Exploración de la conexión entre la salud tiroidea y los trastornos psiquiátricos: una revisión integral con enfoque en la esquizofrenia y el trastorno bipolar

The interplay between thyroid dysfunction and major psychiatric disorders, particularly schizophrenia and bipolar disorder, represents a critical area of research with significant implications for diagnosis and management. Thyroid dysfunction manifests as either hyperthyroidism or hypothyroidism, each exerting distinct effects on psychiatric conditions. This bidirectional relationship underscores the need for a comprehensive understanding to enhance clinical outcomes. This comprehensive review explores the underlying mechanisms linking thyroid dysfunction and psychiatric disorders, including neuroendocrine dysregulation, immune-mediated pathways, and the effects of psychiatric medications on thyroid function. Both hypothyroidism and hyperthyroidism have been implicated in exacerbating psychiatric symptoms such as mood instability, cognitive impairment, and treatment resistance. In addition, thyroid autoimmunity, particularly the presence of thyroid antibodies, has been associated with increased rates of depression and anxiety. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases for studies published up to September 2024. Keywords included "thyroid dysfunction," "psychiatric disorders," "schizophrenia," and "bipolar disorder." Both MeSH terms and free-text terms were utilized to maximize relevant study retrieval. Peer-reviewed articles examining the relationship between thyroid health and psychiatric disorders were included, with exclusions for non-English studies and those not involving human subjects. Data extraction was independently performed by three reviewers, capturing study design, sample size, thyroid and psychiatric assessment methods, and main findings. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias Tool for randomized controlled trials, evaluating selection bias, study design, confounders, outcome measurements, and statistical analysis. Due to study heterogeneity, a meta-analysis was not feasible. Instead, findings were synthesized narratively, categorizing results by type of thyroid dysfunction (hypothyroidism and hyperthyroidism) and psychiatric condition (schizophrenia and bipolar disorder). The review highlights the prevalence and diagnostic challenges of thyroid dysfunction in psychiatric patients, emphasizing the necessity of integrated care approaches that involve collaboration between mental health and endocrine specialists. Understanding these interconnections may facilitate improved screening, diagnosis, and treatment strategies, ultimately contributing to better patient outcomes. This paper seeks to enhance existing knowledge and propose future research directions aimed at optimizing diagnostic and therapeutic practices for individuals affected by these comorbidities.