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Effects of TSH, fT3 and fT4 levels on neurocognitive symptoms in patients with schizophrenia

Year 2022, Volume: 47 Issue: 3, 1263 - 1272, 30.09.2022
https://doi.org/10.17826/cumj.1135374

Abstract

Purpose: The aim of this study is to examine the relationship between thyroid hormone levels and positive, negative, general, and cognitive symptoms in euthyroid patients with psychosis.
Materials and Methods: Thirty-three schizophrenia patients were included in this cross-sectional study. Sociodemographic and clinical data of the participants, positive and negative symptoms assessment scale (PANSS), general assessment of functionality scale (GAF), and clinical global impression scale (CGI) scores were recorded. The relationships between TSH, fT3, and fT4 levels and cognitive performances of patients which is measured via a neurocognitive battery consisting of Trail Making Test (TMT) A, TMT B, verbal fluency test (VFT), digit span (DS), forward and backward, and Wisconsin Card Sorting Test (WCST) were investigated.
Results: Significant correlations were found between fT3 levels and WCST performances. fT3 levels was significantly correlated with the number of categories achieved in WCST (r=.508; p=0.003). A significant correlation was found between fT4 levels and TMT B (r=-.376; p=0.031) and VFT (p=.355; p=0.043) performances. In the linear regression model, it was found that fT3 levels significantly predicted the number of categories achieved in WCST (UB=1.680; p=0.029).
Conclusion: The results of our study suggested that fT3 has more significant effects, primarily on executive functions, compared to T4.

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References

  • Reichenberg A, Weiser M, Rapp MA, Rabinowitz J, Caspi A, Schmeidler J, et al. Elaboration on premorbid intellectual performance in schizophrenia: Premorbid intellectual decline and risk for schizophrenia. Arch Gen Psychiatry. 2005;62(12): 1297-304.
  • Santesteban-Echarri O, Paino M, Rice S, González-Blanch C, McGorry P, Gleeson J, et al. Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review. 2017; 58: 59-75.
  • Ortiga-Carvalho TM, Chiamolera MI, Pazos-Moura CC, Wondisford FE. Hypothalamus-pituitary-thyroid axis. Compr Physiol. 2016;6(3): 1387-428.
  • Leonard JL. Non-genomic actions of thyroid hormone in brain development. Steroids. 2008;73: 1008-12.
  • Bégin ME, Langlois MF, Lorrain D, Cunnane SC. Thyroid Function and Cognition during Aging. Curr Gerontol Geriatr Res. 2008;2008.
  • Osterweil D, Syndulko K, Cohen SN, Pettier‐Jennings PD, Hershman JM, Cummings JL, et al. Cognitive Function in Non‐Demented Older Adults with Hypothyroidism. J Am Geriatr Soc. 1992;40(4): 325-35.
  • Monzanil F, Del Guerra P, Caracciol N, Pruneti CA, Puccil E, Luisit M, et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of l-thyroxine treatment. Clin Investig. 1993;71(5): 367-71.
  • Zhu DF, Wang ZX, Zhang DR, Pan ZL, He S, Hu XP, et al. fMRI revealed neural substrate for reversible working memory dysfunction in subclinical hypothyroidism. Brain. 2006;129(11): 2923-30.
  • Samuels MH. Thyroid disease and cognition. Endocrinology and Metabolism Clinics of North America. 2014;43(2):529-43.
  • Wahlin Å, Bunce D, Wahlin TBR. Longitudinal evidence of the impact of normal thyroid stimulating hormone variations on cognitive functioning in very old age. Psychoneuroendocrinology. 2005;30(7):625-37.
  • Othman SS, Kadir KA, Hassan J, Hong GK, Singh BB, Raman N. High prevalence of thyroid function test abnormalities in chronic schizophrenia. Aust N Z J Psychiatry. 1994; 28(4):620-4.
  • Zhu Y, Ji H, Tao L, Cai Q, Wang F, Ji W, et al. Functional Status of Hypothalamic–Pituitary–Thyroid and Hypothalamic–Pituitary–Adrenal Axes in Hospitalized Schizophrenics in Shanghai. Front Psychiatry. 2020;11: 65.
  • Zhang N, Du H jian, Wang J hua, Cheng Y. A pilot study on the relationship between thyroid status and neuropsychiatric symptoms in patients with Alzheimer disease. Chin Med J (Engl). 2012; 125(18):3211-6.
  • Bunevicius R. Thyroid disorders in mental patients. Curr Opin Psychiatry. 2009 ;22(4):391-5.
  • Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas Á, Solé M, et al. Free thyroxine levels are associated with cognitive abilities in subjects with early psychosis. Schizophr Res. 2014; 166(1-3):37-42.
  • Labad J, Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas, et al. Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study. Schizophr Res. 2016; 171(1-3):182-6.
  • Ichioka S, Terao T, Hoaki N, Matsushita T, Hoaki T. Triiodothyronine may be possibly associated with better cognitive function and less extrapyramidal symptoms in chronic schizophrenia. Prog Neuro-Psychopharmacology Biol Psychiatry. 2012; 39(1):170-4.
  • American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Arlington. 2013.
  • World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373-4.
  • Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(2):261-76.
  • Kostakoglu E, Batur S, Tiryaki A, Gogus A. Reliability and validity of the Turkish version of the Positive and Negative Syndrome Scale (PANSS). Turk Psikol Derg. 1999; 14(44): 23-34.
  • Aas IH. Guidelines for rating global assessment of functioning (GAF). Annals of general psychiatry. 2011; 10(1): 1-11.
  • Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976.
  • Tischler L, Petermann F. Trail Making Test (TMT). Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie. 2010; 58(1): 79-81.
  • Reitan RM. The relation of the Trail Making Test to organic brain damage. J Consult Psychol. 1955; 19(5):393.
  • Türkeş N, Can H, Kurt M, Elmastaş Dikeç B. İz Sürme Testi’nin 20-49 Yaş Aralığında Türkiye İçin Norm Belirleme Çalışması. Turk Psikiyatr. Derg. 2015;26:189-196.
  • Lezak MD, Howieson DB, Loring DW, Hannay JH , Fischer JS. Neuropsychological Assessment. Oxford University Press. New York. 2004.
  • Tümaç A, Canbeyli R. Normal Deneklerde Frontal Hasarlara Duyarli Bazi Testlerde Performansa Yaş ve Eğitimin Etkisi. İstanbul Universitesi, 1997.
  • Heaton RKK, Chelune GJ, Talley JL, Kay GG, Curtiss G, Oreg S, et al. Wisconsin Card Sorting Test Manual: Revised and expanded. Psychol Rep. 1993.
  • Karakaş S, Irak M, E. O. Wisconsin Kart Eşleme Testi (WCST) ve Stroop Testi TBAG formu puanlarının test içi ve testler-arası ilişkileri. Ulus. Psikol. Kongresi özet kitabı. 1998;44.
  • Wechsler, D. Wechsler memory scale - Third edition administration and scoring manual. San Antonio, TX Psychol. Corp. 1997.
  • Karakaş, S. Bilnot Bataryası El Kitabı: Nöropsikolojik Testler İçin Araştırma ve Geliştirme Çalışmaları. Dizayn Ofset, 2004.
  • Santisteban P, Bernal J. Thyroid development and effect on the nervous system. Reviews in Endocrine and Metabolic Disorders. 2005; 6(3): 217-28.
  • Üçok A, Direk N, Koyuncu A, Keskin-Ergen Y, Yüksel Ç, Güler J, et al. Cognitive deficits in clinical and familial high risk groups for psychosis are common as in first episode schizophrenia. Schizophr Res. 2013; 151(1-3):265-9.
  • Kelleher I, Murtagh A, Clarke MC, Murphy J, Rawdon C, Cannon M. Neurocognitive performance of a community-based sample of young people at putative ultra high risk for psychosis: Support for the processing speed hypothesis. Cogn Neuropsychiatry. 2013; 18(1-2):9-25.
  • Chan RCK, Chen EYH, Law CW. Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophr Res. 2006.
  • Holmes AJ, MacDonald A, Carter CS, Barch DM, Stenger VA, Cohen JD. Prefrontal functioning during context processing in schizophrenia and major depression: An event-related fMRI study. Schizophr Res. 2005; 76(2-3):199-206.
  • Wobrock T, Ecker UKH, Scherk H, Schneider-Axmann T, Falkai P, Gruber O. Cognitive impairment of executive function as a core symptom of schizophrenia. World J Biol Psychiatry. 2009; 10(4 Pt 2):442-51.
  • Everett J, Lavoie K, Gagnon JF, Gosselin N. Performance of patients with schizophrenia on the Wisconsin Card Sorting Test (WCST). J Psychiatry Neurosci. 2001; 26(2):123-30.
  • Fatouros-Bergman H, Cervenka S, Flyckt L, Edman G, Farde L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014; 158(1-3):156-62.
  • Boelaert K, Franklyn JA. Thyroid hormone in health and disease. Journal of Endocrinology. 2005; 187(1):1-15.
  • Grigorova M, Sherwin BB. Thyroid hormones and cognitive functioning in healthy, euthyroid women: A correlational study. Horm Behav. 2012; 61(4):617-22.
  • Kolomeets NS, Uranova N. Ultrastructural abnormalities of astrocytes in the hippocampus in schizophrenia and duration of illness: A postortem morphometric study. World J Biol Psychiatry. 2010; 11(2 Pt 2):282-92.

Şizofreni hastalarında TSH, fT3 ve fT4 düzeylerinin nörobilişsel belirtiler üzerine etkisi

Year 2022, Volume: 47 Issue: 3, 1263 - 1272, 30.09.2022
https://doi.org/10.17826/cumj.1135374

Abstract

Amaç: Bu çalışmamızda ötiroid psikoz hastalarında tiroid hormon düzeyleri ile pozitif, negatif, genel ve bilişsel belirtiler arasındaki ilişkiyi incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmaya 33 şizofreni hastası dahil edildi. Katılımcıların sosyodemografik ve klinik verileri, Pozitif ve Negatif Belirtileri Değerlendirme Ölçeği (PANSS), İşlevselliğin Genel Değerlendirilmesi Ölçeği (IGD), Klinik Global İzlenim Ölçeği (KGI) skorları kaydedildi. İz sürme, Sözel Akıcılık Testi, İleri ve Geri Sayı Menzili ile Wisconsin Kart Sayma Testinden (WKST) oluşan bir nörobilişsel batarya uygulanan hastaların bilişsel performanslarının TSH, sT3 ve sT4 düzeyleri ile ilişkisi araştırıldı.
Bulgular: sT4 düzeyleri ile İz Sürme B (r=-,376; p=0,031) ve Sözel Akıcılık test (p=,355; p=0,043) performansları arasında anlamlı derecede ilişki saptandı. Linear regresyon modelinde sT3 düzeylerinin WKST- tamamlanan kategori sayısını (UB=1.680; p=0.029) anlamlı derecede yordadığı saptandı..
Sonuç: Çalışmamızın sonuçları sT3 ün özellikle yürütücü işlevler üzerinde sT4’e kıyasla daha belirleyici etkileri olduğunu düşündürmüştür. İleride yapılacak daha geniş katılımlı araştırmalar, bilişsel belirtilerin tedavisinde tiroid hormon replasmanının etkinliğini belirlemek açısından önemli görünmektedir.

References

  • Reichenberg A, Weiser M, Rapp MA, Rabinowitz J, Caspi A, Schmeidler J, et al. Elaboration on premorbid intellectual performance in schizophrenia: Premorbid intellectual decline and risk for schizophrenia. Arch Gen Psychiatry. 2005;62(12): 1297-304.
  • Santesteban-Echarri O, Paino M, Rice S, González-Blanch C, McGorry P, Gleeson J, et al. Predictors of functional recovery in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Clinical Psychology Review. 2017; 58: 59-75.
  • Ortiga-Carvalho TM, Chiamolera MI, Pazos-Moura CC, Wondisford FE. Hypothalamus-pituitary-thyroid axis. Compr Physiol. 2016;6(3): 1387-428.
  • Leonard JL. Non-genomic actions of thyroid hormone in brain development. Steroids. 2008;73: 1008-12.
  • Bégin ME, Langlois MF, Lorrain D, Cunnane SC. Thyroid Function and Cognition during Aging. Curr Gerontol Geriatr Res. 2008;2008.
  • Osterweil D, Syndulko K, Cohen SN, Pettier‐Jennings PD, Hershman JM, Cummings JL, et al. Cognitive Function in Non‐Demented Older Adults with Hypothyroidism. J Am Geriatr Soc. 1992;40(4): 325-35.
  • Monzanil F, Del Guerra P, Caracciol N, Pruneti CA, Puccil E, Luisit M, et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of l-thyroxine treatment. Clin Investig. 1993;71(5): 367-71.
  • Zhu DF, Wang ZX, Zhang DR, Pan ZL, He S, Hu XP, et al. fMRI revealed neural substrate for reversible working memory dysfunction in subclinical hypothyroidism. Brain. 2006;129(11): 2923-30.
  • Samuels MH. Thyroid disease and cognition. Endocrinology and Metabolism Clinics of North America. 2014;43(2):529-43.
  • Wahlin Å, Bunce D, Wahlin TBR. Longitudinal evidence of the impact of normal thyroid stimulating hormone variations on cognitive functioning in very old age. Psychoneuroendocrinology. 2005;30(7):625-37.
  • Othman SS, Kadir KA, Hassan J, Hong GK, Singh BB, Raman N. High prevalence of thyroid function test abnormalities in chronic schizophrenia. Aust N Z J Psychiatry. 1994; 28(4):620-4.
  • Zhu Y, Ji H, Tao L, Cai Q, Wang F, Ji W, et al. Functional Status of Hypothalamic–Pituitary–Thyroid and Hypothalamic–Pituitary–Adrenal Axes in Hospitalized Schizophrenics in Shanghai. Front Psychiatry. 2020;11: 65.
  • Zhang N, Du H jian, Wang J hua, Cheng Y. A pilot study on the relationship between thyroid status and neuropsychiatric symptoms in patients with Alzheimer disease. Chin Med J (Engl). 2012; 125(18):3211-6.
  • Bunevicius R. Thyroid disorders in mental patients. Curr Opin Psychiatry. 2009 ;22(4):391-5.
  • Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas Á, Solé M, et al. Free thyroxine levels are associated with cognitive abilities in subjects with early psychosis. Schizophr Res. 2014; 166(1-3):37-42.
  • Labad J, Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas, et al. Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study. Schizophr Res. 2016; 171(1-3):182-6.
  • Ichioka S, Terao T, Hoaki N, Matsushita T, Hoaki T. Triiodothyronine may be possibly associated with better cognitive function and less extrapyramidal symptoms in chronic schizophrenia. Prog Neuro-Psychopharmacology Biol Psychiatry. 2012; 39(1):170-4.
  • American Psychiatric Association. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Arlington. 2013.
  • World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373-4.
  • Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13(2):261-76.
  • Kostakoglu E, Batur S, Tiryaki A, Gogus A. Reliability and validity of the Turkish version of the Positive and Negative Syndrome Scale (PANSS). Turk Psikol Derg. 1999; 14(44): 23-34.
  • Aas IH. Guidelines for rating global assessment of functioning (GAF). Annals of general psychiatry. 2011; 10(1): 1-11.
  • Guy W. ECDEU assessment manual for psychopharmacology. US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976.
  • Tischler L, Petermann F. Trail Making Test (TMT). Zeitschrift fur Psychiatrie, Psychologie und Psychotherapie. 2010; 58(1): 79-81.
  • Reitan RM. The relation of the Trail Making Test to organic brain damage. J Consult Psychol. 1955; 19(5):393.
  • Türkeş N, Can H, Kurt M, Elmastaş Dikeç B. İz Sürme Testi’nin 20-49 Yaş Aralığında Türkiye İçin Norm Belirleme Çalışması. Turk Psikiyatr. Derg. 2015;26:189-196.
  • Lezak MD, Howieson DB, Loring DW, Hannay JH , Fischer JS. Neuropsychological Assessment. Oxford University Press. New York. 2004.
  • Tümaç A, Canbeyli R. Normal Deneklerde Frontal Hasarlara Duyarli Bazi Testlerde Performansa Yaş ve Eğitimin Etkisi. İstanbul Universitesi, 1997.
  • Heaton RKK, Chelune GJ, Talley JL, Kay GG, Curtiss G, Oreg S, et al. Wisconsin Card Sorting Test Manual: Revised and expanded. Psychol Rep. 1993.
  • Karakaş S, Irak M, E. O. Wisconsin Kart Eşleme Testi (WCST) ve Stroop Testi TBAG formu puanlarının test içi ve testler-arası ilişkileri. Ulus. Psikol. Kongresi özet kitabı. 1998;44.
  • Wechsler, D. Wechsler memory scale - Third edition administration and scoring manual. San Antonio, TX Psychol. Corp. 1997.
  • Karakaş, S. Bilnot Bataryası El Kitabı: Nöropsikolojik Testler İçin Araştırma ve Geliştirme Çalışmaları. Dizayn Ofset, 2004.
  • Santisteban P, Bernal J. Thyroid development and effect on the nervous system. Reviews in Endocrine and Metabolic Disorders. 2005; 6(3): 217-28.
  • Üçok A, Direk N, Koyuncu A, Keskin-Ergen Y, Yüksel Ç, Güler J, et al. Cognitive deficits in clinical and familial high risk groups for psychosis are common as in first episode schizophrenia. Schizophr Res. 2013; 151(1-3):265-9.
  • Kelleher I, Murtagh A, Clarke MC, Murphy J, Rawdon C, Cannon M. Neurocognitive performance of a community-based sample of young people at putative ultra high risk for psychosis: Support for the processing speed hypothesis. Cogn Neuropsychiatry. 2013; 18(1-2):9-25.
  • Chan RCK, Chen EYH, Law CW. Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia. Schizophr Res. 2006.
  • Holmes AJ, MacDonald A, Carter CS, Barch DM, Stenger VA, Cohen JD. Prefrontal functioning during context processing in schizophrenia and major depression: An event-related fMRI study. Schizophr Res. 2005; 76(2-3):199-206.
  • Wobrock T, Ecker UKH, Scherk H, Schneider-Axmann T, Falkai P, Gruber O. Cognitive impairment of executive function as a core symptom of schizophrenia. World J Biol Psychiatry. 2009; 10(4 Pt 2):442-51.
  • Everett J, Lavoie K, Gagnon JF, Gosselin N. Performance of patients with schizophrenia on the Wisconsin Card Sorting Test (WCST). J Psychiatry Neurosci. 2001; 26(2):123-30.
  • Fatouros-Bergman H, Cervenka S, Flyckt L, Edman G, Farde L. Meta-analysis of cognitive performance in drug-naïve patients with schizophrenia. Schizophr Res. 2014; 158(1-3):156-62.
  • Boelaert K, Franklyn JA. Thyroid hormone in health and disease. Journal of Endocrinology. 2005; 187(1):1-15.
  • Grigorova M, Sherwin BB. Thyroid hormones and cognitive functioning in healthy, euthyroid women: A correlational study. Horm Behav. 2012; 61(4):617-22.
  • Kolomeets NS, Uranova N. Ultrastructural abnormalities of astrocytes in the hippocampus in schizophrenia and duration of illness: A postortem morphometric study. World J Biol Psychiatry. 2010; 11(2 Pt 2):282-92.
There are 43 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Hatice Kaya 0000-0003-3281-5135

Batuhan Ayık 0000-0002-9322-2336

Publication Date September 30, 2022
Acceptance Date August 25, 2022
Published in Issue Year 2022 Volume: 47 Issue: 3

Cite

MLA Kaya, Hatice and Batuhan Ayık. “Effects of TSH, FT3 and FT4 Levels on Neurocognitive Symptoms in Patients With Schizophrenia”. Cukurova Medical Journal, vol. 47, no. 3, 2022, pp. 1263-72, doi:10.17826/cumj.1135374.