Research Article
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Can Sleeping Disorder Continue Despite Hypothyroidism Levothyroxine Therapy Be a Marker for Depression?

Year 2018, Volume: 4 Issue: 3, 1019 - 1027, 15.12.2018
https://doi.org/10.30569/adiyamansaglik.470317

Abstract

Aim: The aim of this study was to investigate the
frequency of depressive symptoms in patients with primary hypothyroidism, to
determine the degree of recovery of these symptoms after levothyroxine (LT4)
treatment, and to assess the presence of predictive symptoms.

Methods: 140 women with primary
hypothyroidism were evaluated with the Beck Depression Inventory (BDI). All
were treated with LT4 alone. Thyroid stimulating hormone (TSH) value was tested
after treatment and patients with previous depressive symptoms were reevaluated
with BDI.

Results: In our study, it was shown
that 72 (51.4%) patients had depressive symptoms and 68 patients (48.6%) did
not have depressive symptoms (BDI=22.8±1.1, TSH=19.1±3.7 iU/ml, (BDI=8.7±0.6,
TSH=12.0±1.2 iU/ml, age (year)=45.0±2.2). After the treatment of primary
hypothyroidism, BDI was reapplied in 72 patients with depressive symptoms (1.54
iU/ml±0.31 after TSH) in the first part of the study and depressive symptoms of
54 patients (75%) were found to be absent (BDI=9.0±1.0, TSH=1.59±0.31 iU/ml,
age (years)=45.0±2.0). Depressive symptoms persisted in 18 (25%) of the
patients (BDI=23.0±2.0, TSH=1.28±0.31 iU/ml, age (year)=42.0±2.0). Sleep
disturbance, item 16, is the only persistent persistence after treatment
(p>0.045).







Conclusion: 51.4% of hypothyroidism
patients showed depressive symptoms. Hypothyroidism therapy was sufficient to
bring the levels of TSH to normal levels in all cases and to reverse the
depressive symptom in 75% of cases. Continuation of sleep disturbance in the
remaining 25% of the group may be considered a predictive, unresponsive
symptom, and indicates that reassessment of the diagnosis and consideration of
the inclusion of another treatment should be considered.

References

  • 1. Fugger G, Dold M, Bartova L, et al. Comorbid thyroid disease in patients with major depressive disorder – results from the European group fort he study of resistant depression (GSRD). Eur Neuropsychopharmacol pii: S0924-977X(18)30074-9. doi: 10.1016/j.euroneuro.2018.03.011.
  • 2. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and Hypothyroidism. Endocr Pract 2002;8(6):457-69.
  • 3. Beydoun MA, Beydoun HA, Rostant OS, et al. Thyroid hormones are associated with longitudinal cognitive change in an urban adult population. Neurobiol Aging 2015;36(11):3056-66.
  • 4. Demartini B, Ranieri R, Masu A, et al. Depressive symptoms and major depressive disorder in patients affected by subclinical hypothyroidism: a cross-sectional study. J Nerv Ment Dis 2014;202(8):603-7.
  • 5. Chattopadhyay C, Chakrabarti N, Ghosh S. An assessment of psychiatric disturbances in Graves disease in a medical college in eastern India. Niger J Clin Pract 2012;15(3):276-9.
  • 6. Petrich CE, Bui MP, Farrell HM. A case of a suicide attempt associated with hyperthyroidism. Gen Hosp Psychiatry 2013;35(5):576.e9576.e10.
  • 7. Mendoza A, Hollenberg AN. New insights onto thyroid hormone action. Pharmacol Ther. 2017;173:135-145.
  • 8. Bauer M, Heinz A, Whybrow PC. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol Psychiatry 2002;7(2):140-56.
  • 9. De Carvalho GA, Bahls SC, Boeving A, et al. Effects of selective serotonin reuptake inhibitors on thyroid function in depressed patients with primary hypothyroidism or normal thyroid function. Thyroid 2009;19(7):691-7.
  • 10. Sullivan GM, Mann JJ, Oquendo MA, et al. Low cerebrospinal fluid transthyretin levels in depression: correlations with suicidal ideation and low serotonin function. Biol Psychiatry 2006;60(5):500-6.
  • 11. Sui L, Rem WW, Li BM. Administration of thyroid hormone increases reelin and brain-derived neurotrophic factor expression in rat hippocampus in alive. Brain Res 2010;1313:9-24.
  • 12. Kamath J, Yarbrough GG, Prange AJ Jr, et al. The thyrotropin-releasing hormone (TRH)-immune system homeostatic hypothesis. Pharmacol Ther 2009;121(1):20-8.
  • 13. Garlow SJ, Dunlop BW, Ninan PT, et al. The combination of triiodothyronine (T3) and sertraline is not superior to sertraline monotherapy in the treatment of major depressive disorder. J Psychiatr Res 2012;46(11):1406-13.
  • 14. Cooper-Kazaz R, Lerer B. Efficacy and safety of triiodothyronine supplementation in patients with major depressive disorder treated with specific serotonin reuptake inhibitors. Int J Neuropsychopharmacol 2008;11:685-99.
  • 15. Duval F, Mokrani MC, Erb A, et al. Chronobiological hypothalamic-pituitary-thyroid axis status and antidepressant outcome in major depression. Psychoneuroendocrinology 2015;59:71-80.16. Ieiri T. Thyroid function tests and thyroid autoantibody tests, a review. Nihon Rinsho 2012;70(11):1892-9.
  • 17. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
  • 18. Hisli, N. Beck Depresyon Envanteri'nin geçerliği üzerine bir çalışma. Psikoloji Dergisi 1988;6(22):118-22.
  • 19. Samuels MH. Subclinical hypothyroidism and depression: Is there a link? J Clin Endocrinol Metab 2018;103(5):2061-4.
  • 20. Krausz Y, Freedman N, Lester H, et al. Brain SPECT study of common ground between hypothyroidism and depression. Int J Neuropsychopharmacol 2007;10(1):99-106.
  • 21. Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep 2014;37(2):239-44.
  • 22. Wang YQ, Li R, Zhang MQ, et al. The neurobiological mechanisms and treatments of REM sleep disturbances in depression. Curr Neuropharmacol 2015;13(4):543-53.
  • 23. Yücel GN, Kaplanoğlu GT, Seymen CM. karanlığın mucizesi: Melatonin ve ovaryum etkileşimi. Dicle Tıp Dergisi 2018;45(1):85-92.
  • 24. Monti JM. Serotonin control of sleep-wake behavior. Sleep Med Rev 2011;15:269-81.

Hipotiroidizmin Levotiroksin ile Tedavisine Rağmen Devam Eden Uyku Bozukluğu Depresyon için Bir Belirteç Olabilir mi?

Year 2018, Volume: 4 Issue: 3, 1019 - 1027, 15.12.2018
https://doi.org/10.30569/adiyamansaglik.470317

Abstract

Amaç: Bu araştırmanın amacı, primer hipotiroidizmi olan
hastalarda depresif semptomların sıklığını araştırmak, bu semptomların
levotiroksin (LT4) tedavisi sonrası iyileşme düzeyini belirlemek ve öngörücü
semptomların varlığını değerlendirmektir.



Yöntemler: 140 primer hipotiroidizmi
olan kadın hasta Beck Depresyon Envanteri (BDÖ) ile değerlendirildi. Hepsi sadece
LT4 ile tedavi edildi. Tiroid stimüle edici hormon (TSH) değeri tedaviden sonra
test edildi ve daha önce depresif belirtiler gösteren hastalar BDÖ ile tekrar
değerlendirildi.



Bulgular: Çalışmamızda 72 (%51.4)
hastada (BDÖ=22.8±1.1, TSH=19.1±3.7 iU/ml, yaş (yıl)=44.0±2.0)
depresif belirti olduğu ve 68 hastada (%48.6) ise olmadığı gösterildi. (BDÖ=8.7±0.6,
TSH=12.0±1.2 iU/ml, yaş (yıl)=45.0± 2.2). Primer hipotiroidizmin
tedavisinden sonra, çalışmanın ilk bölümünde depresif belirtiler gösteren 72
hastada (TSH sonrası 1.54 iU/ml ±0.31) BDÖ tekrar uygulandı ve 54
hastanın (%75) depresif belirtilerinin ortadan kalktığı görüldü (BDÖ=9.0±1.0,
TSH=1.59±0.31 iU/ml, yaş (yıl)=45.0±2.0). Hastaların 18’inde
(%25) depresif semptomların devam ettiği görüldü (BDÖ=23.0±2.0, TSH=1.28±0.31
iU/ml, yaş (yıl)=42.0±2.0). Uyku bozukluğu, madde 16, tedaviden sonra
belirgin kalıcılığı olan tek faktördür (p > 0.045).



Sonuçlar: Hipotiroidizmli hastaların
%51.4'ü depresif belirtiler gösterdi. Hipotiroidizm tedavisi tüm olgularda TSH
değerlerini normal seviyesine getirmek ve %75'inde depresif belirtileri tersine
çevirmek için yeterliydi. Kalan %25’lik grupta uyku bozukluğunun devam etmesi,
öngörücü, yanıtsız bir semptom olarak düşünülebilir ve tanıyı tekrar değerlendirmek
ve başka bir tedavinin eklenmesini göz önünde bulundurmak gerektiğine işaret
eder.

References

  • 1. Fugger G, Dold M, Bartova L, et al. Comorbid thyroid disease in patients with major depressive disorder – results from the European group fort he study of resistant depression (GSRD). Eur Neuropsychopharmacol pii: S0924-977X(18)30074-9. doi: 10.1016/j.euroneuro.2018.03.011.
  • 2. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and Hypothyroidism. Endocr Pract 2002;8(6):457-69.
  • 3. Beydoun MA, Beydoun HA, Rostant OS, et al. Thyroid hormones are associated with longitudinal cognitive change in an urban adult population. Neurobiol Aging 2015;36(11):3056-66.
  • 4. Demartini B, Ranieri R, Masu A, et al. Depressive symptoms and major depressive disorder in patients affected by subclinical hypothyroidism: a cross-sectional study. J Nerv Ment Dis 2014;202(8):603-7.
  • 5. Chattopadhyay C, Chakrabarti N, Ghosh S. An assessment of psychiatric disturbances in Graves disease in a medical college in eastern India. Niger J Clin Pract 2012;15(3):276-9.
  • 6. Petrich CE, Bui MP, Farrell HM. A case of a suicide attempt associated with hyperthyroidism. Gen Hosp Psychiatry 2013;35(5):576.e9576.e10.
  • 7. Mendoza A, Hollenberg AN. New insights onto thyroid hormone action. Pharmacol Ther. 2017;173:135-145.
  • 8. Bauer M, Heinz A, Whybrow PC. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol Psychiatry 2002;7(2):140-56.
  • 9. De Carvalho GA, Bahls SC, Boeving A, et al. Effects of selective serotonin reuptake inhibitors on thyroid function in depressed patients with primary hypothyroidism or normal thyroid function. Thyroid 2009;19(7):691-7.
  • 10. Sullivan GM, Mann JJ, Oquendo MA, et al. Low cerebrospinal fluid transthyretin levels in depression: correlations with suicidal ideation and low serotonin function. Biol Psychiatry 2006;60(5):500-6.
  • 11. Sui L, Rem WW, Li BM. Administration of thyroid hormone increases reelin and brain-derived neurotrophic factor expression in rat hippocampus in alive. Brain Res 2010;1313:9-24.
  • 12. Kamath J, Yarbrough GG, Prange AJ Jr, et al. The thyrotropin-releasing hormone (TRH)-immune system homeostatic hypothesis. Pharmacol Ther 2009;121(1):20-8.
  • 13. Garlow SJ, Dunlop BW, Ninan PT, et al. The combination of triiodothyronine (T3) and sertraline is not superior to sertraline monotherapy in the treatment of major depressive disorder. J Psychiatr Res 2012;46(11):1406-13.
  • 14. Cooper-Kazaz R, Lerer B. Efficacy and safety of triiodothyronine supplementation in patients with major depressive disorder treated with specific serotonin reuptake inhibitors. Int J Neuropsychopharmacol 2008;11:685-99.
  • 15. Duval F, Mokrani MC, Erb A, et al. Chronobiological hypothalamic-pituitary-thyroid axis status and antidepressant outcome in major depression. Psychoneuroendocrinology 2015;59:71-80.16. Ieiri T. Thyroid function tests and thyroid autoantibody tests, a review. Nihon Rinsho 2012;70(11):1892-9.
  • 17. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
  • 18. Hisli, N. Beck Depresyon Envanteri'nin geçerliği üzerine bir çalışma. Psikoloji Dergisi 1988;6(22):118-22.
  • 19. Samuels MH. Subclinical hypothyroidism and depression: Is there a link? J Clin Endocrinol Metab 2018;103(5):2061-4.
  • 20. Krausz Y, Freedman N, Lester H, et al. Brain SPECT study of common ground between hypothyroidism and depression. Int J Neuropsychopharmacol 2007;10(1):99-106.
  • 21. Roberts RE, Duong HT. The prospective association between sleep deprivation and depression among adolescents. Sleep 2014;37(2):239-44.
  • 22. Wang YQ, Li R, Zhang MQ, et al. The neurobiological mechanisms and treatments of REM sleep disturbances in depression. Curr Neuropharmacol 2015;13(4):543-53.
  • 23. Yücel GN, Kaplanoğlu GT, Seymen CM. karanlığın mucizesi: Melatonin ve ovaryum etkileşimi. Dicle Tıp Dergisi 2018;45(1):85-92.
  • 24. Monti JM. Serotonin control of sleep-wake behavior. Sleep Med Rev 2011;15:269-81.
There are 23 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Murat Eren Özen 0000-0003-2981-8036

Mehmet Hamdi Örüm 0000-0002-4154-0738

Ramazan İlyas Öner 0000-0001-6975-4060

Aysun Kalenderoğlu 0000-0002-8216-8610

Murad Atmaca 0000-0003-2772-4124

Publication Date December 15, 2018
Submission Date October 14, 2018
Acceptance Date October 31, 2018
Published in Issue Year 2018 Volume: 4 Issue: 3

Cite

AMA Özen ME, Örüm MH, Öner Rİ, Kalenderoğlu A, Atmaca M. Hipotiroidizmin Levotiroksin ile Tedavisine Rağmen Devam Eden Uyku Bozukluğu Depresyon için Bir Belirteç Olabilir mi?. ADYÜ Sağlık Bilimleri Derg. December 2018;4(3):1019-1027. doi:10.30569/adiyamansaglik.470317