[Medscape] Lower thyroid hormone levels a red flag for higher suicide risk?

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Patients with anxiety and affective disorders have reduced, although “normal” levels of thyroid-stimulating hormone (TSH) may be at increased risk of suicidal thoughts, new research suggests.

In a cross-sectional study, clinical data on diagnosis, medication use, and symptom scores were collected, along with an assessment of serum thyroid hormone levels, in patients with both anxiety and depression. anxiety and emotions.

After investigators reported age, sex, symptoms, medications, and other potential confounding factors, patients with suicidal thoughts were 54% less likely to have high TSH levels. . No association was found with other thyroid hormones.

Based on the results, assessment of thyroid hormone levels “may be important for suicide prevention and may allow clinicians to assess the likelihood of suicidal ideation risk in patients with this disorder.” anxiety and affective disorders,” noted co-investigator Vilma Liaugaudaite, PhD student, Institute of Neuroscience of the Lithuanian University of Health Sciences, Palanga et al.

The findings were presented at the 34th European College of Neuropharmacology (ACNP) Meeting.

“Complex Mechanism”

Liaugaudaite told Medscape Medical Journal that thyroid hormone is known to have a “profound” effect on emotions and behavior.

Recent studies show that “various degrees of hypothalamic-pituitary-thyroid axis dysfunction are associated with suicidal behavior” in depressed patients, she adds.

Noting that disturbances in the serotonin system “constitute most of the biochemical abnormalities associated with suicidal behavior,” Liaugaudaite says, thyroid hormone is thought to be “involved in a complex compensatory mechanism.” to down-regulate central 5-hydroxytrptamne activity through lower TSH concentrations.

In addition, enhancing thyrotropin-releasing hormone, which stimulates TSH release, “is considered a compensatory mechanism to maintain normal thyroid hormone secretion and normalize serotonin activity in depressed patients,” she said. said.

To investigate the association between thyroid hormone and suicide in people with anxiety and affective disorders, researchers evaluated medical visits for stress disorders.

Social and clinical information was collected, and the patient completed a mini international Neuropsychiatric interview, patient health questionnaire-9 (PHQ-9), and disorder scale. general anxiety (GAD-7).

Fasting blood samples were also tested for free throxine (FT4), triiodothyroxine (FT3), and TSH levels.

Meaningful relationship

70 patients aged 18 to 73 participated in the study. Of these, 59 are women. Suicidal intent was identified in 42 participants. Serum FT4, FT3, and TSH levels were within normal limits.

There were no significant differences between patients with and without suicidal ideation in patient groups, sex, education, obesity, smoking and drug use.

Suicide intention was associated with high PHQ-9 scores (15.5 vs 13.3; P=0.085), and low TSH levels (1.54 IU/L vs 2/4 IU/L; P=0.092).

The association between serum TSH levels and suicidal ideation was significant after multivariable logistic regression analysis for age, sex, PHQ-9 and GAD-7 scores, education, mass index body, smoking, and the use of antidepressants, tranquilizers, mood stabilizers, and neuroleptics.

In particular, patients with suicidal ideation had significantly less high TSH levels than those without, with an odds ratio of 0.46 (P=0.027).

There was no significant association between serum free FT4 and FT3 levels and suicidal ideation.

Interesting, but preliminary

Discussing the findings with the Medscape Medical Journal, Sanjeev Sockalingam, MD, vice president and professor of psychiatry at the University of Toronto, Ontario, Canada, said it was an “interesting study” because of the literature. about trying to identify people at risk of suicidal ideation or behavior is “quite mixed, in terms of outcomes.”

However, it was a cross-sectional study with a relatively small sample size, and these naturally occurring studies often included hypothyroid patients “who eventually attempted suicide,” said Sockalingam, who did not participate. said the researcher.

“I wonder if with this sample size and group of patients, maybe other factors are also involved,” he added.

Sockalingam notes that he wants to see more data on the medications his patients are taking, and he emphasizes that thyroid levels are within the normal range, “so it’s been a bit difficult to untangle the meaning of the patient population.” there are subtle changes in thyroid levels.”

Robert Levitan, MD, Cameron Wilson Chair of Depression Research at the Center for Addiction and Mental Health, Toronto, Ontario, Canada, also emphasizes that thyroid levels are within normal limits.

He discussed with the Medical Journal Medscape that it is therefore “not likely that they are some significant biological effect on the brain” to influence suicidal ideation.

Levitan continues, “what could be happening is that there are some other clinical problems here that they just haven’t realized that lead to suicidal ideation and perhaps affect TSH to some degree.”

Although that study was “preliminary,” the findings are “interesting,” he concludes

Source: The study received no funding. Liaugaudaite, Sockalingam, and Levitan have disclosed no relevant financial relationships.

34th European College of Neuropsychopharmacology (ECNP) Congress: Abstract P.0070. Presented October 2, 2021.

Link: https://www.medscape.com/viewarticle/960731

The article is translated and edited by ykhoa.org – please do not reup without permission!

Translator: Le Vy

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