Chang K D, Keck P E, Stanton S P, McElroy S L, Strakowski S M, Geracioti T D
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
Biol Psychiatry. 1998 May 15;43(10):730-3. doi: 10.1016/s0006-3223(98)80003-6.
High rates of thyroid axis abnormalities have been reported in most studies of patients with rapid-cycling bipolar disorder. Mixed states share similarities with rapid-cycling, including close temporal occurrence of manic and depressive symptoms, predominance in women, poor outcome, and less robust response to lithium compared with pure mania; however, thyroid axis abnormalities have not been well studied in mixed mania.
To test the hypothesis that mixed states are associated with a higher prevalence of hypothyroidism than pure mania, immunoreactive triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) concentrations were determined from serum obtained at the time of admission in 37 consecutive patients with DSM-III-R bipolar disorder, manic or mixed.
The mean TSH concentration was significantly higher, and the mean T4 concentration was significantly lower in patients with mixed mania compared with pure mania. There were no significant differences in T3 concentration or in previous lithium exposure.
These findings suggest thyroid axis dysfunction is more common in bipolar mixed than in bipolar manic patients.
在大多数关于快速循环型双相情感障碍患者的研究中，甲状腺轴异常的发生率较高。混合状态与快速循环有相似之处，包括躁狂和抑郁症状在时间上紧密相继出现、女性居多、预后较差以及与单纯躁狂相比对锂盐的反应较弱；然而，甲状腺轴异常在混合性躁狂中尚未得到充分研究。
为了检验混合状态比单纯躁狂与甲状腺功能减退患病率更高相关这一假设，对连续37例符合DSM-III-R双相情感障碍、躁狂或混合状态的患者入院时采集的血清进行免疫反应性三碘甲状腺原氨酸（T3）、甲状腺素（T4）和促甲状腺激素（TSH）浓度测定。
与单纯躁狂患者相比，混合性躁狂患者的平均TSH浓度显著更高，平均T4浓度显著更低。T3浓度或既往锂盐暴露方面无显著差异。
这些发现提示，甲状腺轴功能障碍在双相情感障碍混合状态患者中比在双相情感障碍躁狂患者中更常见。
