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European Archives of Psychiatry and Clinical Neuroscience

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24-03-2023 | Suicide | Original Paper

Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study

Authors: Pu Peng, Qianjin Wang, Yanan Zhou, Yuzhu Hao, Shubao Chen, Qiuxia Wu, Manyun Li, Yunfei Wang, Qian Yang, Xin Wang, Yueheng Liu, Yuejiao Ma, Li He, Huixue Xu, Zejun Li, XiaoE Lang, Tieqiao Liu, Xiangyang Zhang

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 3/2024

Abstract

Both metabolic syndrome (MetS) and subclinical hypothyroidism (SCH) are prevalent in major depressive disorder (MDD) patients. However, their relationship in this population remains unknown. The study assessed the association between SCH and MetS in 1706 first-episode drug-naïve (FEDN) MDD patients. We also compared the relationship between MetS and clinical symptoms in patients with and without comorbid SCH. The Positive and Negative Syndrome Scale positive subscale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale were used to detect clinical symptoms. Serum levels of free triiodothyronine, free thyroxine, thyroid stimulating hormone (TSH), anti-thyroglobulin, thyroid peroxidases antibody, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting glucose were measured. The Area Under the Curve (AUC) was used to test the performance of serum TSH in identifying MetS patients. The prevalence of MetS and SCH was 34.5% (n = 585) and 61% (n = 1034), respectively. The presence of SCH increased the risk of MetS, hyperglycemia, hypertension, obesity, and low HDL-C by 4.91, 3.51, 3.54, 2.02, and 2.34 times, respectively. Serum TSH had a nice ability to distinguish MetS patients from non-MetS patients (AUC value = 0.77). MetS and its components exhibited a positive association with clinical profiles only in SCH patients, but not in non-SCH patients. Taken together, our study suggested SCH was closely related to MetS and might play a vital role in the relationship between MetS and clinical symptoms. Regular thyroid function checks might help early detect MetS.

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Malhi GS, Mann JJ (2018) Depression. The Lancet 392:2299–2312. https://doi.org/10.1016/S0140-6736(18)31948-2CrossRef

Chan KL, Cathomas F, Russo SJ (2019) Central and peripheral inflammation link metabolic syndrome and major depressive disorder. Physiology (Bethesda) 34:123–133. https://doi.org/10.1152/physiol.00047.2018CrossRefPubMed

Vancampfort D, Correll CU, Wampers M et al (2014) Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med 44:2017–2028. https://doi.org/10.1017/S0033291713002778CrossRefPubMed

Pan A, Keum N, Okereke OI et al (2012) Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care 35:1171–1180. https://doi.org/10.2337/dc11-2055CrossRefPubMedPubMedCentral

Hough CM, Bersani FS, Mellon SH et al (2020) Pre-treatment allostatic load and metabolic dysregulation predict SSRI response in major depressive disorder: a preliminary report. Psychol Med. https://doi.org/10.1017/S0033291720000896CrossRefPubMed

Mulvahill JS, Nicol GE, Dixon D et al (2017) Effect of metabolic syndrome on late-life depression: associations with disease severity and treatment resistance. J Am Geriatr Soc 65:2651–2658. https://doi.org/10.1111/jgs.15129CrossRefPubMedPubMedCentral

Yang L, Yang X, Yang T et al (2021) The effect of thyroid function on the risk of psychiatric readmission after hospitalization for major depressive disorder. Psychiatry Res 305:114205. https://doi.org/10.1016/j.psychres.2021.114205CrossRefPubMed

Bekkering GE, Agoritsas T, Lytvyn L et al (2019) Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. BMJ 365:I2006. https://doi.org/10.1136/bmj.l2006CrossRef

Liu F-H, Hwang J-S, Kuo C-F et al (2018) Subclinical hypothyroidism and metabolic risk factors association: a health examination-based study in northern Taiwan. Biomed J 41:52–58. https://doi.org/10.1016/j.bj.2018.02.002CrossRefPubMedPubMedCentral

10.

He J, Lai Y, Yang J et al (2021) The relationship between thyroid function and metabolic syndrome and its components: a cross-sectional study in a Chinese population. Front Endocrinol (Lausanne) 12:661160. https://doi.org/10.3389/fendo.2021.661160CrossRefPubMed

11.

Chang C-H, Yeh Y-C, Caffrey JL et al (2017) Metabolic syndrome is associated with an increased incidence of subclinical hypothyroidism—a Cohort Study. Sci Rep 7:6754. https://doi.org/10.1038/s41598-017-07004-2CrossRefPubMedPubMedCentral

12.

Wu Z, Jiang Y, Zhou D et al (2022) Sex-specific association of subclinical hypothyroidism with incident metabolic syndrome: a population-based cohort study. J Clin Endocrinol Metab 107:e2365–e2372. https://doi.org/10.1210/clinem/dgac110CrossRefPubMed

13.

Loh HH, Lim LL, Yee A, Loh HS (2019) Association between subclinical hypothyroidism and depression: an updated systematic review and meta-analysis. BMC Psychiatry 19:12. https://doi.org/10.1186/s12888-018-2006-2CrossRefPubMedPubMedCentral

14.

Tang R, Wang J, Yang L et al (2019) Subclinical hypothyroidism and depression: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 10:340. https://doi.org/10.3389/fendo.2019.00340CrossRefPubMed

15.

Kim M-D, Yang H-J, Kang NR et al (2020) Association between subclinical hypothyroidism and metabolic syndrome among individuals with depression. J Affect Disord 264:494–497. https://doi.org/10.1016/j.jad.2019.11.080CrossRefPubMed

16.

Fang X, Wang D, Tang W et al (2021) Anhedonia difference between major depressive disorder and bipolar disorder II. BMC Psychiatry 21:531. https://doi.org/10.1186/s12888-021-03548-wCrossRefPubMedPubMedCentral

17.

Liu W, Wu Z, Sun M et al (2022) Association between fasting blood glucose and thyroid stimulating hormones and suicidal tendency and disease severity in patients with major depressive disorder. Bosn J Basic Med Sci 22:635–642. https://doi.org/10.17305/bjbms.2021.6754CrossRefPubMedPubMedCentral

18.

Zimmerman M, Martinez JH, Young D et al (2013) Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 150:384–388. https://doi.org/10.1016/j.jad.2013.04.028CrossRefPubMed

19.

Thompson E (2015) Hamilton Rating Scale for Anxiety (HAM-A). Occup Med (Lond) 65:601. https://doi.org/10.1093/occmed/kqv054CrossRefPubMed

20.

Zhou Y, Wang Q, Ren H et al (2022) Prevalence and related factors of anxiety in first episode and drug naïve Chinese Han outpatients with psychotic major depression. J Affect Disord 316:217–222. https://doi.org/10.1016/j.jad.2022.08.018CrossRefPubMed

21.

Lim K, Peh O-H, Yang Z et al (2021) Large-scale evaluation of the Positive and Negative Syndrome Scale (PANSS) symptom architecture in schizophrenia. Asian J Psychiatr 62:102732. https://doi.org/10.1016/j.ajp.2021.102732CrossRefPubMed

22.

Shen Y, Wei Y, Yang X-N et al (2020) Psychotic symptoms in first-episode and drug naïve patients with major depressive disorder: Prevalence and related clinical factors. Depress Anxiety 37:793–800. https://doi.org/10.1002/da.23026CrossRefPubMed

23.

Li Y-C, Bai W, Cai H et al (2022) Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 12:303. https://doi.org/10.1038/s41398-022-02045-2CrossRefPubMedPubMedCentral

24.

Zhao M, Yang T, Chen L et al (2015) Subclinical hypothyroidism might worsen the effects of aging on serum lipid profiles: a population-based case-control study. Thyroid 25:485–493. https://doi.org/10.1089/thy.2014.0219CrossRefPubMed

25.

Li X, Zhen D, Zhao M et al (2017) Natural history of mild subclinical hypothyroidism in a middle-aged and elderly Chinese population: a prospective study. Endocr J 64:437–447. https://doi.org/10.1507/endocrj.EJ16-0549CrossRefPubMed

26.

Chen Q, Zhu H, Shen F et al (2020) Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 diabetes. J Diabetes Complic 34:107537. https://doi.org/10.1016/j.jdiacomp.2020.107537CrossRef

27.

Su Y, Lu Y, Li W et al (2020) Prevalence and correlation of metabolic syndrome: a cross-sectional study of nearly 10 million multi-ethnic Chinese adults. Diabetes Metab Syndr Obes 13:4869–4883. https://doi.org/10.2147/DMSO.S278346CrossRefPubMedPubMedCentral

28.

Qin X, Qiu L, Tang G et al (2020) Prevalence of metabolic syndrome among ethnic groups in China. BMC Public Health 20:297. https://doi.org/10.1186/s12889-020-8393-6CrossRefPubMedPubMedCentral

29.

Lan Y, Mai Z, Zhou S et al (2018) Prevalence of metabolic syndrome in China: An up-dated cross-sectional study. PLoS ONE 13:e0196012. https://doi.org/10.1371/journal.pone.0196012CrossRefPubMedPubMedCentral

30.

Li R, Li W, Lun Z et al (2016) Prevalence of metabolic syndrome in Mainland China: a meta-analysis of published studies. BMC Public Health 16:296. https://doi.org/10.1186/s12889-016-2870-yCrossRefPubMedPubMedCentral

31.

Huang Y-C, Lin P-Y, Lee Y et al (2021) Metabolic syndrome components and leukocyte telomere length in patients with major depressive disorder. World J Biol Psychiatry. https://doi.org/10.1080/15622975.2021.2013091CrossRefPubMed

32.

Kahl KG, Greggersen W, Schweiger U et al (2012) Prevalence of the metabolic syndrome in unipolar major depression. Eur Arch Psychiatry Clin Neurosci 262:313–320. https://doi.org/10.1007/s00406-011-0277-4CrossRefPubMed

33.

Moreira FP, Jansen K, de Cardoso TA et al (2017) Metabolic syndrome in subjects with bipolar disorder and major depressive disorder in a current depressive episode: population-based study: Metabolic syndrome in current depressive episode. J Psychiatr Res 92:119–123. https://doi.org/10.1016/j.jpsychires.2017.03.025CrossRefPubMed

34.

Marazziti D, Rutigliano G, Baroni S et al (2014) Metabolic syndrome and major depression. CNS Spectr 19:293–304. https://doi.org/10.1017/S1092852913000667CrossRefPubMed

35.

Qiu W, Cai X, Zheng C et al (2021) Update on the relationship between depression and neuroendocrine metabolism. Front Neurosci 15:728810. https://doi.org/10.3389/fnins.2021.728810CrossRefPubMedPubMedCentral

36.

Wei Y-G, Cai D-B, Liu J et al (2020) Cholesterol and triglyceride levels in first-episode patients with major depressive disorder: a meta-analysis of case-control studies. J Affect Disord 266:465–472. https://doi.org/10.1016/j.jad.2020.01.114CrossRefPubMed

37.

Bharti V, Bhardwaj A, Hood K et al (2021) A systematic review and meta-analysis of lipid metabolomic signatures of Major Depressive Disorder. J Psychiatr Res 139:197–205. https://doi.org/10.1016/j.jpsychires.2021.05.036CrossRefPubMed

38.

Wang X, Yang L, Liu J et al (2022) Association of serum lipid levels with psychotic symptoms in first-episode and drug naïve outpatients with major depressive disorder: a large-scale cross-sectional study. J Affect Disord 297:321–326. https://doi.org/10.1016/j.jad.2021.10.053CrossRefPubMed

39.

Ma Y-J, Zhou Y-J, Wang D-F et al (2020) Association of lipid profile and suicide attempts in a large sample of first episode drug-naive patients with major depressive disorder. Front Psychiatry 11:543632. https://doi.org/10.3389/fpsyt.2020.543632CrossRefPubMedPubMedCentral

40.

Delitala AP, Scuteri A, Maioli M et al (2019) Subclinical hypothyroidism and cardiovascular risk factors. Minerva Med 110:530–545. https://doi.org/10.23736/S0026-4806.19.06292-XCrossRefPubMed

41.

Li R-C, Zhang L, Luo H et al (2020) Subclinical hypothyroidism and anxiety may contribute to metabolic syndrome in Sichuan of China: a hospital-based population study. Sci Rep 10:2261. https://doi.org/10.1038/s41598-020-58973-wCrossRefPubMedPubMedCentral

42.

Zhao S, Chen Z, Wang X et al (2021) Increased prevalence of subclinical hypothyroidism in female hospitalized patients with depression. Endocrine 72:479–485. https://doi.org/10.1007/s12020-020-02490-3CrossRefPubMed

43.

Ding X, Zhao Y, Zhu C-Y et al (2021) The association between subclinical hypothyroidism and metabolic syndrome: an update meta-analysis of observational studies. Endocr J 68:1043–1056. https://doi.org/10.1507/endocrj.EJ20-0796CrossRefPubMed

44.

Biondi B, Kahaly GJ, Robertson RP (2019) Thyroid dysfunction and diabetes mellitus: two closely associated disorders. Endocr Rev 40:789–824. https://doi.org/10.1210/er.2018-00163CrossRefPubMedPubMedCentral

45.

Gupta S, Mukherjee A, Biswas S et al (2017) Evaluation of endocrine parameters as predictor of major depressive disorder. Indian J Psychol Med 39:766–769. https://doi.org/10.4103/IJPSYM.IJPSYM_120_17CrossRefPubMedPubMedCentral

46.

Kvetny J, Heldgaard PE, Bladbjerg EM, Gram J (2004) Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years. Clin Endocrinol (Oxf) 61:232–238. https://doi.org/10.1111/j.1365-2265.2004.02088.xCrossRefPubMed

47.

Kalinowska S, Trześniowska-Drukała B, Safranow K et al (2019) Association between thyroid function and metabolic syndrome in male and female schizophrenia patients. Psychiatry Res 274:167–175. https://doi.org/10.1016/j.psychres.2019.02.029CrossRefPubMed

48.

Zhao C, Wang Y, Xiao L, Li L (2022) Effect of levothyroxine on older patients with subclinical hypothyroidism: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 13:913749. https://doi.org/10.3389/fendo.2022.913749CrossRefPubMed

49.

Gurka MJ, Filipp SL, Musani SK et al (2018) Use of BMI as marker of adiposity in a metabolic syndrome severity score: derivation and validation in predicting long-term disease outcomes. Metabolism 83:68–74. https://doi.org/10.1016/j.metabol.2018.01.015CrossRefPubMedPubMedCentral

50.

Li Y, Zhao L, Yu D et al (2018) Metabolic syndrome prevalence and its risk factors among adults in China: a nationally representative cross-sectional study. PLoS ONE 13:e0199293. https://doi.org/10.1371/journal.pone.0199293CrossRefPubMedPubMedCentral

51.

Grundy SM (2016) Metabolic syndrome update. Trends Cardiovasc Med 26:364–373. https://doi.org/10.1016/j.tcm.2015.10.004CrossRefPubMed

Title: Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study
Authors: Pu Peng
Qianjin Wang
Yanan Zhou
Yuzhu Hao
Shubao Chen
Qiuxia Wu
Manyun Li
Yunfei Wang
Qian Yang
Xin Wang
Yueheng Liu
Yuejiao Ma
Li He
Huixue Xu
Zejun Li
XiaoE Lang
Tieqiao Liu
Xiangyang Zhang
Publication date: 24-03-2023
Publisher: Springer Berlin Heidelberg
Keywords: Suicide
Obesity
Suicide
Obesity
Hyperglycemia
Hypothyroidism
Published in: European Archives of Psychiatry and Clinical Neuroscience / Issue 3/2024
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI: https://doi.org/10.1007/s00406-023-01588-9

At a glance: The STEP trials

Springer Medicine

Association of subclinical hypothyroidism with metabolic syndrome and its components among outpatients with first-episode drug-naïve major depressive disorder: a large-scale cross-sectional study

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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