Thyroid function within the normal range and the risk of depression: a population-based cohort study.

CONTEXT Overt hypo- and hyperthyroidism are associated with an increased risk of depression. Little is known about the effects of variation in thyroid function within the normal range on the risk of depression. OBJECTIVE The objective of the study was to examine the association between normal-range thyroid function and the risk of depression. DESIGN, SETTING, AND PARTICIPANTS This was a cohort study in 1503 Dutch men and women, aged 70.6 (7.3) (mean [SD]) years. At baseline, serum TSH, thyroperoxidase antibody levels, and depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D)] were assessed. A CES-D of 16 or greater is indicative of a depressive disorder. During follow-up (mean 8.0 y), participants were continuously monitored for the occurrence of incident depressive syndromes (n = 156). RESULTS Cross-sectionally, persons in the lowest TSH tertile (0.3-1.0 mU/L) had more depressive symptoms [CES-D score (mean): 7.95 vs 6.63, P = .014] as well as an increased risk of a CES-D of 16 or greater [10.7% vs 5.0%, odds ratio (95% confidence interval) 2.22 (1.18-4.17)], compared with persons in the highest normal range TSH tertile (1.6-4.0 mU/L). In the prospective analyses, persons in the lowest TSH tertile who were depression free at baseline had a higher risk of incident depressive syndromes [12.3% vs 7.6%, odds ratio (95% confidence interval) 1.85 (1.10-3.11)]. Thyroid autoimmunity (thyroperoxidase antibody positivity) was not associated with CES-D scores or incident depressive syndromes. CONCLUSIONS Elderly persons with low-normal TSH levels have more concurrent depressive symptoms as well as a substantially increased risk of developing a depressive syndrome in the subsequent years. This study identifies low-normal TSH as an important risk factor for depression in the elderly.

[1]  L. Kiemeney,et al.  Association between thyroid function, thyroid autoimmunity, and state and trait factors of depression , 2012, Acta psychiatrica Scandinavica.

[2]  Y. Toledano,et al.  Depression in patients with euthyroid chronic autoimmune thyroiditis. , 2012, Endocrine journal.

[3]  S. Amur,et al.  Sex differences and genomics in autoimmune diseases. , 2012, Journal of autoimmunity.

[4]  L. Trupin,et al.  Cardiovascular and disease‐related predictors of depression in systemic lupus erythematosus , 2011, Arthritis care & research.

[5]  A. Hofman,et al.  Associations of serum cortisol with cognitive function and dementia: the Rotterdam Study. , 2011, Journal of Alzheimer's disease : JAD.

[6]  Electron Kebebew,et al.  Thyroid cancer gender disparity. , 2010, Future oncology.

[7]  G. Beckett,et al.  Mechanisms behind the non-thyroidal illness syndrome: an update. , 2010, The Journal of endocrinology.

[8]  Paolo Vitti,et al.  Assessment of nodular goitre. , 2010, Best practice & research. Clinical endocrinology & metabolism.

[9]  B. Åsvold,et al.  A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study , 2009, Clinical endocrinology.

[10]  Alison Little,et al.  Treatment-resistant depression. , 2009, American family physician.

[11]  R. Bunevic̆ius.  Thyroid disorders in mental patients , 2009, Current opinion in psychiatry.

[12]  C. Nemeroff,et al.  Emerging targets for antidepressant therapies. , 2009, Current opinion in chemical biology.

[13]  C. Aceves,et al.  The maintenance of hippocampal pyramidal neuron populations is dependent on the modulation of specific cell cycle regulators by thyroid hormones , 2009, Brain Research.

[14]  J. Gallacher,et al.  Thyroid function and the natural history of depression: findings from the Caerphilly Prospective Study (CaPS) and a meta‐analysis , 2009, Clinical endocrinology.

[15]  R. Vasan,et al.  Thyroid function and Alzheimer's disease. , 2009, Journal of Alzheimer's disease : JAD.

[16]  A. Hofman,et al.  Incidence and recurrence of late-life depression. , 2008, Archives of general psychiatry.

[17]  T. Glenn,et al.  The Thyroid‐Brain Interaction in Thyroid Disorders and Mood Disorders , 2008, Journal of neuroendocrinology.

[18]  R. Peeters.  Non thyroidal illness: to treat or not to treat? , 2007, Annales d'endocrinologie.

[19]  J. Franklyn,et al.  Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction? , 2006, Annals of Internal Medicine.

[20]  T. Visser,et al.  Psychological well-being correlates with free thyroxine but not free 3,5,3'-triiodothyronine levels in patients on thyroid hormone replacement. , 2006, The Journal of clinical endocrinology and metabolism.

[21]  R. Philibert,et al.  Lower TSH and higher T4 levels are associated with current depressive syndrome in young adults , 2006, Acta psychiatrica Scandinavica.

[22]  V. Burke,et al.  Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial. , 2006, The Journal of clinical endocrinology and metabolism.

[23]  Bradley R. Johnson,et al.  Psychiatric evaluation of adults: Second edition , 2006 .

[24]  R. Freedman.  Nancy C. Andreasen, M.D., Ph.D.: editor emeritus perfectus. , 2006, The American journal of psychiatry.

[25]  A. Mykletun,et al.  Thyroid autoimmunity, depression and anxiety; are there any connections? An epidemiological study of a large population. , 2005, Journal of psychosomatic research.

[26]  R. E. Noble.  Depression in women. , 2005, Metabolism: clinical and experimental.

[27]  A. F. Thomsen,et al.  Increased risk of affective disorder following hospitalisation with hyperthyroidism - a register-based study. , 2005, European journal of endocrinology.

[28]  A. D. de Craen,et al.  Thyroid status, disability and cognitive function, and survival in old age. , 2004, JAMA.

[29]  Claudia Sardu,et al.  The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future , 2004, BMC psychiatry.

[30]  J. Jolles,et al.  Thyroid function, depressed mood, and cognitive performance in older individuals: the Maastricht Aging Study , 2004, Psychoneuroendocrinology.

[31]  K. Vedhara,et al.  Psychological well‐being in patients on ‘adequate’ doses of l‐thyroxine: results of a large, controlled community‐based questionnaire study , 2002, Clinical endocrinology.

[32]  Richard Hellman,et al.  American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. , 2002, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[33]  A. Mykletun,et al.  An association between depression, anxiety and thyroid function – a clinical fact or an artefact? , 2002, Acta psychiatrica Scandinavica.

[34]  A. Heinz,et al.  Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain , 2002, Molecular Psychiatry.

[35]  J. Hetta,et al.  Anxiety and depression in patients with primary Sjögren's syndrome. , 2000, The Journal of rheumatology.

[36]  L. Chiovato,et al.  Prevalence of Psychiatric Disorders in Thyroid Diseased Patients , 1998, Neuropsychobiology.

[37]  V. Pop,et al.  Are autoimmune thyroid dysfunction and depression related? , 1998, The Journal of clinical endocrinology and metabolism.

[38]  J. van Limbeek,et al.  Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. , 1997, Psychological medicine.

[39]  L. Lumley,et al.  The multiple interactional biological processes that might lead to depression and gender differences in its appearance. , 1993, Journal of affective disorders.

[40]  J. Calabrese,et al.  Autoimmunity in depression: increased antiphospholipid autoantibodies , 1993, Acta psychiatrica Scandinavica.

[41]  J. Greenhouse,et al.  A psychiatric and neuropsychological study of patients with untreated Graves' disease. , 1988, General hospital psychiatry.