Thyroid axis function after in-patient treatment of acute psychosis with antipsychotics: a naturalistic study

Abstract

BackgroundEndocrine function in psychiatric patients may be affected by mental disorder itself as well as by antipsychotic medications.The aim of this naturalistic observational study was to determine if treatment of acute psychotic episode with antipsychotic medication affects thyroid axis hormone concentrations and if such changes are associated with symptomatic improvement.MethodsEighty six adult acute psychotic patients, consecutively admitted to a mental hospital, were recruited for the study. All patients were physically healthy and without thyroid disease. During the hospitalization period all study patients received treatment with antipsychotic medication according to clinical need. Severity of the psychotic episode was evaluated using the Brief Psychiatric Rating Scale (BPRS) and venous blood samples were drawn for analysis of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) concentrations on the day of admission and on the day of discharge from the hospital.ResultsAntipsychotic drug treatment was associated with decrease of mean FT3 (p < 0.001) and FT4 (p = 0.002) concentrations; and with increase of mean TSH (p = 0.016) concentrations. Changes in thyroid hormone concentrations were mostly predicted by baseline hormone concentrations. Individual changes were not limited to decrease in high hormone concentrations; in patients who had low FT3 or FT4 concentrations, treatment resulted in increase in concentrations. Such an increase was established in one-quarter of patients for FT3 concentrations and in one-third of patients for FT4 concentrations. Fall in FT4 concentrations negatively correlated with the improvement in the BPRS score (r = −0.235, p = 0.023).ConclusionsThe study indicates that antipsychotic treatment resulted in a decrease in mean FT3 concentrations and in an increase in mean TSH concentrations after recovery from acute psychosis. Symptomatic improvement was less evident in patients who experienced a decrease in FT4 concentrations.Trial registrationEudraCT No.2007-001541-18

The impact of Lithium on thyroid function in Chinese psychiatric population

“…Antipsychotics were well known for their central activity on tuberoinfundibular dopaminergic pathway. The antagonism of dopamine 2 receptor could increase Thyroid Releasing Hormone stimulated TSH levels [ 12 ]. Use of depot injection had been shown to decrease risk of developing SCH.…”

FT4 and TSH, relation to diagnoses in an unselected psychiatric acute-ward population, and change during acute psychiatric admission

“…In a study with longer follow up (mean 21 days) in 22 acutely ill patients [ 23 ], a decrease in FT4 was seen, and in another longer follow up (mean 29 days) on acutely ill psychotic patients, both a decrease in FT4 and an increase in TSH were seen. However, despite a longer follow up than in our study, the increase in TSH was seen in fewer patients than those with a decrease in FT4 (41% vs 66%) [ 25 ]. Together, the findings indicate that the change in FT4 is not primarily driven by the central TSH as one could expect according to theories on the effect of psychiatric stress on the pituitary gland.…”

“…Together, the findings indicate that the change in FT4 is not primarily driven by the central TSH as one could expect according to theories on the effect of psychiatric stress on the pituitary gland. Bunevicius suggests that the reduction in FT4 [ 25 ] is due to the use of antipsychotics. This would be in line with the mood stabilizer Li + known to cause hypothyroidism by reducing production in the thyroid gland [ 26 ].…”

Sex difference in the progression of manic symptoms during acute hospitalization: A prospective pilot study

“…Collectively, these results suggest that acute mania is associated with altered peripheral thyroid indices. However, we cannot role an effect for antipsychotic medications on the low FT3 levels we observed (Bunevicius, Steibliene, & Prange, 2014). Regardless to the basis for the change in FT3, and given the significant role of optimal thyroid economy on brain function (see Figure 3 for details), further studies are needed to investigate thyroid dynamic changes during acute manic episode and its relationship with sex-specific variability in mania phenotype.…”