A prospective critical evaluation of in vitro thyroid function tests

A number of 2 325 serum samples from a population of in- and outpatients were collected during a six-month period in order to evaluate the usefulness of various thyroid function tests in the clinical laboratory routine. The samples were analysed with the following thyroid function tests: total triiodothyronine (T3) (TT3), total thyroxine (T4) (TT4), free T3 index (FT3I), free T4 index (FT4I) and thyrotropin (TSH). One to two years after the primary evaluation, a follow-up was performed and the final diagnoses were checked in the patients' records. The values of these parameters in the diagnosis of hyperthyroidism were: FT3I greater than FT4I greater than TT3 greater than TT4. The corresponding results in the diagnosis of hypothyroidism were: TSH greater than FT4I greater than FT3I = TT3. No single test could detect both hyper- and hypothyroidism effectively. The only one-step strategy for thyroid evaluation in patients without apparent clinical signs of hyper- or hypothyroidism would therefore be the combined determination of T3 and TSH. The study also showed distinct differences between the reference values of the healthy population and patients without thyroid disorders.     

Diurnal profiles of thyroid hormones are altered in depression.

Free thyroxine index (FT4I), serum thyroxine (T4) and thyrotrophin concentrations were measured in 45 depressed subjects and 23 controls. The FT4I am/pm ratio was significantly higher in depressed subjects than in controls. This elevated diurnal ratio of thyroid hormones in depression adds to the literature on the chronobiology of affective disorders, and may help to explain differences in thyroid hormone levels in depressed patients in other studies, where time of sampling has seldom been reported.     

The Relationships between Thyroid Hormones and Thyroid-stimulating Hormone with Lipid Profile in Euthyroid Men

Background and Aim: Alteration in lipid profile is a common observation in patients with thyroid dysfunction, but the current knowledge on the relationship between lipids and thyroid hormone levels in euthyroid state is insufficient. The current study aimed to determine the association between thyroid hormones and thyroid-stimulating hormone (TSH) with lipid profile in a euthyroid male population.Methods: A total of 708 Chinese and Malay men aged 20 years and above were recruited in this cross-sectional study. Their blood was collected for the determination of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG), free thyroxine (FT4), free triiodothyronine (FT3) and TSH levels. The association was analyzed using multiple regression and logistic regression models with adjustment for age, ethnicity, body mass index and FT4/FT3/TSH levels.Results: In multiple regression models, TSH was positively and significantly associated with TG (p<0.05). Free T4 was positively and significantly associated with TC, LDL-C and HDL-C (p<0.05). Free T3 was negatively and significantly associated with HDL-C (p<0.05). In binary logistic models, an increase in TSH was significantly associated with higher prevalence of elevated TG in the subjects (p<0.05), while an increase in FT4 was significantly associated with higher prevalence of elevated TC but a lower prevalence of subnormal HDL in the subjects (p<0.05). Free T3 was not associated with any lipid variables in the logistic regression (p>0.05).Conclusions: In euthyroid Malaysian men, there are positive and significant relationships between TSH level and TG level, and between FT4 level and cholesterol levels.     

The influence of blood chemistry on T4 and FT4I in major depression

The pathophysiology underlying thyroid dysfunction in some depressed patients has not yet been determined. In order to clarify possible biochemical influences on thyroid regulation in these patients, we retrospectively examined several thyroid indices in charts from 81 depressed inpatients and 82 psychiatric controls. The depressed group had significantly higher T4 levels and free T4 index (FT4I), as well as lower chloride (CL) levels than controls. Albumin (ALB) also tended to be higher in the depressives. After adjustment for previously reported effects of ALB and CL on thyroid hormone binding in plasma, the initial differences in thyroid indices became non-significant. We suggest from these findings that plasma biochemical factors contribute significantly to the transient changes in thyroid function observed in some acutely depressed patients. Potential explanations for these biochemical alterations are discussed.     

Gender differences in response to antidepressant treatment prescribed in primary care. Does menopause make a difference?

BACKGROUND: Epidemiological surveys have consistently reported that the prevalence of major depression in women is almost twice as high as it is in men. While it seems that no major gender differences have been observed in the severity and symptomatology of depression, results regarding differences in antidepressant treatment response are controversial, especially when considering menopause in treatment response. METHODS: A total of 242 women (95 in their menopause), and 59 men beginning antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI; Citalopram, Fluoxetine, Paroxetine or Sertraline) from 16 primary care (PC) centres were followed up during 6 months. Menopause effect and gender differences in antidepressant treatment response were evaluated. Additionally, severity and symptomatology of depression were compared among genders. RESULTS: Overall results suggest that menopause is related to a worse treatment response and to a poorer self-evaluation of global health status. No gender differences were observed in treatment response, depression severity, and symptomatology. LIMITATIONS: Since our sample included PC participants, a wide spectrum of depression severity was considered. Additionally, menopause was assessed by means of participants' self-report. CONCLUSIONS: Menopause seems to negatively affect SSRI treatment response of depressed women treated in PC.     

某院医务人员甲状腺功能检测结果分析

目的 调查我院医务人员甲状腺功能情况。方法 选取2016年1月~2018年12月在我院进行甲状腺功能检测的医务人员168名,采用化学发光分析仪检测促甲状腺素（TSH）、血清三碘甲状腺原氨酸（T3）、血清甲状腺素（T4）、血清游离三碘甲状腺原氨酸（FT3）及血清游离四碘甲状腺原氨酸（FT4）,并根据性别、岗位及年龄进行分类,比较不同性别、年龄及岗位医务人员的甲状腺功能状况。结果 168例受检者中,甲状腺功能异常34例（20.23%）,其中亚甲减所占比例最高;男性甲状腺功能异常检出率为8.06%（5/62）,女性甲状腺功能异常检出率为27.36%（29/106）,女性高于男性,差异有统计学意义（P＜0.05）;医生甲状腺功能异常检出率为11.70%（11/94）,护士甲状腺功能异常检出率为31.08%（23/74）,护士高于医生,差异有统计学意义（P＜0.05）;≥35岁男性的TSH水平为（2.94±1.90）μIU/ml,高于＜35岁男性的 (1.71±0.79) μIU/ml,差异有统计学意义（P＜0.05）;＜35岁女性TSH水平为（3.08±2.75）μIU/ml,高于＜35岁男性的 (1.71±0.79) μIU/ml,差异有统计学意义（P＜0.05）;＜35岁女性FT3为（2.75±0.45）pg/ml,FT4为（12.78±1.96）pg/ml ,低于＜35岁男性的FT3（3.02±0.59）pg/ml、FT4（13.97±1.90）pg/ml,差异有统计学意义（P＜0.05）。结论 我院医务人员甲状腺功能紊乱发病率较高,以亚甲减为主,其中女性发病率高于男性,护士发病率高于医生,年龄因素对甲状腺疾病有一定影响。     

帕罗西汀治疗伴情绪障碍甲亢患者的临床观察

目的：探讨甲亢患者情绪障碍的特点及抗抑郁剂帕罗西汀对其治疗效果，方法：收集初诊甲亢患者82例，并对52例伴有抑郁情绪的患者在抗甲亢药物治疗的基础上，对随机单盲法分成观察组25例，用帕罗西汀20g/日治疗，对照组27例未用帕罗西汀治疗，观察8周，结果：63．41％的甲亢患者初诊时伴有抑郁情绪。治疗第四周及第八周发现，观察组比对照组抑郁、焦虚分值下降显著，观察组患者甲状腺激素TT3、TT4下降较对照组显著。观察组未见明显副反应。结论抑制郁剂不仅能改善甲亢患者伴有的抑郁、焦虑情绪，而且改善原发病的康复。     

Are there gender differences in major depression and its response to antidepressants?

BACKGROUND: The prevalence of major depression for women is about twice that for men. This gender difference in prevalence rates has led to much research addressing gender differences in the presentation and features of major depression, and, to a lesser extent, research addressing gender differences in treatment response and personality. However, studies differ considerably in the population sampled, and findings vary significantly. In the current retrospective examination of data, we investigated all of these variables in one single sample of outpatients with major depression seen in a tertiary care centre. METHODS: A sample of 139 men and 246 women with major depression receiving antidepressant treatment (SSRIs, TCAs, SNRIs, MAOIs, or RIMAs) in an outpatient setting were contrasted with regard to symptoms and severity of depression, course of illness, treatment response, and personality. RESULTS: Women were found to experience more vegetative and atypical symptoms, anxiety, and anger than men, and to report higher severity of depression on self-report measures. Regarding personality, women scored higher on conscientiousness, the extraversion facet warmth, the openness facet feelings, and sociotropy. Effect sizes were small to moderate. No differences were found in the course of the illness and treatment response. LIMITATIONS: Findings are not generalizable to inpatient or community samples, and some of the gender differences may be accounted for by gender differences in treatment seeking behaviour. CONCLUSIONS: While men and women receiving antidepressant treatment show some gender differences in the psychopathology of major depression, these differences do not appear to translate into differences in response to antidepressants. Gender differences in personality appear less profound than in the average population, indicating the potential role of a certain personality type that predisposes individuals to develop clinical depression, independent of gender. CLINICAL RELEVANCE: The current examination underscores the role gender plays in the presentation and treatment of major depression.     

Gender and Depression in Men: Extending Beyond Depression and Extending Beyond Gender

The study of gender issues in men is an interesting, relatively new, area of focus in depression research. It is exciting to anticipate the continued development of the gender frameworks described by Addis (2008) , as they are more thoroughly investigated. Given the high comorbidity rates in depression and the wealth of research on risk factors for depression, it is important that researchers who enter this arena remember (a) not to limit their exploration of gender in men to only depression nor (b) to focus their study of risk factors for depression in men too exclusively on gender issues.     

Young adult reference ranges for thyroid function tests on the Centaur immunoassay analyser

This study aims to establish reference ranges for thyroid tests in young Saudi adults using the Centaur immunoassay method. Physical examination is performed and thyroid function tests include thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3). These are performed on 291 young Saudi adults (182 [63%] females and 109 [37%] males; average age: 27 years [range 18-50]). Clinical thyroid abnormality, related symptoms and/or abnormal thyroid function tests exclude a person from the study and thus a total of 276 subjects (171 [62%] females and 105 [38%] males) are used to establish the new reference ranges. Combined female and male ranges for TSH, FT4, and FT3 were found to be 0.48-6.30 miu/L (9.00-18.62 pmol/L and 3.39-6.85 pmol/L, respectively). Mean TSH and FT4 levels were significantly different (P<0.0001) from those quoted by the manufacturer. Ranges for TSH were 0.48-6.30 miu/L (female) and 0.52-4.89 miu/L (male) (P=0.08). Female ranges for FT4 and FT3 were 9.00-17.15 pmol/L and 3.39-5.82 pmol/L, respectively. Male ranges were 9.92-18.62 pmol/L (P=0.0001) and 4.36-6.85 pmol/L (P<0.0001). The range of TSH levels in the young local Saudi population proved to be higher than that quoted by the manufacturer. FT4 range was lower and narrower than that quoted by the manufacturer. Significant differences between female and male populations suggest that partitioning of the reference ranges by gender is necessary.     

The relationship of deiodinase 1 genotype and thyroid function to lifetime history of major depression in three independent populations

Major depression (MD) is often associated with disturbances of the hypothalamic/pituitary/thyroid (HPT) axis. Unfortunately, whether this association is secondary to common underlying genetic variation or whether the MD‐associated disturbances in HPT function are chronic or state‐dependent is unknown. To examine these questions, we genotyped 12 single nucleotide polymorphisms identified in previous genome wide association analyses of thyroid function in DNA contributed by 1,555 subjects from three longitudinal ethnically diverse studies that are well‐characterized for lifetime MD and thyroid function. We then examined associations between genetic variants and key outcomes of thyroid stimulating hormone, free thyroxine (FT4) and depression. We confirmed prior findings that two variants in deiodinase 1 (DIO1), including a variant in the 3′UTR of DIO1 (rs11206244), were associated with altered FT4 levels in both White and African American subjects. We also found that rs11206244 genotype was associated with lifetime MD in White female subjects, in particular those from high‐risk cohorts. However, we found no association of current FT4 levels with lifetime MD in either ethnic group. We conclude that genetic variation influencing thyroid function is a risk factor for MD. Given the evidence from prior studies, further investigations of role of HPT variation in etiology and treatment of MD are indicated. © 2011 Wiley‐Liss, Inc.     

Thyroid disease associated with rheumatoid arthritis is not adequately screened with a sensitive chemiluminescence thyrotrophin assay

The objective of this study was to screen for thyroidopathies in patients with rheumatoid arthritis (RA). Screening for thyroid disorders is advocated in patients with autoimmune diseases, and rheumatoid arthritis has been linked to thyroid autoimmune disorders, more particularly Hashimoto's thyroiditis and sometimes Graves' disease. We performed thyroid disease screening in 69 patients with RA free of medication for at least a 2 weeks period, not in remission, and in 65 patients with osteoarthritis (OA). The latter were studied as a control group of non-autoimmune arthritis patients. Basal levels of thyrotrophin (TSH) were measured using a sensitive chemiluminescence serum TSH assay. Serum antithyroperoxidase and antithyroglobulin (anti-Tg) autoantibodies were measured as well. If TSH values were found to be outside the normal limits, serum total thyroxine, total triiodothyronine (T3), resin T3 uptake, the free thyroxine index (FT4I) and free triiodothyronine index (FT3I) were evaluated. Rheumatoid arthritis patients exhibited statistically significant lower mean TSH values as compared to OA patients. However, RA patients with low TSH values did not have elevated FT4I. Previous use of corticosteroids in some of the RA patients may be responsible for these results. The autoantibodies levels did not differ between the two groups. We conclude that thyroid function screening with sensitive TSH assays is not sufficient for assessment of early stages of autoimmune thyroidopathies in patients with RA. Thyroid hormones should also be estimated.     

Is gender a factor in psychiatrists' evaluation and treatment of patients with major depression?

BACKGROUND: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression. METHODS: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist. RESULTS: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists. LIMITATIONS: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments. CONCLUSIONS: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.     

Gender differences in seasonal affective disorder (SAD)

Summary 146 women and 44 men (out- and inpatients; treatment sample) with Seasonal Affective Disorder (SAD; winter type) were tested for gender differences in demographic, clinical and seasonal characteristics. Sex ratio in prevalence was (women : men) 3.6 : 1 in unipolar depressives and 2.4 : 1 in bipolars (I and II). Sex ratios varied also between different birth cohorts and men seemed to underreport symptoms. There was no significant difference in symptom-profiles in both genders, however a preponderance of increased eating and different food selection on a trend level occured in women. The female group suffered significantly more often from thyroid disorders and from greater mood variations because of dark and cloudy weather. Women referred themselves to our clinic significantly more frequently as compared to men. In summary gender differences in SAD were similar to those of non-seasonal depression: the extent of gender differences in the prevalence of affective disorders appears to depend on case criteria such as diagnosis (unipolar vs. bipolar), birth cohort and number of symptoms as minimum threshold for diagnosis. We support the idea of applying sex-specific diagnostic criteria for diagnosing depression on the basis of our data and of the literature.     

A one-year follow-up on the effects of raloxifene on thyroid function in postmenopausal women

OBJECTIVE: Estrogens increase serum thyroxine-binding globulin (TBG) and total thyroxine (TT4) concentrations. Serum free thyroxine (FT4) concentrations, however, remain normal. Raloxifene (RAL) is a selective estrogen receptor modulator used to treat postmenopausal osteoporosis. Data on the long-term effects of RAL on thyroid physiology are scanty. We evaluated the effects of RAL administration for 1 year on thyroid function in osteopenic, postmenopausal women. DESIGN: Fifty osteopenic, postmenopausal women were randomly assigned to receive either RAL (60 mg/day, n = 25) or placebo (PL, n = 25) for 1 year, in a double-blind study. Measurements of serum TBG, TT4, FT4, thyroid-stimulating hormone (TSH), thyroid hormone-binding ratio (THBR), FT4 index (FT4-I) and TT4/TBG ratio were carried out at baseline and after 4 and 12 months of therapy. RESULTS: Baseline values were similar in both treatment groups. Serum TBG concentrations were increased during RAL treatment from baseline values of 29.60 +/- 0.9 microg/mL to 31.45 +/- 1.33 and 32.34 +/- 1.37 microg/mL at 4 months and 1 year, respectively (P < 0.05, baseline v 1-year values) but were unchanged during PL treatment. A small, insignificant increase in TT4 and TSH concentrations occurred in the RAL group and no changes in the PL group. All other values were unchanged during either treatment. CONCLUSIONS: These results demonstrate that RAL significantly increased serum TBG levels, but the changes were small and not accompanied by changes in FT4-I, FT4, or TSH concentrations, suggesting that long-term RAL treatment is unlikely to clinically affect the thyroid status in euthyroid, postmenopausal women.     

Sexual dysfunction before antidepressant therapy in major depression

BACKGROUND: Decreased sexual interest and function both occur as a consequence of antidepressant medication use, and are especially associated with serotonin reuptake inhibitors (SRIs). However, few investigators have reported the base rate for disturbances in sexual desire, arousal and orgasm or ejaculation in patients with major depression (MD) prior to antidepressant treatment. The purpose of this report is to define the frequency of sexual dysfunction (SD) in 134 patients with MD and examine the relationship between SD and demographic, clinical and personality variables. METHOD: A consecutive series of 55 male and 79 female MD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire, which asked about change in sexual interest and function as well as sexual activity during the preceding month. RESULTS: Only 50% of women and 75% of men reported sexual activity during the preceding month. Over 40% of men and 50% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (40-50%) than ejaculatory or orgasm difficulties (15-20%). In women, problems with arousal and orgasm correlated with higher neuroticism and lower extraversion. There was no relationship between SD and personality measures in men. While age at onset of depression and number of prior episodes showed a modest correlation with SD measures, there were no correlations with severity of depression or specific symptoms clusters. LIMITATIONS AND CONCLUSIONS: Although limited by a relatively small sample of drug free patients with MD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of antidepressant related sexual dysfunction.     

孕前及孕期甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。     

孕前及孕期妇女甲状腺功能减退筛查的临床分析

目的探讨甲状腺功能减退与不良孕史的相关性及孕期甲状腺功能减退筛查的意义。方法选取2010年10月-2011年8月期间在我院门诊就诊的生育年龄妇女共243例,采用化学发光（CIA）进行甲状腺功能激素系列（TSH、FT4、TPOAb）测定。结果不良孕史中甲状腺功能低下所占比例明显高于无不良孕史组;亚临床甲状腺功能低下在临床上发生率相对较高。结论甲状腺功能减低与不良孕史有明显相关性;要重视亚临床甲状腺功能低下的发生;进行孕期甲状腺功能筛查很有必要。     

Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use

BACKGROUND: There are numerous reports of abnormal glucose metabolism, including increased rates of type 2 diabetes mellitus, in psychiatric patients. It remains unclear, however, whether there is an intrinsic relationship between abnormal glucose metabolism and particular psychiatric disorders, because the relationship is complicated by treatment with psychotropic medications that promote weight gain and hyperglycemia. This study aimed to clarify this relationship. METHODS: The medical records of 243 inpatients, aged 50-74 years, with diagnoses of major depression, bipolar I disorder, schizoaffective disorder, schizophrenia, and dementia were reviewed. Psychiatric and type 2 diabetes mellitus diagnoses, medications, body mass index (BMI), age, gender, and race were recorded. Diabetes rates were compared to age, race, and gender-matched rates in the US general population. RESULTS: Rates of type 2 diabetes mellitus were: schizoaffective (50%) > bipolar I (26%) > major depression (18%) = dementia (18%) > schizophrenia (13%) (p < 0.006). Diabetic patients had a higher mean BMI (p = 0.01), but not a significantly higher use of psychotropic medications previously reported to be associated with new-onset type 2 diabetes (e.g., phenothiazines, clozapine, olanzapine). Logistic regression revealed that psychiatric diagnosis and BMI were the only significant and independent predictors of diabetes diagnosis. Compared to national norms, diabetes rates were significantly elevated only in bipolar I affective and schizoaffective patients. LIMITATIONS: This study was a retrospective chart review of older, hospitalized patients. CONCLUSIONS: This is the first published study to show an increased prevalence of type 2 diabetes mellitus among psychiatric patients with particular psychiatric illnesses independent of the effects of age, race, gender, medication, and body mass. This finding, which requires replication in a larger scale, prospective study, suggests an intrinsic relationship between abnormal glucose metabolism and bipolar I affective and schizoaffective disorders.