Clinical Thyroidology® for the Public

Summaries for the Public from recent articles in Clinical Thyroidology
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HYPOTHYROIDISM
Is there an increased risk of depression with patients with hypothyroidism?

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BACKGROUND
Hypothyroidism is common and the rate of hypothyroidism is more common in women than men. Hypothyroidism and mood disorders often occur together, especially in women. The most common mood disorder seen in patients with hypothyroidism is depression. Low thyroid hormone levels may be in part responsible, especially when hypothyroidism is severe.

In patients with mild/subclinical hypothyroidism, a very mild form of hypothyroidism in which TSH levels are elevated but thyroid hormone levels are normal, the link with mood disorders is not clear. Treatment of subclinical hypothyroidism with thyroid hormone to improve depressive symptoms is still debatable. This study looks at the association of TSH levels and depressive symptoms in patients with and without mood disorders.

THE FULL ARTICLE TITLE
 Singh B, et al. The association between thyrotropin and clinically relevant depression: a retrospective cross-sectional study. Thyroid doi: 10.1089/thy.2024.0428. PMID: 39909475.

SUMMARY OF THE STUDY
This study was done at the University of Utah. The authors looked at 33,138 patients who had TSH levels and completed a health questionnaire between 2016 and 2021. The health questionnaire was used to assess clinically relevant depression in the individuals that responded. The average age was 42 and 69% were women.

Overall, 45% of individuals responding to the health questionnaire had a diagnosis of mood disorder, most often depression. Increasing TSH levels were linked to clinically relevant depression, particularly in women, those with hypothyroidism and those on thyroid hormone replacement. When divided by the TSH level, both subgroups with low and high TSH levels were linked to clinically relevant depression, but the link between high TSH and clinically relevant depression was stronger. Patients with subclinical hypothyroidism were more likely to have clinically relevant depression, in both groups with and without mood disorders.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study found that increasing TSH levels and clinically relevant depression are associated in patients with hypothyroidism and receiving thyroid hormone. This was true in patients with or without a diagnosis of mood disorders and those with mild hypothyroidism not on thyroid hormone. More studies are needed to evaluate this association and to determine the effect of treatment with thyroid hormone on patients with subclinical hypothyroidism with depressive symptoms.

— Susana Ebner MD

ABBREVIATIONS & DEFINITIONS

Hypothyroidism: a condition where the thyroid gland is underactive and doesn’t produce enough thyroid hormone. Treatment requires taking thyroid hormone pills.

Subclinical Hypothyroidism: a mild form of hypothyroidism where the only abnormal hormone level is an increased TSH. There is controversy as to whether this should be treated or not.

Thyroid hormone therapy: patients with hypothyroidism are most often treated with Levothyroxine in order to return their thyroid hormone levels to normal.

TSH (thyroid stimulating hormone): produced by the pituitary gland that regulates thyroid function; also, the best screening test to determine if the thyroid is functioning normally.

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