Depression and Anxiety in Hyperthyroidism

doi:10.1016/S0188-4409(02)00410-1

Archives of Medical Research

Volume 33, Issue 6, November–December 2002, Pages 552-556

https://doi.org/10.1016/S0188-4409(02)00410-1 Get rights and content

Abstract

Background

Our objective was to determine symptomatology of depression and anxiety in patients with untreated hyperthyroidism and compare with euthyroid patients.

Methods

Thirty-two patients with hyperthyroidism (high free T3 and free T4, and suppressed TSH) and 30 euthyroid (normal free T3, free T4, and TSH) controls attending the Endocrinology Out-Patient Department at Celal Bayar University Hospital in Manisa, Turkey were included in the study. Hormonal screening was performed by immunoassay and hemagglutination method. For psychiatric assessment, Hospital Anxiety and Depression Scale [HAD], Hamilton Depression Rating Scale [HAM-D], and Hamilton Anxiety Rating Scale [HAM-A] were used. There was no difference between the two groups in terms of demographic features.

Results

Total scores obtained both from HAM-D and HAM-A were significantly greater in the hyperthyroidism group than that of the euthyroid group (p <0.05); there was no difference in terms of HAD. When compared in terms of symptomatology, early insomnia (HAM-D#6), work and activities (HAM-D#7), psychic anxiety (HAM-D#10), weight loss (HAM-D#16), insomnia (HAM-A#4), and cardiovascular symptoms (HAM-A#8) were significantly more frequent in the hyperthyroidism group. By Wilks lambda discriminant analysis, psychomotor agitation (HAM-D#9), weight loss (HAM-D#16), and insomnia (HAM-A#4) were found as the discriminating symptoms for the hyperthyroidism group, whereas somatic anxiety (HAM-A#11) and loss of interest (HAD#14) were distinguishing symptoms of the euthyroidism group.

Conclusions

Hyperthyroidism and syndromal depression–anxiety have overlapping features that can cause misdiagnosis during acute phase. For differential diagnosis, one should follow-up patients with hyperthyroidism with specific hormonal treatment and evaluate persisting symptoms thereafter. In addition to specific symptoms of hyperthyroidism, psychomotor retardation, guilt, muscle pain, energy loss, and fatigue seem to appear more frequently in patients with comorbid depression and hyperthyroidism; thus, presence of these symptoms should be a warning sign to nonpsychiatric professionals for the need for psychiatric consultation.

Introduction

It is well documented in the literature that features of hyperthyroidism may be similar to those observed in patients with psychiatric disease. The most frequently reported features in common are depression and anxiety (1). It has been previously reported that major depression, generalized anxiety disorder, and hypomania may be associated with Graves' disease (2). Trzepacz and colleagues found mild deficiency in attention and memory and complex problem-solving in patients with Graves' disease and reported that anxiety levels of these patients were much higher than patients admitted for a variety of other reasons (3). In their study on patients with recently diagnosed untreated hyperthyroidism, Kathol and Delahunt found depression and anxiety in approximately one third of patients, bringing to mind that concurrent presence of somatic thyroid symptoms artificially inflates levels of depression and anxiety. They also suggested that a psychiatrist should be careful to exclude patients with hyperthyroidism prior to primary psychiatric diagnosis (4). Rodewig stated that psychologic symptoms in hyperthyroidism are similar to neurotic anxiety symptomatology and anxious depressive syndrome (5). In 1996, Stern et al. reported that subjects with hyperthyroidism displayed significantly worse memory, attention, planning, and productivity, indicating that neuropsychiatric impairment is highly prevalent in Graves' disease (6). In 1989, in a series of 25 patients with Graves' disease assessed by Hamilton Depression Rating Scale (HAM-D) and Beck Depression Inventory (BDI), Trzepacz and colleagues reported that these patients additionally had symptoms of depression and anxiety above cut-off point (7). Hendrick et al. reported in their review that even mild thyroid dysfunction was associated with changes in mood and cognitive functioning (8). The aim of this study was to determine symptomatology of depression and anxiety in patients with hyperthyroidism and compare these with euthyroid patients.

Section snippets

Methods

The study was carried out at the Department of Psychiatry and Division of Endocrinology, Department of Internal Medicine, Medical Faculty of Celal Bayar University in Manisa, Turkey. Study subjects were selected from patients diagnosed with hyperthyroidism or euthyroidism at the Endocrinology Department. Inclusion criteria for this study were being 18 years of age or older and having sufficient education to appropriately fill out self-report scales. Patients with known preexisting psychiatric

Results

The study groups consisted of 32 hyperthyroid patients and 30 euthyroid patients, respectively. There was no significant difference in mean age and gender between the two groups. There was a significant difference between hyperthyroid group and euthyroid group in terms of FT₃, FT₄, TSH, anti-T, and anti-M levels (Table 1). As seen in Table 1, thyroid antibodies measured in euthyroid group did not represent very early disease.

In patients with hyperthyroidism, 87.5% were diagnosed with Graves'

Discussion

It was revealed that HAM-D and HAM-A mean scores in hyperthyroid patients were significantly higher than those of euthyroid patients. In our study, there was positive correlation between FT₄ level and HAM-A, and TSH and HAM-A scores; however, no correlation between scores of psychometric scales and FT₃ level was found. Because FT4 and TSH determine diagnosis of hyperthyroidism and FT4 is mainly responsible for clinical symptomatology that resembles anxiety, positive correlation between FT4/TSH

Acknowledgements

This work was presented at the 24^th Congress of Endocrinology and Metabolism Disease of the Turkish Joint Meeting with the American Association of Clinical Endocrinology (October 4–6, 2001, Istanbul, Turkey) (Endocrine Practice Supplement for September/October 2001, p. 38).

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ClinicalDepression and Anxiety in Hyperthyroidism

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgements

Biol Psychiatry

Gen Hosp Psychiatry

Gen Hosp Psychiatry

Am J Med

Psychiatr Clin North Am

Psychosomatics

Psychoneuroendocrinology

Psychosomatics

Endocrine and metabolic disorders

Psychosomatic aspects of hyperthyroidism with special reference to Basedow's disease (abstract)

Psychother Psychosom Med Psychol

A survey study of neuropsychiatric complaints in patients with Graves' disease

J Neuropsychiatry Clin Neurosci

Clinical
Depression and Anxiety in Hyperthyroidism