Thyroid Evaluation of Hospitalized Psychiatric Patients: The Role of TSH Screening for Thyroid Dysfunction

Abstract

The incidence and pattern of changes in thyroid function tests were studied in acutely hospitalized psychiatric patients and the cost effectiveness of a systematic screening program for thyroid dysfunction was estimated. Thyroid testing was performed on 1275 of 1424 (90%) admissions to the psychiatric wing of Strong Memorial Hospital between April 1, 1993 and March 30, 1994. Discharge samples were obtained in 232 patients who were hospitalized at least 2 days; 163 patients were admitted multiple times. Psychiatric diagnosis was coded using DSM-III-R criteria. TSH, T4, free T4, and T3 levels were measured within 48 h of admission. TSH values were most frequently abnormal (7.8%) and free T4 the least (1.3%). Admission and discharge thyroid tests were similar. Significant differences in the four parameters of thyroid function were present among the psychiatric groups. By analysis of variance every 1 microU/mL increase in TSH levels was associated with a 2.5% increase in length of stay (LOS) (95% confidence intervals: 0.21%, 4.75%), holding psychiatric diagnosis, age, and gender constant. For patients with elevated TSH levels, the average LOS was increased by 10.7 days (95% confidence intervals: 2.8, 18.7 days). It is concluded that patients hospitalized for psychiatric illness have an incidence of thyroid dysfunction at or slightly higher than the general population. However, patients with elevated TSH levels are hospitalized longer than those with normal or suppressed values.

The Effectiveness of Thyroid Function Tests Screening in Psychiatric Inpatients

“…Also, our results did not confirm the correlation between length of stay in a hospital and TSH levels that were reported in previous studies (25,26).…”

A Grave Set of Diagnoses: A Case of Mania with Comorbid Autoimmune Thyroiditis Precipitated by Multiple Sclerosis Treatment

“…In one study that assessed thyroid dysfunction in patients hospitalized for psychiatric disease, over 90% of patients had thyroid levels checked but only 4.4% had low TSH levels, and of these, only 1% had elevated free T4 levels. 37 Assessments for other common symptoms of hyperthyroidism should be conducted to guide screening for thyroid dysfunction. Physical findings in hyperthyroidism include tachycardia, tremor, palpable goiter, and in the case of Graves' disease, ocular changes such as proptosis, lid lag, and stare.…”

Mental changes in hypo- and hyperthyroidism

“…Aufgrund der alters-und geschlechtsabhängig erhöhten Prävalenz von Hypothyreosen bei psychiatrischen Patienten wird sowohl bei ambulanten als auch bei hospitalisierten Patienten, insbesondere Frauen über 60 Jahren ein routinemäßiges TSH-Screening empfohlen (41). Weitere Kriterien für eine erhöhte Inzidenz von Hypothyreosen sind »rapid-cycling« bipolare Störungen (9, 12), therapierefraktäre Depressionen (23) und Patienten unter einer Lithiumtherapie (14,26,27,43 (26). Die höchste Prävalenz findet sich während der ersten beiden Behandlungsjahren, insbesondere bei Frauen über 40 Jahren (Prävalenz>20%) (26).…”