and if it could characterize MDD phenotype.
A PubMed/MEDLINE, Scopus and Web of Science databases was researched up to January 2025. The studies eligible addressed the questions define based on the PICO framework: (1) Are TSH levels different between first episode drug-naïve (FEDN) patients diagnosed with MDD and healthy subjects? (2) What are the TSH levels in FEDN patients diagnosed with MDD who attempt suicide compared to who do not? This review followed PRISMA guidelines. The quality assessment and the risk of bias were analyzed using QUADAS-2.
We included 45 studies in the qualitative synthesis, and 18 in the quantitative one, encompassing a total of 34,448 participants. Our systematic review showed conflicting data about TSH levels in FEDN MDD patients compared to healthy subjects. However, the meta-analysis showed in 6,224 patients that higher TSH levels are related to an increased risk of suicide attempt (Standardized Mean Difference = 1.848 mIU/L, C.I. 95%:1.506 to 2.190) with moderate-high heterogeneity across studies (I = 67%, p = .009).
We showed conflicting data about TSH levels in FEDN MDD patients compared to healthy subjects. On the contrary, the meta-analysis evidenced significant higher TSH levels among MDD patients with suicide attempt than those without it. The clinical implications of this finding have yet to be established.
本系统评价旨在评估促甲状腺激素（TSH）血清水平是否以及如何影响未服用过药物的患者的重度抑郁症（MDD），以及它是否可以表征MDD的表型。
截至2025年1月，对PubMed/MEDLINE、Scopus和Web of Science数据库进行了检索。纳入的研究解决了基于PICO框架定义的问题：（1）首次发作未服用过药物（FEDN）的MDD患者与健康受试者之间的TSH水平是否不同？（2）与未自杀的FEDN MDD患者相比，有自杀企图的患者的TSH水平是多少？本评价遵循PRISMA指南。使用QUADAS-2分析质量评估和偏倚风险。
我们在定性综合分析中纳入了45项研究，在定量分析中纳入了18项研究，总共涵盖34448名参与者。我们的系统评价显示，与健康受试者相比，FEDN MDD患者的TSH水平数据存在冲突。然而，荟萃分析显示，在6224名患者中，较高的TSH水平与自杀企图风险增加相关（标准化平均差=1.848 mIU/L，95%置信区间：1.506至2.190），各研究之间存在中度至高度异质性（I=67%，p=.009）。
我们发现，与健康受试者相比，FEDN MDD患者的TSH水平数据存在冲突。相反，荟萃分析表明，有自杀企图的MDD患者的TSH水平明显高于无自杀企图的患者。这一发现的临床意义尚待确定。
