[Depressive symptoms in a sample of women with subclinical hypothyroidism and their relationship to chlorates in tap water]. / Síntomas depresivos en una muestra de mujeres con hipotiroidismo subclínico y su relación con los cloratos del agua del grifo.

Introduction: Introduction: depressive symptoms may develop in subclinical hypothyroidism and their presence usually facilitates recognition and the establishment of replacement treatment; however, recent studies have found no association between the two. Besides, thyroid function can be affected by endocrine disruptors and some of them, such as chlorates, can be found in the water we drink. Objectives: to know if the type of water consumed may influence the development of depressive symptoms in patients with subclinical hypothyroidism. Methods: 96 women with subclinical hypothyroidism, without thyroid treatment, were enrolled. We studied, among other variables, the presence of depressive symptoms, type of water consumption (tap, bottled or spring) and the level of chlorates in the tap water. Results: 41.7 % (40) of women presented depressive symptoms and these were related to the consumption of tap water (p = 0.001), resulting in a reliable predictor (OR, 27.79; p = 0.007). Chlorate level in the tap water was 250 µg/L, a value within the maximum limit allowed by law. Conclusions: chronic exposure to chlorates in water, in women with subclinical hypothyroidism, at levels authorized by law, could favor the inhibition of iodine transport and the appearance of depressive symptoms. It would be interesting to test this hypothesis as well as its possible effect on other population profiles.

Introducción: Introducción: en el hipotiroidismo subclínico pueden aparecer síntomas depresivos y su presencia suele facilitar la instauración de un tratamiento de reemplazo; sin embargo, estudios recientes no han encontrado una asociación entre ambos. Por otra parte, la función tiroidea puede verse afectada por disruptores endocrinos y, algunos de ellos, como los cloratos, pueden encontrarse en el agua que bebemos. Objetivos: conocer si el tipo de consumo de agua puede influir en la aparición de síntomas depresivos en pacientes con hipotiroidismo subclínico. Métodos: participaron 96 mujeres con hipotiroidismo subclínico, sin tratamiento tiroideo, de un área de salud de España. Estudiamos, entre otras variables, la presencia de síntomas depresivos, el tipo de consumo de agua (grifo/embotellada o manantial) y el nivel de cloratos en el agua del grifo. Resultados: el 41,7 % (40) de las mujeres presentaban síntomas depresivos y estos se relacionaban con el consumo de agua del grifo (p = 0,001), resultando este un predictor confiable (OR: 27,79; p = 0,007). El nivel de cloratos en el agua del grifo era de 250 µg/L, valor situado en el límite máximo permitido por la ley. Conclusiones: en mujeres con hipotiroidismo subclínico, la exposición crónica a cloratos en el agua, en niveles autorizados por la ley, podría favorecer la inhibición del transporte de yodo y la aparición de síntomas depresivos. Sería interesante comprobar esta hipótesis, así como su posible efecto sobre otros perfiles poblacionales.

Thyroid dysfunction and Alzheimer's disease, a vicious circle.

Recently, research into the link between thyroid dysfunction and Alzheimer's disease (AD) remains a current topic of interest. Previous research has primarily concentrated on examining the impact of thyroid dysfunction on the risk of developing AD, or solely explored the mechanisms of interaction between hypothyroidism and AD, a comprehensive analysis of the mechanisms linking thyroid dysfunction, including hyperthyroidism and hypothyroidism, to Alzheimer's disease (AD) still require further elucidation. Therefore, the aim of this review is to offer a thorough and comprehensive explanation of the potential mechanisms underlying the causal relationship between thyroid dysfunction and AD, highlighting the existence of a vicious circle. The effect of thyroid dysfunction on AD includes neuron death, impaired synaptic plasticity and memory, misfolded protein deposition, oxidative stress, and diffuse and global neurochemical disturbances. Conversely, AD can also contribute to thyroid dysfunction by affecting the stress repair response and disrupting pathways involved in thyroid hormone (TH) production, transport, and activation. Furthermore, this review briefly discusses the role and significance of utilizing the thyroid as a therapeutic target for cognitive recovery in AD. By exploring potential mechanisms and therapeutic avenues, this research contributes to our understanding and management of this devastating neurodegenerative disease.

[Hypothyroidism and aging: the search for protective factors].

Searching for aging key points is one of the main problems in geriatrics. More and more research in recent years has been devoted to the study of geroprotective mechanisms, the impact of various conditions and diseases on aging in general. Of particular importance is the determination of age-related involutive processes in the human body, whether they are part of normal aging or a condition that needs to be corrected to improve the functioning of organs and systems. An important mechanism of aging starts is a change in hormonal activity of endocrine glands, in particular in hormonal activity of thyroid. Frequency of hypothyroidism in advanced age explains relevance of the chosen topic. The aim of the review was to find out the role hypothyroidism in aging. The main task was to define, whether thyroid hormones decrease in older age was a protective factor or pathological process. A review of the literature over the past 10 years on subclinical treatment was carried out and we identified the most pressing issues associated with hypothyroidism and aging. We studied data on the relationship between hypothyroidism and major geriatric syndromes, with special attention paid to cognitive diseases and emotional disorders.

Are We Restoring Thyroid Hormone Signaling in Levothyroxine-Treated Patients With Residual Symptoms of Hypothyroidism?

INTRODUCTION: Levothyroxine (LT4) at doses that maintain the serum thyroid-stimulating hormone levels within the normal range constitutes the standard of care for the treatment of hypothyroidism. After a few months, this eliminates the signs and symptoms of overt hypothyroidism in the majority of patients, owing to the endogenous activation of thyroxine to triiodothyronine, the biologically active thyroid hormone. Still, a small percentage of the patients (10%-20%) exhibit residual symptoms, despite having normal serum thyroid-stimulating hormone levels. These symptoms include cognitive, mood, and metabolic deficits, with a significant impairment in psychological well-being and quality of life. OBJECTIVE: To provide a summary of progress in the approach of patients with hypothyroidism that exhibit residual symptoms despite treatment. METHODS: We reviewed the current literature and here we focused on the mechanisms leading to a deficiency of T3 in some LT4-treated patients, the role of residual thyroid tissue and the rationale for combination therapy with LT4 + liothyronine (LT3). RESULTS: A score of clinical trials comparing therapy with LT4 versus LT4 + LT3 concluded that both are safe and equally effective (neither is superior); however, these trials failed to recruit a sufficiently large number of patients with residual symptoms. New clinical trials that considered LT4-treated symptomatic patients revealed that such patients benefit from and prefer therapy containing LT4 + LT3; desiccated thyroid extract has also been used with similar results. A practical approach to patients with residual symptoms and on initiation of combination therapy with LT4 + LT3 is provided. CONCLUSION: A recent joint statement of the American, British, and European Thyroid Associations recommends that a trial with combination therapy be offered to patients with hypothyroidism that do not fully benefit from therapy with LT4.

Cognitive decline in mid-life: Changes in memory and cognition related to hypothyroidism.

This study assessed specific cognitive impairments within a primarily female, hypothyroid population, while controlling for factors that commonly contribute to cognitive decline. Participants (N = 739) included 461 individuals with hypothyroidism. This study involved an online survey assessing several aspects of memory and cognition. Those with hypothyroidism generally scored worse on self-assessments of memory, higher perceived stress, high rates of depression and anxiety, greater fatigue, poorer concentration, and less motivation. A Receiver Operating Characteristic curve indicated that the cognitive questionnaires are successful at classifying hypothyroidism and a mediation analysis showed fatigue is a mediating symptom of these cognitive outcomes.

Language and Neurocognitive Impairments Associated with Hypothyroidism.

INTRODUCTION: Accumulating clinical evidence has indicated that hypothyroidism was associated with neurocognitive and linguistic impairments; however, these impairments were not reported in Arabic individuals. The aims of the present study were (1) to investigate the patterns of linguistic and neurocognitive impairments associated with hypothyroidism in native speakers of Jordanian Arabic and (2) to examine the accuracy of TFT in confirming a clinical diagnosis of hypothyroidism. METHODS: A cross-sectional design with random recruitment of participants from targeted hypothyroid (HT) and euthyroid (ET) groups was conducted. Clinical evaluation of hypothyroidism was obtained via a structured questionnaire followed by TFT. Evaluation measures included digit span, confrontation naming, color naming, auditory and visual memory, and visual recognition tasks. The HT group comprised 36 participants including 8 males and 28 females with a ratio of 1:3.5. Their age ranged between 5.11 and 10.7 years (M = 7.7, SD = ±1.4). The ET group included an equal number of participants in terms of age and gender, their age ranged between 5.9 and 10.8 years (M = 7.6, SD = ±1.5). RESULTS: Results revealed significant differences between the two experimental groups in all of the linguistic and neurocognitive tasks. The HT showed 10- and 26-s delayed responses on a timed color naming and visual recognition tasks compared to the ET group, whereas the ET group showed larger scores compared to the HT on the digit span, confrontation naming, auditory memory, and visual memory tasks. Differences were 2.2, 4, 1.7, and 3 points, respectively. CONCLUSION: Hypothyroidism influences linguistic and neurocognitive functions mainly naming ability, working memory, and auditory and visual processes needed for learning. Clinicians ought to be attentive to these impacts when designing screening and therapy protocols for children with hypothyroidism. Furthermore, TSH showed higher prediction of hypothyroidism and may be used in favor of FT3 and FT4.

Thyroid Disorders and Development of Cognitive Impairment: A Review Study.

Dementia is a neurological disorder that is spreading with increasing human lifespan. In this neurological disorder, memory and cognition are declined and eventually impaired. Various factors can be considered as the background of this disorder, one of which is endocrine disorders. Thyroid hormones are involved in various physiological processes in the body; one of the most important of them is neuromodulation. Thyroid disorders, including hyperthyroidism or hypothyroidism, can affect the nervous system and play a role in the development of dementia. Despite decades of investigation, the nature of the association between thyroid disorders and cognition remains a mystery. Given the enhancing global burden of dementia, the principal purpose of this study was to elucidate the association between thyroid disturbances as a potentially modifiable risk factor of cognitive dysfunction. In this review study, we have tried to collect almost all of the reported mechanisms demonstrating the role of hypothyroidism and hyperthyroidism in the pathogenesis of dementia.

Association of Thyroid Dysfunction With Cognitive Function: An Individual Participant Data Analysis.

Importance: In clinical guidelines, overt and subclinical thyroid dysfunction are mentioned as causal and treatable factors for cognitive decline. However, the scientific literature on these associations shows inconsistent findings. Objective: To assess cross-sectional and longitudinal associations of baseline thyroid dysfunction with cognitive function and dementia. Design, Setting, and Participants: This multicohort individual participant data analysis assessed 114 267 person-years (median, 1.7-11.3 years) of follow-up for cognitive function and 525 222 person-years (median, 3.8-15.3 years) for dementia between 1989 and 2017. Analyses on cognitive function included 21 cohorts comprising 38 144 participants. Analyses on dementia included eight cohorts with a total of 2033 cases with dementia and 44 573 controls. Data analysis was performed from December 2016 to January 2021. Exposures: Thyroid function was classified as overt hyperthyroidism, subclinical hyperthyroidism, euthyroidism, subclinical hypothyroidism, and overt hypothyroidism based on uniform thyrotropin cutoff values and study-specific free thyroxine values. Main Outcomes and Measures: The primary outcome was global cognitive function, mostly measured using the Mini-Mental State Examination. Executive function, memory, and dementia were secondary outcomes. Analyses were first performed at study level using multivariable linear regression and multivariable Cox regression, respectively. The studies were combined with restricted maximum likelihood meta-analysis. To overcome the use of different scales, results were transformed to standardized mean differences. For incident dementia, hazard ratios were calculated. Results: Among 74 565 total participants, 66 567 (89.3%) participants had normal thyroid function, 577 (0.8%) had overt hyperthyroidism, 2557 (3.4%) had subclinical hyperthyroidism, 4167 (5.6%) had subclinical hypothyroidism, and 697 (0.9%) had overt hypothyroidism. The study-specific median age at baseline varied from 57 to 93 years; 42 847 (57.5%) participants were women. Thyroid dysfunction was not associated with global cognitive function; the largest differences were observed between overt hypothyroidism and euthyroidism-cross-sectionally (-0.06 standardized mean difference in score; 95% CI, -0.20 to 0.08; P = .40) and longitudinally (0.11 standardized mean difference higher decline per year; 95% CI, -0.01 to 0.23; P = .09). No consistent associations were observed between thyroid dysfunction and executive function, memory, or risk of dementia. Conclusions and Relevance: In this individual participant data analysis of more than 74 000 adults, subclinical hypothyroidism and hyperthyroidism were not associated with cognitive function, cognitive decline, or incident dementia. No rigorous conclusions can be drawn regarding the role of overt thyroid dysfunction in risk of dementia. These findings do not support the practice of screening for subclinical thyroid dysfunction in the context of cognitive decline in older adults as recommended in current guidelines.

Burnout and metabolic syndrome among healthcare workers: Is subclinical hypothyroidism a mediator?

OBJECTIVES: Evidence suggests that subclinical hypothyroidism (SCH) is associated with burnout and metabolic syndrome (MetS). We examined the relationship between burnout and MetS among healthcare workers (HCWs) and investigated the potential mediation of SCH. METHODS: This cross-sectional study included HCWs from a tertiary medical center; demographic data were obtained using a questionnaire. Burnout was evaluated according to the Chinese version of the Maslach Burnout Inventory-Health Services Survey (MBI-HSS). MetS and thyroid function data were obtained from a physical check-up. Logistic regression models were used to evaluate the adjusted odds ratio (aOR), and mediation analysis was employed to examine the mediation effect. RESULTS: Among 945 non-doctor/nurse and 1868 doctor/nurse staff, MetS was 30% and 14%, respectively, and the prevalence of burnout was nearly 6.5%. The results showed that burnout induced higher aOR of MetS in the doctor/nurse group (1.27, 95% confidence interval [CI]: 1.05-3.62). Thyroid-stimulating hormone (TSH) showed a positive association factor of MetS in doctor/nurse group-adjusted burnout (aOR = 1.15, 95% CI: 1.01-4.19). A higher TSH level was associated with an increased odds of MetS in younger doctor/nurse staff with burnout syndrome (aOR = 1.74; 95% CI: 1.04-3.22). There was a borderline significant mediation effect of SCH in the association between burnout and MetS in doctor/nurse staff. CONCLUSIONS: The results showed that higher TSH levels were positively associated with burnout and MetS in doctor/nurse professionals, especially in the young cohort. Burnout may rely on the borderline mediation effect of SCH, which is likely to affect MetS.

Levothyroxine Therapy in Elderly Patients With Hypothyroidism.

Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.

Does Subclinical Hypothyroidism Add Any Symptoms? Evidence from a Danish Population-Based Study.

BACKGROUND: Few studies have scrutinized the spectrum of symptoms in subclinical hypothyroidism. METHODS: From 3 Danish Investigation on Iodine Intake and Thyroid Diseases (DanThyr) cross-sectional surveys performed in the period 1997 to 2005, a total of 8903 subjects participated in a comprehensive investigation including blood samples and questionnaires on previous diseases, smoking habits, alcohol intake, and education. From the 3 surveys we included patients with subclinical hypothyroidism (n = 376) and euthyroid controls (n = 7619). We explored to what extent patients with subclinical hypothyroidism reported 13 previously identified hypothyroidism-associated symptoms (tiredness, dry skin, mood lability, constipation, palpitations, restlessness, shortness of breath, wheezing, globus sensation, difficulty swallowing, hair loss, dizziness/vertigo, and anterior neck pain). In various uni- and multivariate regression models we searched for circumstances predicting why some patients have more complaints than others. RESULTS: Subclinically hypothyroid patients did not report higher hypothyroidism score [(median, interquartile range), 2 (0-4) vs 2 (0-4), P = .25] compared with euthyroid controls. Within the group of subclinical hypothyroid patients, comorbidity had the highest impact on symptoms (tiredness, shortness of breath, wheezing; all P < .001); TSH level had no impact on symptom score; and younger age was accompanied by higher mental burden (tiredness, P < .001; mood lability, P < .001; restlessness, P = .012), whereas shortness of breath was associated with high body mass index (P < .001) and smoking (P = .007). CONCLUSION: Patients with a thyroid function test suggesting subclinical hypothyroidism do not experience thyroid disease-related symptoms more often than euthyroid subjects. In subclinical hypothyroidism, clinicians should focus on concomitant diseases rather than expecting symptomatic relief following levothyroxine substitution.

Gray Matter and Regional Brain Activity Abnormalities in Subclinical Hypothyroidism.

Background: Subclinical hypothyroidism (SCH) brain structure and resting state of functional activity have remained unexplored. Purpose: To investigate gray matter volume (GMV) and regional brain activity with the fractional amplitude of low-frequency fluctuations (fALFF) in subclinical hypothyroidism (SCH) patients before and after treatment. Material and Methods: We enrolled 54 SCH and 41 age-, sex-, and education-matched controls. GMV and fALFF of SCH were compared with controls and between pre- and post-treatment within SCH group. Correlations of GMV and fALFF in SCH with thyroid function status and mood scales were assessed by multiple linear regression analysis. Results: Compared to controls, GMV in SCH was significantly decreased in Orbital part of inferior frontal, superior frontal, pre-/postcentral, inferior occipital, and temporal pole gyrus. FALFF values in SCH were significantly increased in right angular, left middle frontal, and left superior frontal gyrus. After treatment, there were no significant changes in GMV and the local brain function compared to pre-treatment, however the GMV and fALFF of the defective brain areas were improved. Additionally, decreased values of fALFF in left middle frontal gyrus were correlated with increased mood scales. Conclusion: In this study we found that patients with SCH, the gray matter volume in some brain areas were significantly reduced, and regional brain activity was significantly increased. After treatment, the corresponding structural and functional deficiencies had a tendency for improvement. These changes may reveal the neurological mechanisms of mood disorder in SCH patients.

Contribution of Hypothyroidism to Cognitive Impairment and Hippocampal Synaptic Plasticity Regulation in an Animal Model of Depression.

The role that thyroid hormone deficiency plays in depression and synaptic plasticity in adults has only begun to be elucidated. This paper analyzes the possible link between depression and hypothyroidism in cognitive function alterations, using Wistar-Kyoto (WKY-an animal model of depression) rats and control Wistar rats under standard and thyroid hormone deficiency conditions (propylthiouracil administration-PTU). A weakening of memory processes in the WKY rats is shown behaviorally, and in the reduction of long-term potentiation (LTP) in the dentate gyrus (DG) and CA1 hippocampal regions. PTU administration decreased LTP and increased basal excitatory transmission in the DG in Wistar rats. A decrease in short-term synaptic plasticity is shown by the paired-pulse ratio measurement, occurring during hypothyroidism in DG and CA1 in WKY rats. Differences between the strains may result from decreases in the p-CaMKII, p-AKT, and the level of acetylcholine, while in the case of the co-occurrence of depression and hypothyroidism, an increase in the p-ERK1-MAP seemed to be important. Obtained results show that thyroid hormones are less involved in the inhibition of glutamate release and/or excitability of the postsynaptic neurons in WKY rats, which may indicate a lower sensitivity of the hippocampus to the action of thyroid hormones in depression.

Effect of Levothyroxine Therapy on the Development of Depressive Symptoms in Older Adults With Subclinical Hypothyroidism: An Ancillary Study of a Randomized Clinical Trial.

Importance: Previous trials on the effect of levothyroxine on depressive symptom scores in patients with subclinical hypothyroidism were limited by small sample sizes (N = 57 to 94) and potential biases. Objective: To assess the effect of levothyroxine on the development of depressive symptoms in older adults with subclinical hypothyroidism in the largest trial on this subject and to update a previous meta-analysis including the results from this study. Design, Setting, and Participants: This predefined ancillary study analyzed data from participants in the Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism (TRUST) trial, a double-blind, randomized, placebo-controlled, parallel-group clinical trial conducted from April 2013 to October 31, 2016. The TRUST trial included adults aged 65 years or older diagnosed with subclinical hypothyroidism, defined as the presence of persistently elevated thyroid-stimulating hormone (TSH) levels (4.6-19.9 mIU/L) with free thyroxine (T4) within the reference range. Participants were identified from clinical and general practitioner laboratory databases and recruited from the community in Switzerland, the Netherlands, Ireland, and the UK. This ancillary study included a subgroup of 472 participants from the Netherlands and Switzerland; after exclusions, a total of 427 participants (211 randomized to levothyroxine and 216 to placebo) were analyzed. This analysis was conducted from December 1, 2019, to September 1, 2020. Interventions: Randomization to either levothyroxine or placebo. Main Outcomes and Measures: Depressive symptom scores after 12 months measured with the Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (minimal clinically important difference = 2). Results: A total of 427 participants with subclinical hypothyroidism (mean [SD] age, 74.52 [6.29] years; 239 women [56%]) were included in this analysis. The mean (SD) TSH level was 6.57 (2.22) mIU/L at baseline and decreased after 12 months to 3.83 (2.29) mIU/L in the levothyroxine group; in the placebo group, it decreased from 6.55 (2.04) mIU/L to 5.91 (2.66) mIU/L. At baseline, the mean (SD) GDS-15 score was 1.26 (1.85) in the levothyroxine group and 0.96 (1.58) in the placebo group. The mean (SD) GDS-15 score at 12 months was 1.39 (2.13) in the levothyroxine and 1.07 (1.67) in the placebo group with an adjusted between-group difference of 0.15 for levothyroxine vs placebo (95% CI, -0.15 to 0.46; P = .33). In a subgroup analysis including participants with a GDS-15 of at least 2, the adjusted between-group difference was 0.61 (95% CI, -0.32 to 1.53; P = .20). Results did not differ according to age, sex, or TSH levels. A previous meta-analysis (N = 278) on the association of levothyroxine with depressive symptoms was updated to include these findings, resulting in an overall standardized mean difference of 0.09 (95% CI, -0.05 to 0.22). Conclusions and Relevance: This ancillary study of a randomized clinical trial found that depressive symptoms did not differ after levothyroxine therapy compared with placebo after 12 months; thus, these results do not provide evidence in favor of levothyroxine therapy in older persons with subclinical hypothyroidism to reduce the risk of developing depressive symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT01853579.

The role of coping strategies, depression and anxiety in thyroid disease / A megküzdési stratégiák, a depresszió és a szorongás szerepe a pajzsmirigybetegségekben.

Összefoglaló. Bevezetés: A tudományos szakirodalomban számos kérdés fogalmazódik meg a pajzsmirigybetegségeket befolyásoló pszichológiai tényezokrol. Kevés tanulmány készült a pajzsmirigybetegségek és a megküzdési stratégiák kapcsolatáról. Célkituzés: Jelen tanulmányunk célja felmérni a megküzdési stratégiák, a depresszió és a szorongás szintjének változásait a pajzsmirigybetegek (hyperthyreosis és hypothyreosis) esetében a gyógyszeres kezelés (Thyrozol és Euthyrox) hatására. Módszer: A betegeket a szakorvos diagnózisa, illetve a TSH- és fT4-szint alapján hyperthyreosis- (n = 10) és hypothyreosis- (n = 21) csoportba soroltuk. Mindkét csoport tagjait az endokrinológiai kezelés elott és után pszichológiai felmérésnek vetettük alá. A felmérés során a megküzdési stratégiák felméréséhez a következo skálákat alkalmaztuk: Kognitív Érzelem Szabályozás Kérdoív (Cognitive Emotion Regulation Questionnaire - CERQ), Hobfoll-féle Megküzdési Stratégia Kérdoív (Strategic Approach to Coping Scale - SACS). A Beck Depresszió Kérdoívet (Beck Depression Inventory - BDI-II) alkalmaztuk a depresszió felmérésére, az Állapot- és Vonásszorongás Kérdoívet (State-Trait Anxiety Inventory, Form Y - STAI-Y) a szorongás szintjének felmérésére. Eredmények: A két csoport pszichológiai és laboreredményeit összehasonlítottuk a gyógyszeres kezelés elott és után. Mind a hyperthyreosisban, mind a hypothyreosisban szenvedo betegeknél magas volt a depresszió és a szorongás szintje. A hyperthyreosisban szenvedo betegeknél a depresszió magasabb. A gyógyszeres kezelés után a depresszió és a szorongás szintje csökkent mindkét csoportban, a megküzdési stratégiák többnyire változatlanok maradtak. Következtetések: Pajzsmirigybetegeknél a kognitív viselkedésbeli pszichoterápiás beavatkozás a gyógyszeres kezelés kiegészíto alternatívája lehet a szorongás és a depresszió szintjének csökkentése és a diszfunkcionális megküzdési stratégiák módosítása szempontjából. Orv Hetil. 2021; 162(7): 262-268. INTRODUCTION: There is a high interest in the scientific literature in psychological factors that influence the course of thyroid disease. There are a few studies on the link between thyroid disease and coping strategies. OBJECTIVE: In the present study, we aimed to evaluate the manifestation of depression, anxiety and coping strategies in people with thyroid disease and the impact of endocrinological medication on these psychologic items. METHOD: The patients were grouped into two groups, hyperthyroid (n = 10) and hypothyroid (n = 21), according to the diagnosis established by the attending physician, TSH and fT4 level. Patients with hyperthyroidism and hypothyroidism were evaluated before and after endocrinological treatment with the Cognitive Emotion Regulation Questionnaire (CERQ), Strategic Approach to Coping Scale (SACS) for the evaluation of coping strategies, Beck Depression Inventory (BDI-II) for assessing the level of depression, State-Trait Anxiety Inventory, Form Y (STAI-Y) for assessing anxiety. These two groups have been compared. RESULTS: The psychological and laboratory results of the two groups were compared before and after drug treatment. Both patients with hyperthyroidism and with hypothyroidism had high levels of depression and anxiety. In hyperthyroidism, depression is more severe. Following treatment with Thyrozol and Euthyrox, the level of depression and anxiety decreases in patients with hyper- and hypothyroidism; the coping strategies remained almost unchanged. CONCLUSION: Cognitive-behavioral psychotherapeutic intervention could be supplementary to drug treatment in terms of reducing anxiety, depression, and modifying dysfunctional coping strategies for patients with thyroid diseases. Orv Hetil. 2021; 162(7): 262-268.

Outcomes of Thyroid Dysfunction in People Aged Eighty Years and Older: An Individual Patient Data Meta-Analysis of Four Prospective Studies (Towards Understanding Longitudinal International Older People Studies Consortium).

Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disability in daily living, cognitive function, depressive symptoms, physical function, and mortality in people aged 80 years and older. Methods: Four prospective cohorts participating in the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included. We performed a two-step individual participant data meta-analysis on source data from community-dwelling participants aged 80 years and older from the Netherlands, New Zealand, United Kingdom, and Japan. Outcome measures included disability in daily living (disability in activities of daily living [ADL] questionnaires), cognitive function (Mini-Mental State Examination [MMSE]), depressive symptoms (Geriatric Depression Scale [GDS]), physical function (grip strength) at baseline and after 5 years of follow-up, and all-cause five-year mortality. Results: Of the total 2116 participants at baseline (mean age 87 years, range 80-109 years), 105 participants (5.0%) were overtly hypothyroid, 136 (6.4%) subclinically hypothyroid, 1811 (85.6%) euthyroid, 60 (2.8%) subclinically hyperthyroid, and 4 (0.2%) overtly hyperthyroid. Participants with thyroid dysfunction at baseline had nonsignificantly different ADL scores compared with euthyroid participants at baseline and had similar MMSE scores, GDS scores, and grip strength. There was no difference in the change of any of these functional measures in participants with thyroid dysfunction during five years of follow-up. Compared with the euthyroid participants, no 5-year survival differences were identified in participants with overt hypothyroidism (hazard ratio [HR] 1.0, 95% confidence interval [CI 0.6-1.6]), subclinical hypothyroidism (HR 0.9 [CI 0.7-1.2]), subclinical hyperthyroidism (HR 1.1 [CI 0.8-1.7]), and overt hyperthyroidism (HR 1.5 [CI 0.4-5.9]). Results did not differ after excluding participants using thyroid-influencing medication. Conclusions: In community-dwelling people aged 80 years and older, (sub-)clinical thyroid dysfunction was not associated with functional outcomes or mortality and may therefore be of limited clinical significance.

[Features of the use of synthetic analogues of thyroid hormones: а 2020 THESIS* questionnaire survey of members of the Belarusian Public Medical Association of Endocrinology and Metabolism].

BACKGROUND: The standard treatment for hypothyroidism is levothyroxine (LT4), which in the Republic of Belarus is available in tablet form whereas liothyronine (LT3) is not registered, but patients can purchase them on their own abroad. AIM: This study aimed to investigate Belarusian endocrinologists' attitude of thyroid hormones in hypothyroid and euthyroid patients. MATERIALS AND METHODS: An online survey was conducted, for which members of the Belarusian Medical Association of Endocrinology and Metabolism were invited by posting information in the group chat and by e-mail. The research period was from October 1 to December 26, 2020. 210 questionnaires were received, 146 of which were used. RESULTS: The majority of participants, 145 (99.3%), indicated that they were using LT4 as the first-choice drug for the treatment hypothyroidism. Sixty-one (41.8%) doctors answered that LT3 + LT4 combination likely can be used in patients with long-term untreated hypothyroidism and 15 (10.3%) - in patients with persistent symptoms of hypothyroidism, despite biochemical euthyroidism on therapy LT4. Over half of the respondents 84 (57.5%) answered that thyroid hormone therapy was never indicated for euthyroid patients, but 50 (34.2%) would consider it for female infertility with high level of thyroid antibodies and 36 (24.7%) for simple goiter growing over time. In various conditions that could interfere with absorption of LT4, most responding Belarusian endocrinologists do not expect a significant difference with different formulations (tablets+"I do not expect major changes in different forms" vs. "soft gel capsules"+"liquid solution"; p <0.001). Persistent symptoms of hypothyroidism on the background of LT4 replacement therapy with the achievement of the target TSH can mainly be caused by psychosocial factors, concomitant diseases, unrealistic patient expectations, chronic fatigue syndrome, and the burden of chronic disease. CONCLUSION: The method of choice of Belarusian endocrinologists in the treatment of hypothyroidism is LT4 replacement therapy, but the appointment of LT4 + LT3 combination therapy can be considered in certain clinical situations. As a rule, endocrinologists do not prescribe LT4 in patients with euthyroidism and do not expect a significant difference when using other forms of levothyroxine.

Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation.

OBJECTIVE: Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. DESIGN AND PATIENTS: We conducted an online survey of individuals with self-reported hypothyroidism. RESULTS: Nine hundred sixty-nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L-T4) and liothyronine (L-T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L-T4 or L-T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L-T4 + L-T3 or L-T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L-T4 (P < .001) and expectations for more support from the GP (P < .001), for L-T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L-T3 independently (P = .014), negative experiences with L-T4 (P = .013), having expectations for L-T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006). CONCLUSIONS: Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.

Livro de resumos: XVII Jornada Acadêmica de Saúde Mental da Faculdade de Medicina da Universidade Federal de Minas Gerais / Livro de resumos: XVII Jornada Acadêmica de Saúde Mental da Faculdade de Medicina da Universidade Federal de Minas Gerais

A XVII Jornada Acadêmica de Saúde mental é um evento que busca aproximar os estudantes de cursos variados do campo de estudo da Saúde Mental. Além de aulas ministradas na forma de palestras, os acadêmicos são convidados a produzirem trabalhos para serem apresentados aos demais participantes, ampliando o leque de assuntos abordados. Além de proporcionar aos estudantes interessados maior contato com temas específicos da área, a produção de resumos para apresentação é uma ferramenta para aprimoramento das técnicas de escrita e produção de conteúdo. Elaborar os trabalhos amplia os conhecimentos dos alunos sobre escrita científica e os aproxima do meio acadêmico científico. Ademais, o contato com professores e pesquisadores da área, que orientam os participantes durante o processo, cria canais de comunicação e abre novas oportunidades para os estudantes. Para esta edição do evento, os trabalhos foram selecionados pela Comissão Científica da Jornada, que verificou um alto nível nas submissões. Aqueles mais originais, relevantes e bem produzidos foram aprovados e compõem esse livro, mostrando à comunidade a qualidade dos estudantes e do conteúdo apresentado na XVII JASME. Os assuntos discutidos nos próximos capítulos, desenvolvidos por estudantes de cursos da área da saúde, abrangem a saúde mental por variados ângulos e sob diversas abordagens. Escolher alguns trabalhos significa, necessariamente, prescindir de outros. Cientes do desafio de estabelecer uma coletânea que tivesse o padrão de qualidade e a feição da UFMG sem nos obnubilar pela subjetividade, estabelecemos critérios objetivos e submetemos cada resumo à apreciação independente de pelo menos três integrantes da junta científica para apreciação. Por fim, aferimos que não houve divergência de rigor entre os subgrupos e selecionamos os trinta melhores, ou seja, os mais inovadores, bem escritos, objetivos e bem fundamentados. Procuramos, diante dos diversos recortes da pandemia da COVID-19, incluir aqueles que, em vez de vagos de tão abrangentes, descreviam impactos tangíveis, mensuráveis e inusitados, isto é, Relacionados a grupos que não têm sido abordados pela grande mídia e tampouco pelo profissional de saúde médio. Assim, cremos que os resumos a seguir são os que mais bem abordam tanto questões atemporais em saúde mental quanto aquelas que emergiram nos últimos meses e ainda não sabemos por quanto tempo perdurarão. Os trabalhos tratam desde questões relacionadas aos fatores de risco para o desenvolvimento de transtornos psiquiátricos aos aspectos do tratamento farmacológico. Com uma perspectiva atual e relevante para as condições de saúde vigente, as temáticas se relacionam com diversas áreas da saúde mental, como as consequências da pandemia da SARS-COV2, aspectos da saúde mental em jovens e idosos, condutas da saúde mental na saúde primária, psicofarmacologia, transtornos psiquiátricos.

Severe Hypothyroidism Manifested as Acute Mania With Psychotic Features: A Case Report and Review of the Literature.

Hypothyroidism is associated with a wide array of medical, neurological, and psychiatric symptoms. Severe hypothyroidism may present as myxedema coma, a medical emergency. In addition, patients may present with myxedema psychosis, a psychiatric emergency manifested as hyperactive encephalopathy, hallucinations, delusions, and suicidal ideation. In rare instances, patients may present with symptoms of mania with psychosis. We present the case of a 26-year-old woman with no known psychiatric history who presented with gradual onset of altered mental status, distractibility, decreased need for sleep, pressured speech, and religious and paranoid delusions. Her medical history was significant for a surgically absent thyroid gland and nonadherence to thyroid hormone. The patient was found to have a severely elevated level of thyroid-stimulating hormone, low level of triiodothyronine, and undetectable thyroxine. Thyroid ultrasound demonstrated a surgically absent thyroid gland. The patient's metabolic panel and random serum cortisol level were normal. Rapid plasma reagin was nonreactive, and toxin screening was negative. It was concluded that severe hypothyroidism was the cause of the patient's mania with psychotic features, given her thyroid hormone levels and lack of history of a psychiatric or substance use disorder. Thyroid hormone monitoring and treatment of hypothyroidism is necessary in all patients who have undergone surgical excision of the thyroid gland. All patients presenting with a first episode mania should be screened for thyroid dysfunction. The preferred treatment includes an atypical antipsychotic and thyroid replacement therapy. Rapid resolution of symptoms can occur with combined levothyroxine and liothyronine. Correction of hypothyroidism improves response to antipsychotics.