Association between subclinical hypothyroidism and depression: an updated systematic review and meta-analysis

Abstract

BackgroundAlthough depression is associated with changes in the hypothalamic-pituitary-thyroid axis, its relationship with subclinical hypothyroidism (SCH) is controversial. To date, there is a lack of data on the improvement of depressive symptoms with levothyroxine therapy among individuals with coexistent SCH.MethodsWe conducted a meta-analysis to evaluate the association between SCH and depression including 1) the prevalence of depression in SCH (with a sub-analysis of the geriatric cohort), 2) thyroid stimulating hormone (TSH) level among patients with depression and 3) the effect of levothyroxine therapy among patients with SCH and coexistent depression.ResultsIn a pooled analysis of 12,315 individuals, those with SCH had higher risk of depression than euthyroid controls (relative risk 2.35, 95% confidence intervals [CI], 1.84 to 3.02; p < 0.001). Geriatric cohort with SCH had a 1.7-fold higher risk of depression compared with healthy controls (odds ratio 1.72, CI, 1.10 to 2.70; p = 0.020). There was no difference in the mean TSH level between individuals with depression and healthy controls (2.30 ± 1.18 vs. 2.13 ± 0.72 mIU/L, p = 0.513). In individuals with SCH and coexistent depression, levothyroxine therapy was neither associated with improvement in the Beck Depression Inventory scoring (pooled d + = − 1.05, CI -2.72 to 0.61; p = 0.215) nor Hamilton Depression Rating Scale (pooled d + = − 2.38, CI -4.86 to 0.10; p = 0.060).ConclusionSCH has a negative impact on depression. Early and routine screening of depression is essential to prevent morbidity and mortality. However, the use of levothyroxine among patients with SCH and coexistent depression needs to be individualized.

No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study

“…However, only a small fraction of children and adolescents in either study was affected by HYPO SC when applying a pediatric reference range for TSH. Drawing on a sample of children and adolescents affected by HYPO SC , Cerbone et al ( 8 ) found no relationship between HYPO SC and mental health, which is supported by results of the present study as well as the two most recent meta-analyses of the relationship between HYPO SC and depression in adults ( 73 , 74 ). Tang et al ( 74 ) showed in a subgroup analysis that only adults aged 50 and above were more likely to experience depression which agrees with considerations by Dayan and Panicker ( 75 ), arguing that an underlying chronic condition, more likely to occur in the elderly, could be the cause of increased rates of depression in adults rather than HYPO SC .…”

Depression, Metabolic Syndrome, Serum TSH, and Vitamin D Concentrations in Rural and Urban Postmenopausal Women

“…A study by Guimarães et al [ 40 ] based on almost 1300 Brazilian, middle-aged women from urban areas demonstrated that women with a high TSH level (>10 mUI/mL) had a three-fold higher chance of presenting depressive symptoms than women having with levels of TSH. In contrary, Loh et al [ 41 ] reported no significant difference in the mean TSH level between individuals with depression and healthy controls (2.30 vs. 2.13 mIU/L, respectively).…”

Impaired Brain Energy Metabolism: Involvement in Depression and Hypothyroidism

“…The low efficacy of pharmacotherapy is probably because the antidepressant drugs currently in use mainly affect noradrenergic and serotonergic neurotransmission, while many studies have shown that this disease involves not only disturbances in neurotransmission but also changes in hormonal systems, immune systems, and energy processes that together impair synaptic plasticity, leading to numerous functional changes, including depressed mood (Horowitz and Zunszain, 2015). The participation of thyroid hormones in the pathogenesis of depression is evidenced by epidemiologic data that indicate that thyroid dysfunction often leads to the development of mental diseases; among patients with affective disorders, 1-4% have hypothyroidism, and 4-40% present subclinical hypothyroidism (Duntas and Maillis, 2013;Loh et al, 2019). The therapeutic effectiveness of adjunctive treatment of refractory depression with superphysiological doses of thyroid hormones is well established, but the mechanism of action of thyroid hormones on the function of the central nervous system in adults is not well known (Bauer et al, 2002(Bauer et al, , 2016.…”