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Thyroid hormone elevations during acute psychiatric illness: relationship to severity and distinction from
R P Roca1, M R Blackman, M B Ackerley
1Department of Psychiatry, Francis Scott Key Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224.
Endocrine Research
|January 1, 1990
Summary
Transient hyperthyroxinemia is common in acute psychiatric illness. Thyrotropin (TSH) levels are elevated early in illness and correlate with symptom severity, suggesting a central mechanism.
Area of Science:
- Endocrinology
- Psychiatry
- Neuroscience
Background:
- Acute psychiatric disorders can present with transient elevations in thyroid hormones.
- The underlying mechanisms, particularly the role of thyrotropin (TSH), require elucidation.
Purpose of the Study:
- To investigate the role of TSH in the development of transient hyperthyroxinemia in acutely hospitalized psychiatric patients.
- To explore the relationship between thyroid hormone levels and psychiatric symptom severity.
Main Methods:
- Serial measurements of TSH, thyroxine (T4), free T4 index (FT4I), triiodothyronine (T3), and free T3 index (FT3I) were conducted in 45 psychiatric inpatients.
- Thyroid hormone levels and TSH were analyzed in relation to psychiatric diagnoses and symptom severity.
Main Results:
- Nearly half (49%) of patients showed elevated thyroid hormone levels.
- Elevated FT4I in depressed patients was associated with higher TSH levels on peak days.
- Thyroid hormone levels positively correlated with psychiatric symptom severity in depressed and schizophrenic patients.
Conclusions:
- Elevated peripheral thyroid hormones are frequent in psychiatric inpatients, especially early in hospitalization.
- TSH is elevated early in acute illness and not suppressed by high thyroid hormones, differentiating it from typical hyperthyroidism.
- Centrally-mediated TSH hypersecretion may cause peripheral thyroid hormone elevation, particularly in depressed patients.