Long-term treatment of children with epilepsy with valproate or carbamazepine may cause subclinical hypothyroidism

PURPOSE: The aim of the study was to evaluate serum thyroid hormone balance in children receiving long-term therapy with carbamazepine (CBZ), valproate (VPA), and phenobarbital (PB). METHODS: We determined serum levels of triiodothyronine (T3), thyroxine (T4), free thyroxine (FT4), thyroxine-binding globulin (TBG), and thyroid-stimulating hormone (TSH) in 148 healthy children and 141 children with epilepsy who had been receiving CBZ (61 patients), VPA (51 patients), or PB (29 patients) for 12-161 months. In view of TSH values, three categories of subclinical hypothyroidism were considered: I, TSH greater than the control-group mean + 2 SD (4.37 mIU/L in our study) and <6 mIU/L; II, TSH between 6 and 12 mIU/L; and III, TSH >12 mIU/L. RESULTS: In all treated groups, mean T4 and FT4 levels were lower than in the control group, whereas the CBZ- and VPA-treated children additionally showed reduced mean T3 and TBG levels and increased mean TSH levels. In the group receiving CBZ, 8.2% had TSH values higher than the normal-range maximum, by comparison with only 3.6% of healthy children. The increase in TSH levels was particularly marked in VPA-treated children, accounting for 26% of patients with subclinical hypothyroidism. CONCLUSIONS: Our results, in contrast to previous reports, suggest that CBZ and particularly VPA may induce subclinical hypothyroidism. This suggests a need for careful monitoring of TSH levels in children receiving CBZ or VPA.     

抗癫痫药物对癫痫患者甲状腺激素水平影响的研究

目的 研究癫痫患者甲状腺激素水平和抗癫痫药物对其影响以及与疗效之间的关系。方法 测定已确诊的45例未服用过抗癫痫药物的癫痫患者血清甲状腺激素水平并与30例健康对照组进行比较。再经卡马西平、苯妥英钠、丙戊酸钠三种抗癫痫药物分组单药治疗3个月、6个月、年后观察甲状腺激素水平的变化及与疗效之间的关系。结果 未服用抗癫痫药物的新诊断癫痫患者游离甲状腺素（FT4）水平显著低于健康对照组,经苯妥英钠、卡马西平分别治疗3个月、6个月、1年后T4、FT4、FT3显著低于治疗前水平,TSH无显著性变化。经丙戊酸钠治疗后的不同时间段各甲状腺激素水平与治疗前比较无显著性差异（P＞0．05）。甲状腺激素水平的变化与化疗效之间似无相关性。结论 癫痫的反复发作虽未经抗癫痫药物治疗已存在FT4水平的降低。苯妥英钠、卡马西平可明显造成癫痫患者的亚临床甲状腺功能降低（T4、FT4、FT3下降）,丙戊酸钠对患者甲状腺激素水平无显著影响。甲状腺激素水平的变化与疗效之间无相关性。     

Carbamazepine and risk of hypothyroidism: a prospective study

OBJECTIVES - While carbamazepine (CBZ) decreases thyroid hormone concentrations it rarely causes hypothyroidism. We assessed prospectively the early effect of CBZ on thyroid status in thyroxine-supplemented hypothyroid patients, when compared with patients without a thyroid disorder. METHODS - In 29 patients, thyrotropin (TSH), total thyroxine (TT4) and free thyroxine (FT4) serum levels were assayed before starting CBZ, and then weekly for 7 weeks. Nineteen patients with no thyroid disorder (group A) were compared with 10 thyroxine-supplemented hypothyroid patients, stable before CBZ treatment (group B). RESULTS - In group A, TT4 decreased significantly by ca. 15-25%, starting from the first week (Friedman, P < 0.001). FT4 decline was smaller (ca. 10-15%) and delayed till the second week. FT4/TT4 ratio increased significantly (P < 0.001), while TSH only slightly (P = 0.073), never exceeding normal range. In group B, similar TT4 and FT4 decline was followed by significantly increasing TSH (P = 0.011), while the FT4/TT4 ratio was not significantly changed. In 3 of 10 patients TSH rose over 5 mIU/l, necessitating treatment adjustment. CONCLUSIONS - In patients with no thyroid disorder, CBZ causes hormonal changes of no clinical relevance, due to adaptive response. In T4-supplemented hypothyroid patients this adaptation is lacking, CBZ may precipitate subclinical or overt hypothyroidism, and early thyroid function monitoring seems advisable.     

Thyroid function in men taking carbamazepine, oxcarbazepine, or valproate for epilepsy

PURPOSE: Antiepileptic drugs (AEDs) may affect serum thyroid hormone concentrations. This study aimed to evaluate thyroid function in men taking carbamazepine (CBZ), oxcarbazepine (OCBZ), or valproate (VPA) for epilepsy. METHODS: Ninety men with epilepsy (40 taking CBZ, 29 taking OCBZ, and 21 taking VPA monotherapy) and 25 control subjects participated in the study. After clinical examination, a blood sample for hormone, gamma-glutamyl-transferase (GGT) and antibody (ab) assays was obtained. RESULTS: Serum thyroxine (T4) and free thyroxine (FT4) concentrations were low in men taking CBZ or OCBZ. Forty-five percent of men taking CBZ and 24% of men taking OCBZ had serum T4 and/or FT4 levels below the reference range. However, no correlations were found between T4 or FT4 and GGT concentrations in men taking CBZ or OCBZ. Thirteen percent of men taking CBZ, 17% of men taking OCBZ, and 6% of control men had increased levels of thyroid peroxidase (TPO)-ab and/or thyroglobulin (TG)-ab, but these were not associated with altered serum thyroid hormone concentrations. Serum triiodothyronine and thyrotropin levels in men taking CBZ or OCBZ were normal. In men taking VPA, the concentrations of thyroid hormones, thyrotropin, and antithyroid ab were normal. CONCLUSIONS: Serum thyroid hormone concentrations are low in CBZ- or OCBZ-treated men. However, these low levels do not seem to be due to liver enzyme induction or activation of immunologic mechanisms. Therefore, interference with hypothalamic regulation of thyroid function by CBZ and OCBZ seems possible. VPA does not have any significant effects on thyroid function.     

急性脑出血患者血清甲状腺激素水平的变化及其意义

目的探讨急性脑出血患者血清甲状腺激素水平的变化及其意义。方法 65例急性脑出血患者于入院第1 d、第3 d、第7 d、第15 d,52名正常对照者于体检日进行血清三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离T3(FT3)、游离T4(FT4)和促甲状腺激素(TSH)水平检测和比较。并对不同病情及预后的急性脑出血患者入院第3 d的血清甲状腺激素水平进行比较。结果与正常对照组比较,急性脑出血组入院第1 d、第3 d、第7 d时血清T3、FT3水平明显降低,血清T4、FT4水平明显增高(均P<0.05)。与急性脑出血轻度亚组比较,中度亚组及重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血中度亚组比较,重度亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。与急性脑出血显著进步亚组比较,进步亚组及死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05);与急性脑出血进步亚组比较,死亡亚组血清T3、FT3水平明显降低,血清T4、FT4及TSH水平明显增高(均P<0.05)。结论急性脑出血...     

难治性抑郁症患者甲状腺激素水平的分析

目的 探讨难治性抑郁症患者的甲状腺激素水平。方法 按性别、年龄1：1匹配选取难治性抑郁症患者和健康对照各30例，采用放射免疫法测定患者组治疗前和对照组血清TSH、T3、T4、FT3、FT4水平。结果 患者组异常者17例，占56．7％，对照组异常者2例，占6．7％，两组比较，患者组甲状腺激素水平出现异常的比率明显高于对照组，主要表现为TSH升高、T3降低、FT4降低，差异均有统计学意义（P〈0．05）。结论 难治性抑郁症患者中有56．7％的患者存在亚临床型甲状腺功能的减退。     

Sinemet and thyroid function in Parkinson disease

Patients on chronic carbidopa-levodopa (Sinemet) therapy underwent thyroid function testing that included measurement of serum thyroxine (T4), triiodothyronine (t3), thyrotropin (TSH), T3 uptake (T3U), free T4 index (FT4I), and free T3 index (FT3I). The subjects were studied both in a random sampling and in a controlled manner, fasting and 2 hours after receiving the drug. All subjects were euthyroid by testing, and there was no significant difference in thyroid hormone levels of patients and controls or in fasting values and values 2 hours after the drug. However, there was a small but significant reduction in serum TSH levels after Sinemet. Therapeutic doses of Sinemet have no significant effect on thyroid function in euthyroid patients with Parkinson disease.     

Thyroid Function with Antiepileptic Drugs

Serum thyroid hormone balance was assessed in 108 patients receiving chronic antiepileptic drug (AED) therapy. Forty-five patients were receiving carbamazepine (CBZ), 26 phenytoin (PHT), 16 CBZ-PHT, 11 valproate (VPA), and 10 CBZ-VPA. Serum thyroxine (T4) and free thyroxine (FT4) concentrations were low in patient groups receiving CBZ and/or PHT. Serum T4 concentrations were below the normal range in 24 (53.3%) CBZ patients, 11 (42.3%) PHT patients, 12 (75%) CBZ-PHT patients, and in all 10 patients (100%) receiving CBZ-VPA. Furthermore, serum levels of FT4 were below the normal range in 13 (28.9%) CBZ patients, 6 PHT (23.1%) patients, 5 (31.3%) CBZ-PHT patients, and 5 (50%) CBZ-VPA patients. Despite the decreased serum T4 and FT4 levels in these patients, serum basal and stimulated thyrotropin (TSH) concentrations were normal, except for the slightly increased basal TSH in the CBZ-VPA group. In the VPA group, the findings were different from those in other patients: T4 serum levels were unchanged and FT4, T3, and basal TSH levels increased, but stimulated TSH levels did not differ from those of the control group. The decrease in serum thyroid hormone levels during CBZ and/or PHT medication probably is caused by an accelerated hepatic plasma clearance of these hormones due to induction of hepatic microsomal enzyme systems by these AEDs. VPA, an AED with no liver enzyme-inducing properties, does not cause similar changes. The feedback mechanism is not activated, possibly because of a hypothalamic interference by CBZ and PHT.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in thyroid hormones, thyroid stimulating hormone and cortisol in acute spinal cord injury.

To determine the hormonal response to acute spinal cord injury, serial serum samples were collected from 18 patients with acute spinal cord injury and from 14 control patients with spinal fractures without cord injury. The first sample was taken within 24 hours of injury, the second at 24-48 hours; and the third at 7 days for determination of thyroxine (T4), free T4 (FT4), triiodothyronine (T3), reverse T3 (rT3), T3 uptake (T3U), thyroid stimulating hormone (TSH), thyroxine binding globulin (TBG), growth hormone (GH), cortisol, and insulin. Significant increases were observed in rT3 levels and transient changes were observed in the T4 and T3 levels in the spinal cord injured group but not in the group with spinal fractures alone. The changes in the spinal cord injured patients are consistent with the 'low T3 syndrome'. However, the persisting rise of rT3 at 7 days was an unexpected finding. In addition to the cord injury, these changes may also be related to dexamthasone administration and nutritional factors.     

急性脑梗死患者甲状腺激素变化及其临床意义

目的探讨急性脑梗死患者甲状腺激素水平的变化及其临床意义。方法采用化学发光法检测65例急性脑梗死患者治疗前后和50例健康对照者血清三碘甲状腺原氨(T3)、游离三碘甲状腺原氨(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,并对2组进行比较。结果甲状腺激素水平T4、FT4、TSH在治疗前后各组与对照组相比差异无统计学意义(P>0.05)。T3在治疗前较对照组明显降低(P<0.05),FT3治疗前与对照组相比降低更显著(P<0.01),在治疗后T3、FT3与对照组相比差异无统计学意义(P>0.05)。结论脑梗死患者急性期的保护性应激反应可引起T3和FT3下降,并且T3和FT3的降低与病情严重程度及预后密切相关,随着病情好转逐渐恢复;对于治疗前后甲状腺激素水平的变化,有助于监测治疗和判断预后有一定临床意义。     

卒中恢复期甲状腺激素水平与认知功能的相关性研究

目的 探讨卒中恢复期患者甲状腺激素水平与认知功能的相关性,为认知功能康复提供参考。 方法 前瞻性连续纳入2018年12月-2020年1月于石家庄市人民医院康复医学科收治的卒中恢复期 患者为研究对象,根据MMSE评分将患者分为认知功能损害组和无认知功能损害组。比较两组甲状 腺激素各项指标水平,包括三碘甲状腺原氨酸（triiodothyronine,T3）、甲状腺素、游离三碘甲状腺原氨 酸（free triiodothyronine,FT3）、游离甲状腺素及促甲状腺激素水平,采用多元线性回归分析甲状腺激 素各项指标水平与MMSE评分的相关性。 结果 最终纳入210例患者,平均年龄59.97±7.12岁,男性138例（65.7%）,其中认知功能损害组146 例,无认知功能损害组64例。认知功能损害组T3、FT3水平低于无认知功能损害组,差异有统计学意 义。多元线性回归分析结果显示,卒中恢复期患者血清T3、FT3水平与MMSE评分呈正相关（β=0.389, P <0.001;β=0.237,P =0.014）。 结论 卒中恢复期患者血清T3、FT3水平越低,提示认知功能损害越重。临床工作中应积极关注卒 中恢复期患者甲状腺激素水平,以尽早给予全面地康复干预。     

Long;-term observation of the hypgthalamic-pituitary-thyroid (HPT) axis in alcohol-dependent patients

Thyroid hormone levels and thyrotrophin (TSH) were measured in 45 alcohol-dependent patients before detoxification and 8 days, 3 months and 6 months after detoxification, and compared to levels in healthy controls. Before detoxification, levels of thyroxine (T₄) and thyroxine-binding globulin (TBG) were significantly reduced in patients compared with healthy controls, while triiodothyronine (T₃), reverse T₃, and TSH levels did not differ from those in healthy controls. During the entire observation period, free T₄ (fT₄) and free T, (fT₃) levels were slightly elevated compared with those in healthy controls. T₄ and TBG levels increased significantly during the first week of abstinence. Severity of withdrawal symptoms was negatively correlated with the total T₄ levels after 8 days of abstinence. Three months after detoxification, relapsers displayed significantly lower T₄ and TBG levels compared with abstinent patients. The increase in T₃ levels was most pronounced between 8 days and 3 months of abstinence in both relapsing and abstinent patients. Six months after detoxification, only abstinent patients could be assessed, and they displayed increased TBG and T₃ levels compared to healthy controls. Our findings suggest a different time-course for T₃ and T₄ levels after detoxification in alcohol-dependent patients, and indicate that T₄ levels after detoxification interact with withdrawal symptoms.     

Evaluation of thyroid and parathyroid functions in children receiving long-term carbamazepine therapy

We studied serum calcium, phosphorus, alkaline phosphatase (ALP), thyroid hormones (total thyroxine [TT4], free thyroxine [FT4], thyroid-stimulating hormone [TSH]), parathyroid hormone (PH), and osteocalcine levels in children with epilepsy who had been receiving long-term carbamazepine (CBZ) therapy to determine whether there was any effect of CBZ therapy on these hormones. The study included 18 patients with epilepsy receiving CBZ and 16 healthy age-matched controls. The age ranged from 4-18 years (11.26 +/- 3.59 years) and 4.5-17 years (11.16 +/- 3.13 years) in the study and control group, respectively. The duration of CBZ use was between 10 months-5 years (3.12 +/- 1.09 years). When comparing the results we did not find any significant difference in serum calcium, phosphorus, ALP, osteocalcine and TSH and PH levels between the groups (p >.05). However, serum TT4 and FT4 levels were found to be significantly lower in the study group than those of control group (p <.05). However, we observed no clinical signs of hypothyroidism in all subjects. To these findings we suggest that serum thyroid hormone levels should be monitored in children receiving long-term CBZ therapy.     

Brief Communication: EVALUATION OF THYROID AND PARATHYROID FUNCTIONS IN CHILDREN RECEIVING LONG-TERM CARBAMAZEPINE THERAPY

We studied serum calcium, phosphorus, alkaline phosphatase (ALP), thyroid hormones (total thyroxine [TT4], free thyroxine [FT4], thyroid-stimulating hormone [TSH]), parathyroid hormone (PH), and osteocalcine levels in children with epilepsy who had been receiving long-term carbamazepine (CBZ) therapy to determine whether there was any effect of CBZ therapy on these hormones. The study included 18 patients with epilepsy receiving CBZ and 16 healthy age-matched controls. The age ranged from 4-18 years (11.26 &#45 3.59 years) and 4.5-17 years (11.16 &#45 3.13 years) in the study and control group, respectively. The duration of CBZ use was between 10 months-5 years (3.12 &#45 1.09 years). When comparing the results we did not find any significant difference in serum calcium, phosphorus, ALP, osteocalcine and TSH and PH levels between the groups (p >. 05). However, serum TT4 and FT4 levels were found to be significantly lower in the study group than those of control group (p <. 05). However, we observed no clinical signs of hypothyroidism in all subjects. To these findings we suggest that serum thyroid hormone levels should be monitored in children receiving long-term CBZ therapy.­­     

情感性精神障碍治疗前后血清甲状腺激素水平的对照观察

目的了解血清甲状腺激素水平与情感性精神障碍的关系。方法对２６例住院的情感性精神障碍患者做了治疗前后血清三碘甲状腺原氨酸（Ｔ３）、甲状腺素（Ｔ４）、Ｔ３树脂摄取比值（ＲＵＲ）和游离甲状腺素指数（ＦＴ４Ｉ）的对照观察，其中躁狂发作１９例，抑郁发作７例。同时以３０名健康人作为对照组。治疗前后应用Ｂｅｃｈ－Ｒａｆａｅｌｓｅｎ躁狂量表（ＢＲＭＳ）和汉密尔顿抑郁量表（ＨＡＭＤ）评定躁狂和抑郁症状的严重程度。结果患者组治疗前后的Ｔ４（１４２±４０和１３１±３７ｍｍｏｌ／Ｌ）、ＦＴ４Ｉ（１０．６±３．４和１０．５±３．７ｍｍｏｌ／Ｌ）明显高于对照组（１１１±２２，８．３±２．４ｍｍｏｌ／Ｌ）。治疗前７例躁狂发作患者的Ｔ３（１．０９±０．１６ｍｍｏｌ／Ｌ）低于正常组（２．０±０．５ｍｍｏｌ／Ｌ）；抑郁发作的Ｔ４（１７９±３１ｍｍｏｌ／Ｌ）、ＦＴ４Ｉ（１２．５±４．５ｍｍｏｌ／Ｌ）治疗前高于正常水平，治疗后均恢复到正常范围，ＢＲＭＳ和ＨＡＭＤ评分也随之明显下降。结论提示某些情感性精神障碍患者的甲状腺激素改变与症状的消长有关，甲状腺素异常是继发于情绪障碍，这种类型可能是情感性精神障碍的具有某种生物学异常的一个亚型。     

Serum thyroid hormones and blood folic acid during monotherapy with carbamazepine or valproate

Studies investigating the influence of antiepileptic drugs on thyroid hormones usually have compared patients chronically treated with antiepileptic drugs to controls. To date, this type of designs has produced divergent results both with regard to individual drugs and individual thyroid hormones. The present study comprised 31 patients with newly diagnosed epilepsy, commencing treatment with either carbamazepine or valproate. T3, T4, FT4, FT3, rT3, TSH, T3 resin uptake and blood folic acid, were determined before and during antiepileptic monotherapy, thus making the patient his own control. During treatment with carbamazepine, a significant decrease in T4, FT4, FT3, rT3 and TBG was observed. Valproate caused a decrease in T4, FT4 and T3. Neither of the drugs caused any changes in blood folic acid concentrations or persistent increases in the TSH values. None of the patients developed overt symptoms of hypothyreoidism. Conceivable mechanisms underlying these hormonal changes are reviewed.     

抑郁症患者抗抑郁药治疗效果与述情障碍及甲状腺功能的关系

目的:探讨抑郁症患者抗抑郁药治疗的效果与述情障碍及甲状腺功能的关系。方法:52例抑郁症患者经抗抑郁治疗8周后给予汉密尔顿抑郁量表(HAMD-17)评定,≤7分为治愈组(28例),7分为非治愈组(24例);于治疗前检测三碘甲状腺原氨酸(T3)、总甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)水平;采用多伦多述情障碍量表(TAS-20)于治疗前后评估述情障碍程度,对述情障碍与甲状腺激素水平的相关性进行分析。结果:治疗前治愈组TAS总分、F1、F2因子分低于非治愈组(Z=-2.493,t=-2.99,Z=-2.530;P0.05或P0.01);T3、T4水平高于非治愈组(Z=-2.801,Z=-2.294;P0.05或P0.01)。相关分析显示,治疗前TAS总分、F1因子分与T3、T4呈负相关(r=-0.291~-0.399;P0.05或P0.01)。结论:抑郁症患者的述情障碍越重则甲状腺激素水平越低,抗抑郁药疗效越差;反之亦然。     

The prognostic significance of thyroid function in mania

Free thyroxine index (FT4I) and thyroxine (T4) levels were measured in 31 manic patients shortly after admission to a psychiatric hospital. Over one-third had elevated thyroid hormone levels, and this was largely due to increases in FT4I. Increased FT4I levels were associated with greater sleep disturbance and with being male, and were negatively associated with having had hospital admissions in the past six months. More interestingly, however, low FT4I levels prospectively predicted more hospital admissions in the 12 months from index admission, and this was not due to past admissions predicting future admissions. This adds to the growing literature on important relationships between thyroid hormones and treatment outcome in patients with affective disorders.     

焦虑与抑郁障碍共病患者症状与血清甲状腺激素水平的相关分析

目的探讨焦虑与抑郁障碍共病患者症状与血清甲状腺激素及促甲状腺激素(TSH)水平的相关性,为焦虑与抑郁障碍共病的治疗提供理论依据。方法采用单纯随机抽样法,于2014年1月-2015年6月在四川省人民医院心身医学中心抽取50例符合《美国精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)中焦虑与抑郁障碍共病诊断标准的首次住院患者为研究对象。采用化学发光分析法检测患者血清总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、促甲状腺激素(TSH)水平,并对患者进行焦虑自评量表(SAS)、抑郁自评量表(SDS)及症状自评量表(SCL-90)评定。结果焦虑抑郁障碍共病患者的甲状腺激素各项及TSH水平与SAS、SDS评分均无相关性(P均0.05);TT_4水平与SCL-90的躯体化因子评分呈负相关;FT_4水平与SCL-90中的其他因子评分呈负相关。结论焦虑与抑郁障碍共病患者的症状水平与血清甲状腺激素水平有一定的相关性。甲状腺激素水平的异常与焦虑抑郁障碍共病患者躯体化症状、睡眠及饮食问题的产生有一定的关系。     

An evaluation of basal hypothalamic-pituitary-thyroid axis function in depression: Results of a large-scaled and controlled study

In order to evaluate the function of the hypothalamic-pituitary-thyroid (HPT)-axis in unipolar depression, the authors measured basal 0800h plasma levels of free thyroxine (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH) by means of the new, ultrasensitive assays (TSH-IRMA) in 69 healthy controls, 62 minor, 101 simple major, and 57 melancholic depressed subjects. Basal HPT-axis hormone levels of almost all (96.8%) unipolar depressed patients fell within the normal, euthyroid range. None of the major depressed subjects showed subclinical hypothyroidism. It was found that 8.8% of the melancholic subjects exhibited some degree of subclinical hyperthyroidism. Basal TSH-IRMA values were significantly lower in melancholic patients than in healthy controls, minor and simple major depressed patients, and in major vs. minor depressed subjects. FT4 circulating levels were significantly higher in melancholic patients than in all other subjects. Basal TSH-IRMA and FT4 levels were significantly correlated with severity of illness. In depression, there was a significant and negative correlation between basal TSH-IRMA values and FT4 concentrations. No significant gender- or age-related differences in TSH-IRMA or thyroid hormones were detected in depression. It is argued that—in depression research—the assays of basal TSH-IRMA should replace thyrotropin releasing hormone tests.