Lei Xiu-Ping, Liao De-Xin, Wu Guo-Ying, Shuai Dan, Zhang Hong-Li, Wang Bin-You, Wang Yi-Lin
Department of Psychiatry, Zigong Mental Health Center, Zigong 643020, Sichuan Province, China.
Zigong Institute of Brain Science, Zigong Mental Health Center, Zigong 643020, Sichuan Province, China.
World J Psychiatry. 2025 Sep 19;15(9):109858. doi: 10.5498/wjp.v15.i9.109858.
Neuroendocrine dysfunction, especially involving the hypothalamic-pituitary-thyroid axis, plays a critical role in the onset and progression of schizophrenia. Alterations in thyroid stimulating hormone (TSH), triiodothyronine (T3), free T3 (FT3), thyroxine (T4), and free T4 have been implicated in this process. Although previous studies have established an association between thyroid function and psychiatric symptoms, how thyroid hormone levels vary with disease duration remains underexplored.
To investigate duration stage-specific associations between thyroid hormones and psychotic symptoms among inpatients with stable schizophrenia.
This cross-sectional study was conducted at Zigong Mental Health Center, China, and included 237 hospitalized patients with stable schizophrenia. Participants were stratified into three groups based on disease duration: 0-10 years, 10.1-20 years, and over 20 years. Peripheral blood samples were collected to measure serum thyroid hormone levels. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. Covariate-adjusted linear regression analyses were performed to assess the relationships between thyroid hormone levels and Positive and Negative Syndrome Scale sub-scale scores.
The relationship between thyroid hormones and psychotic symptoms varied by disease duration. In patients with a disease course of 0-10 years, T4 [β = -0.848; 95% confidence interval (CI): -1.564 to -0.133; = 0.021] and FT3 (β = -2.483; 95%CI: -4.693 to -0.273; = 0.028) levels were significantly inversely associated with general psychopathology scores. Among those with 10.1-20 years of disease, only TSH showed a significant negative correlation with general psychopathology (β = -1.429; 95%CI: -2.348 to -0.509; = 0.003). No significant correlations were found in the > 20 years group.
The associations between thyroid hormones and psychotic symptoms vary according to the duration of schizophrenia (T4/FT3 early; TSH mid), enabling the development of stage-adapted models and management.
神经内分泌功能障碍，尤其是涉及下丘脑 - 垂体 - 甲状腺轴的功能障碍，在精神分裂症的发病和进展中起关键作用。促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）、游离T3（FT3）、甲状腺素（T4）和游离T4的改变与这一过程有关。尽管先前的研究已证实甲状腺功能与精神症状之间存在关联，但甲状腺激素水平如何随疾病持续时间变化仍未得到充分研究。
探讨稳定期精神分裂症住院患者甲状腺激素与精神症状之间病程阶段特异性的关联。
本横断面研究在中国自贡精神卫生中心进行，纳入237例稳定期精神分裂症住院患者。参与者根据病程分为三组：0 - 10年、10.1 - 20年和20年以上。采集外周血样本以测量血清甲状腺激素水平。使用阳性和阴性症状量表评估精神症状。进行协变量调整的线性回归分析，以评估甲状腺激素水平与阳性和阴性症状量表各子量表得分之间的关系。
甲状腺激素与精神症状之间的关系因病程而异。在病程为0 - 10年的患者中，T4[β = -0.848；95%置信区间（CI）：-1.564至 -0.133；P = 0.021]和FT3（β = -2.483；95%CI：-4.693至 -0.273；P = 0.028）水平与总体精神病理学得分显著负相关。在病程为10.1 - 20年的患者中，只有TSH与总体精神病理学呈显著负相关（β = -1.429；95%CI：-2.348至 -0.509；P = 0.003）。在病程>20年的组中未发现显著相关性。
甲状腺激素与精神症状之间的关联因精神分裂症病程而异（早期为T4/FT3；中期为TSH），这有助于制定阶段适应性模型和管理方案。
