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The thyroid axis and depression

I M Jackson1

  • 1Division of Endocrinology, Rhode Island Hospital, Brown University School of Medicine, Providence 02903, USA.

Thyroid : Official Journal of the American Thyroid Association
|November 25, 1998
PubMed
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Thyroid dysfunction, including hypothyroidism, can cause depression and may improve with thyroxine treatment. Even in euthyroid depressed patients, thyroid function is altered, suggesting a link between thyroid health and mood regulation.

Area of Science:

  • Endocrinology
  • Neuropsychiatry
  • Molecular Psychiatry

Background:

  • Hypothyroidism can manifest as clinical depression, often responsive to thyroxine therapy.
  • Subclinical hypothyroidism and autoimmune thyroiditis may also warrant similar treatment approaches.
  • Depression, even in euthyroid individuals, is associated with thyroid function alterations.

Purpose of the Study:

  • To explore the relationship between thyroid function and depression.
  • To investigate the potential role of triiodothyronine (T3) as an adjunctive treatment for resistant depression.
  • To elucidate the underlying mechanisms of thyroid axis dysregulation in depression.

Main Methods:

  • Review of existing literature on hypothyroidism and depression.
  • Analysis of thyroid function tests (serum thyroxine (T4), thyrotropin (TSH), response to thyrotropin-releasing hormone (TRH)) in depressed patients.

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  • Discussion of potential neuroendocrine mechanisms involving the hypothalamus and glucocorticoid feedback.

    • Main Results:

    • Depressed patients, even if euthyroid, exhibit thyroid function changes like elevated T4, blunted TSH response to TRH, and loss of nocturnal TSH rise.
    • These thyroid alterations often normalize with depression alleviation.
    • Adjuvant T3 therapy may benefit approximately 25% of patients with resistant depression, though further controlled trials are needed.

    Conclusions:

    • Thyroid dysfunction is closely linked to depression, with potential benefits from thyroxine and possibly T3 therapy.
    • Neuroendocrine dysregulation, particularly involving the hypothalamus and glucocorticoid feedback, may underlie thyroid axis abnormalities in depression.
    • Further research is required to confirm the efficacy of T3 in resistant depression and fully understand the mechanisms involved.