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Published in: BMC Endocrine Disorders 1/2021

Open Access 01-12-2021 | Mood Disorders | Research article

Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder

Authors: Shengnan Zhao, Xu Zhang, Yaling Zhou, Hao Xu, Yuwei Li, Yuexin Chen, Bo Zhang, Xueli Sun

Published in: BMC Endocrine Disorders | Issue 1/2021

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Abstract

Background

Previous studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and thyroid hormone levels can also affect the effect of drug treatment. Therefore, the purpose of this study is assessment the thyroid function of drug-naive bipolar disorder across different mood states, with the expectation of providing support for treatment options.

Methods

The present study is a cross-sectional study. Patients diagnosed with bipolar disorder according to the International Classification of Diseases diagnostic Criteria, Edition 10 (ICD 10) and who had never received medication were included in the study. The Montgomery Depression Scale (MADRS) was used to assess depressive symptoms and the Young Mania Rating Scale (YMRS) for manic symptoms. Thyroid function indicators include thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Levels of TSH, TT4, FT4, TT3, and FT3 were measured within 48 h of hospitalization, between 06:00 and 08:00.

Results

The data analysis finally covered the data of 291 subjects (136 in a bipolar manic group, 128 in a bipolar depressive group, and 27 in a bipolar mixed group), including 140 males and 151 females, with an average age of 27.38 ± 8.01. There was no significant difference in age, sex, marital status, work status, family history, and course of illness among the manic group, depressive group, and mixed group. The level of FT3, the rate of thyroid hormone increased secretion, and the total abnormality rate of thyroid hormone secretion in the manic group were significantly higher than those in the depressive group.

Conclusion

These findings indicate that thyroid functions were significantly different between depressive and manic episodes in BD patients. In clinical practice, it is necessary to take into account the differences in thyroid hormone levels in patients with BD across different emotional states in choosing drug.
Literature
1.
go back to reference Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, et al. Bipolar disorders. Nat Rev Dis Primers. 2018;4:18008.CrossRef Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, et al. Bipolar disorders. Nat Rev Dis Primers. 2018;4:18008.CrossRef
2.
go back to reference Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar Spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68(3):241–51.CrossRef Merikangas KR, Jin R, He JP, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar Spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68(3):241–51.CrossRef
3.
go back to reference Vojta C, Kinosian B, Glick H, Altshuler L, Bauer MS. Self-reported quality of life across mood states in bipolar disorder. Compr Psychiatry. 2001;42(3):190–5.CrossRef Vojta C, Kinosian B, Glick H, Altshuler L, Bauer MS. Self-reported quality of life across mood states in bipolar disorder. Compr Psychiatry. 2001;42(3):190–5.CrossRef
4.
go back to reference McIntyre RS, Calabrese JR. Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Curr Med Res Opin. 2019;35(11):1993–2005.CrossRef McIntyre RS, Calabrese JR. Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Curr Med Res Opin. 2019;35(11):1993–2005.CrossRef
5.
go back to reference Simon GE, Ludman EJ, Unutzer J, Operskalski BH, Bauer MS. Severity of mood symptoms and work productivity in people treated for bipolar disorder. Bipolar Disord. 2008;10(6):718–25.CrossRef Simon GE, Ludman EJ, Unutzer J, Operskalski BH, Bauer MS. Severity of mood symptoms and work productivity in people treated for bipolar disorder. Bipolar Disord. 2008;10(6):718–25.CrossRef
6.
go back to reference Cloutier M, Greene M, Guerin A, Touya M, Wu E. The economic burden of bipolar I disorder in the United States in 2015. J Affect Disord. 2018;226:45–51.CrossRef Cloutier M, Greene M, Guerin A, Touya M, Wu E. The economic burden of bipolar I disorder in the United States in 2015. J Affect Disord. 2018;226:45–51.CrossRef
7.
go back to reference Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea JM, Salamero M, et al. Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 2007;9(1–2):103–13.CrossRef Martinez-Aran A, Vieta E, Torrent C, Sanchez-Moreno J, Goikolea JM, Salamero M, et al. Functional outcome in bipolar disorder: the role of clinical and cognitive factors. Bipolar Disord. 2007;9(1–2):103–13.CrossRef
8.
go back to reference Grande I, Goikolea JM, de Dios C, González-Pinto A, Montes JM, Saiz-Ruiz J, et al. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatr Scand. 2013;127(5):403–11.CrossRef Grande I, Goikolea JM, de Dios C, González-Pinto A, Montes JM, Saiz-Ruiz J, et al. Occupational disability in bipolar disorder: analysis of predictors of being on severe disablement benefit (PREBIS study data). Acta Psychiatr Scand. 2013;127(5):403–11.CrossRef
9.
go back to reference Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Ustun TB, et al. Days out of role due to common physical and mental conditions: results from the WHO world mental health surveys. Mol Psychiatry. 2011;16(12):1234–46.CrossRef Alonso J, Petukhova M, Vilagut G, Chatterji S, Heeringa S, Ustun TB, et al. Days out of role due to common physical and mental conditions: results from the WHO world mental health surveys. Mol Psychiatry. 2011;16(12):1234–46.CrossRef
10.
go back to reference Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: a brief review. Medicina. 2019;55(8):403.CrossRef Dome P, Rihmer Z, Gonda X. Suicide risk in bipolar disorder: a brief review. Medicina. 2019;55(8):403.CrossRef
11.
go back to reference McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721–8.CrossRef McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721–8.CrossRef
12.
go back to reference Bou Khalil R, Richa S. Thyroid adverse effects of psychotropic drugs: a review. Clin Neuropharmacol. 2011;34(6):248–55.CrossRef Bou Khalil R, Richa S. Thyroid adverse effects of psychotropic drugs: a review. Clin Neuropharmacol. 2011;34(6):248–55.CrossRef
13.
go back to reference Chakrabarti S. Thyroid functions and bipolar affective disorder. J Thyroid Res. 2011;2011:306367.CrossRef Chakrabarti S. Thyroid functions and bipolar affective disorder. J Thyroid Res. 2011;2011:306367.CrossRef
14.
go back to reference Szuba MP, Amsterdam JD, Fernando AT 3rd, Gary KA, Whybrow PC, Winokur A. Rapid antidepressant response after nocturnal TRH administration in patients with bipolar type I and bipolar type II major depression. J Clin Psychopharmacol. 2005;25(4):325–30.CrossRef Szuba MP, Amsterdam JD, Fernando AT 3rd, Gary KA, Whybrow PC, Winokur A. Rapid antidepressant response after nocturnal TRH administration in patients with bipolar type I and bipolar type II major depression. J Clin Psychopharmacol. 2005;25(4):325–30.CrossRef
15.
go back to reference Bottlender R, Rudolf D, Strauss A, Möller HJ. Are low basal serum levels of the thyroid stimulating hormone (b-TSH) a risk factor for switches into states of expansive syndromes known in Germany as “maniform syndromes” in bipolar I depression? Pharmacopsychiatry. 2000;33(2):75–7.CrossRef Bottlender R, Rudolf D, Strauss A, Möller HJ. Are low basal serum levels of the thyroid stimulating hormone (b-TSH) a risk factor for switches into states of expansive syndromes known in Germany as “maniform syndromes” in bipolar I depression? Pharmacopsychiatry. 2000;33(2):75–7.CrossRef
16.
go back to reference Larsen JK, Faber J, Christensen EM, Bendsen BB, Solstad K, Gjerris A, et al. Relationship between mood and TSH response to TRH stimulation in bipolar affective disorder. Psychoneuroendocrinology. 2004;29(7):917–24.CrossRef Larsen JK, Faber J, Christensen EM, Bendsen BB, Solstad K, Gjerris A, et al. Relationship between mood and TSH response to TRH stimulation in bipolar affective disorder. Psychoneuroendocrinology. 2004;29(7):917–24.CrossRef
17.
go back to reference Cole DP, Thase ME, Mallinger AG, Soares JC, Luther JF, Kupfer DJ, et al. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002;159(1):116–21.CrossRef Cole DP, Thase ME, Mallinger AG, Soares JC, Luther JF, Kupfer DJ, et al. Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry. 2002;159(1):116–21.CrossRef
18.
go back to reference Li C, Lai J, Huang T, Han Y, Du Y, Xu Y, et al. Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study. Neuropsychiatr Dis Treat. 2019;15:2285–90.CrossRef Li C, Lai J, Huang T, Han Y, Du Y, Xu Y, et al. Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study. Neuropsychiatr Dis Treat. 2019;15:2285–90.CrossRef
19.
go back to reference Bunevicius R, Velickiene D, Prange AJ Jr. Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves' disease. Gen Hosp Psychiatry. 2005;27(2):133–9.CrossRef Bunevicius R, Velickiene D, Prange AJ Jr. Mood and anxiety disorders in women with treated hyperthyroidism and ophthalmopathy caused by Graves' disease. Gen Hosp Psychiatry. 2005;27(2):133–9.CrossRef
20.
go back to reference Bunevicius R, Prange AJ Jr. Thyroid disease and mental disorders: cause and effect or only comorbidity? Curr Opin Psychiatry. 2010;23(4):363–8.CrossRef Bunevicius R, Prange AJ Jr. Thyroid disease and mental disorders: cause and effect or only comorbidity? Curr Opin Psychiatry. 2010;23(4):363–8.CrossRef
21.
go back to reference Kuman Tunçel Ö, Akdeniz F, Özbek SS, Kavukçu G, Ünal Kocabaş G. Thyroid function and ultrasonography abnormalities in Lithium-treated bipolar patients: a cross-sectional study with healthy controls. Noro Psikiyatr Ars. 2017;54(2):108–15.CrossRef Kuman Tunçel Ö, Akdeniz F, Özbek SS, Kavukçu G, Ünal Kocabaş G. Thyroid function and ultrasonography abnormalities in Lithium-treated bipolar patients: a cross-sectional study with healthy controls. Noro Psikiyatr Ars. 2017;54(2):108–15.CrossRef
22.
go back to reference Bocchetta A, Cocco F, Velluzzi F, Del Zompo M, Mariotti S, Loviselli A. Fifteen-year follow-up of thyroid function in lithium patients. J Endocrinol Investig. 2007;30(5):363–6.CrossRef Bocchetta A, Cocco F, Velluzzi F, Del Zompo M, Mariotti S, Loviselli A. Fifteen-year follow-up of thyroid function in lithium patients. J Endocrinol Investig. 2007;30(5):363–6.CrossRef
23.
go back to reference Fagiolini A, Kupfer DJ, Scott J, Swartz HA, Cook D, Novick DM, et al. Hypothyroidism in patients with bipolar I disorder treated primarily with lithium. Epidemiologia e Psichiatria Sociale. 2006;15(2):123–7.CrossRef Fagiolini A, Kupfer DJ, Scott J, Swartz HA, Cook D, Novick DM, et al. Hypothyroidism in patients with bipolar I disorder treated primarily with lithium. Epidemiologia e Psichiatria Sociale. 2006;15(2):123–7.CrossRef
24.
go back to reference Vedal TSJ, Steen NE, Birkeland KI, Dieset I, Reponen EJ, Laskemoen JF, et al. Free thyroxine and thyroid-stimulating hormone in severe mental disorders: a naturalistic study with focus on antipsychotic medication. J Psychiatr Res. 2018;106:74–81.CrossRef Vedal TSJ, Steen NE, Birkeland KI, Dieset I, Reponen EJ, Laskemoen JF, et al. Free thyroxine and thyroid-stimulating hormone in severe mental disorders: a naturalistic study with focus on antipsychotic medication. J Psychiatr Res. 2018;106:74–81.CrossRef
25.
go back to reference Fatimi J, Lagorce JF, Chabernaud ML, Comby F, Buxeraud J, Raby C. Synthesis and antithyroid activity of 1,4,5-trialkyl 2-thioimidazole derivatives. Farmaco. 1994;49(4):253–7.PubMed Fatimi J, Lagorce JF, Chabernaud ML, Comby F, Buxeraud J, Raby C. Synthesis and antithyroid activity of 1,4,5-trialkyl 2-thioimidazole derivatives. Farmaco. 1994;49(4):253–7.PubMed
26.
go back to reference Joffe RT, Sokolov ST. Thyroid hormones, the brain, and affective disorders. Crit Rev Neurobiol. 1994;8(1–2):45–63.PubMed Joffe RT, Sokolov ST. Thyroid hormones, the brain, and affective disorders. Crit Rev Neurobiol. 1994;8(1–2):45–63.PubMed
27.
go back to reference Bauer M, Priebe S, Kürten I, Gräf KJ, Baumgartner A. Psychological and endocrine abnormalities in refugees from East Germany: part I. prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity. Psychiatry Res. 1994;51(1):61–73.CrossRef Bauer M, Priebe S, Kürten I, Gräf KJ, Baumgartner A. Psychological and endocrine abnormalities in refugees from East Germany: part I. prolonged stress, psychopathology, and hypothalamic-pituitary-thyroid axis activity. Psychiatry Res. 1994;51(1):61–73.CrossRef
28.
go back to reference Bauer M, Hellweg R, Gräf KJ, Baumgartner A. Treatment of refractory depression with high-dose thyroxine. Neuropsychopharmacology. 1998;18(6):444–55.CrossRef Bauer M, Hellweg R, Gräf KJ, Baumgartner A. Treatment of refractory depression with high-dose thyroxine. Neuropsychopharmacology. 1998;18(6):444–55.CrossRef
29.
go back to reference Stancer HC, Persad E. Treatment of intractable rapid-cycling manic-depressive disorder with levothyroxine. Clinical observations. Arch Gen Psychiatry. 1982;39(3):311–2.CrossRef Stancer HC, Persad E. Treatment of intractable rapid-cycling manic-depressive disorder with levothyroxine. Clinical observations. Arch Gen Psychiatry. 1982;39(3):311–2.CrossRef
30.
go back to reference Bauer MS, Whybrow PC, Winokur A. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch Gen Psychiatry. 1990;47(5):427–32.CrossRef Bauer MS, Whybrow PC, Winokur A. Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism. Arch Gen Psychiatry. 1990;47(5):427–32.CrossRef
31.
go back to reference Thase ME, Kupfer DJ, Jarrett DB. Treatment of imipramine-resistant recurrent depression: I. an open clinical trial of adjunctive L-triiodothyronine. J Clin Psychiatry. 1989;50(10):385–8.PubMed Thase ME, Kupfer DJ, Jarrett DB. Treatment of imipramine-resistant recurrent depression: I. an open clinical trial of adjunctive L-triiodothyronine. J Clin Psychiatry. 1989;50(10):385–8.PubMed
32.
go back to reference Nierenberg AA, White K. What next? A review of pharmacologic strategies for treatment resistant depression. Psychopharmacol Bull. 1990;26(4):429–60.PubMed Nierenberg AA, White K. What next? A review of pharmacologic strategies for treatment resistant depression. Psychopharmacol Bull. 1990;26(4):429–60.PubMed
33.
go back to reference Sachs GS. Treatment-resistant bipolar depression. Psychiatr Clin North Am. 1996;19(2):215–36.CrossRef Sachs GS. Treatment-resistant bipolar depression. Psychiatr Clin North Am. 1996;19(2):215–36.CrossRef
34.
go back to reference Chang KD, Keck PE Jr, Stanton SP, McElroy SL, Strakowski SM, Geracioti TD Jr. Differences in thyroid function between bipolar manic and mixed states. Biol Psychiatry. 1998;43(10):730–3.CrossRef Chang KD, Keck PE Jr, Stanton SP, McElroy SL, Strakowski SM, Geracioti TD Jr. Differences in thyroid function between bipolar manic and mixed states. Biol Psychiatry. 1998;43(10):730–3.CrossRef
Metadata
Title
Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder
Authors
Shengnan Zhao
Xu Zhang
Yaling Zhou
Hao Xu
Yuwei Li
Yuexin Chen
Bo Zhang
Xueli Sun
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-021-00869-5

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