Abstract
Objetivo
Determinar la prevalencia de alteraciones tiroideas en pacientes diagnosticados de depresión.
Diseño
Estudio descriptivo transversal (muestreo aleatorio).
Emplazamiento
Atención primaria, en San Fernando (Cádiz).
Población de estudio
Pacientes diagnosticados de depresión (criterios DSM lV) en el Centro de Salud Mental de San Fernando.
Mediciones y resultados principales
Se estudiaron 108 pacientes (intervalo de confianza del 95%; p = 11 ± 5%), a los que se les determinaron los valores sanguíneos de TSH, T3 y T4 libres y anticuerpos antitiroideos (antitiroglobulina y anti-TPO). Encontramos predominio del sexo femenino entre los pacientes estudiados (5:1) y únicamente apreciamos alteraciones tiroideas en mujeres (100%). El grupo de edad con mayor frecuencia de enfermedad depresiva fue el de 50–59 años, y entre los 30 y 59 años se contabilizó un 73,1% de todas las alteraciones tiroideas. Detectamos una elevada proporción de enfermos depresivos con alteración analítica tiroidea no conocida (24,1%), y una relevante prevalencia de depresivos con enfermedad autoinmune tiroidea (16,6%), especialmente por anti-TPO positivos, superando las prevalencias de estudios previos. La prevalencia de hipotiroidismo fue menor de la esperada (7,4% frente al 8–14%), aunque mayor de la calculada para la población general (5%).
Conclusiones
Como método de cribado, no parece indispensable la determinación indiscriminada de pruebas tiroideas a los pacientes depresivos. Ante los resultados de anticuerpos antitiroideos, y dada la escasez de estudios de prevalencia en población depresiva, parece indicado realizar estudios con mayor tamaño muestral, así como metaanálisis de investigaciones previas.
Palabras clave: Anticuerpos antitiroideos, Depresión, Hormonas tiroideas, Prevalencia, Pruebas tiroideas
Abstract
Objective
To determine the prevalence of thyroid disorders in patients diagnosed with depression.
Design
Cross-sectional descriptive study (random sampling).
Setting
Primary care, San Fernando (Cádiz).
Patients
Patients diagnosed with depression (DSM IV criteria) at the San Fernando Mental Health Centre.
Measurements and main results
108 patients were studied (95% CI; p = 11 ± 5%), in whom figures for TSH in the blood, free T3 and T4 and anti-thyroid antibodies (anti-thyroglobulin and anti-TPO) were determined.We found a predominance of women among the patients studied (5:1) and only found thyroid disorders in women (100%). The age group with greatest frequency of depressive illness was from 50 to 59. 73.1% of all the thyroid disorders were found in the 30- 59 age group.We detected a high number of depressive patients with unknown thyroid analytic disorder (24.1%) and a relevant prevalence of depressives with thyroid auto-immune disease (16.6%), especially due to positive anti-TPOs, exceeding the prevalence in previous studies. There was less hypothyroidism than expected (7.4% against 8–14%), although more than the estimated figure for the population as a whole (5%).
Conclusions
Indiscriminate thyroid tests on depressive patients, as a screening method, can be dispensed with. Given the results of anti-thyroid antibodies and the few studies of prevalence in the depressive population, it seems appropriate to conduct studies with a bigger sample and meta-analysis of previous research.
Bibliografía
- 1.Hidalgo Rodrigo M.I., Díaz González R.J., Hidalgo Rodrigo M.A. 2.a. Gráficas Letra; Madrid: 1996. Manual de psiquiatría para el médico de atención primaria. En: Trastornos del estado de ánimo; pp. 87–131. [Google Scholar]
- 2.Musselman D.L., Nemeroff C.B. Depression and endocrine disorders: focus on the thyroid and adrenal system. Br J Psychiatry. 1996;168(Supl 30):123–128. [PubMed] [Google Scholar]
- 3.Doron L.D., Burgess E.S., Dichek H.L., Putnam F.W., Chrousos G.P., Gold P.W. Thyroid hormone concentrations in depressed and nondepressed adolescents: group differences and behavioral relations. I Am Acad Child Adolesc Psychiatry Mar. 1996;35(3):299–306. doi: 10.1097/00004583-199603000-00010. [DOI] [PubMed] [Google Scholar]
- 4.Masson; Barcelona: 1997. DSM-IV Atención primaria; pp. 39–40. [Google Scholar]
- 5.Hall R.W.R., Dunlap P.K., Hall R.C.W., Pacheco C.A., Blakey R.K., Abraham J. Thyroid disease and abnormal thyroid function tests in women with eating disorders and depression. J Fla Med Assoc. 1995;82(3):187–192. [PubMed] [Google Scholar]
- 6.Tallis J. Primary hypothyroidism: a case for vigilance in the psychological treatment of depression. Br J Clin Psychol. 1993;32(pt 3):261–270. doi: 10.1111/j.2044-8260.1993.tb01056.x. [DOI] [PubMed] [Google Scholar]
- 7.Sokolov S.T., Kutcher S.P., Joffe R.T. Basal thyroid indices in adolescent depression and bipolar disorder. J Am Acad Child Adolesc Psychiatry. 1994;33(4):469–475. doi: 10.1097/00004583-199405000-00004. [DOI] [PubMed] [Google Scholar]
- 8.Haggerty JJ J.r., Prange A.J. Bordeline hypothyroidism and depression. Ann Rev Med. 1995;46:37–46. doi: 10.1146/annurev.med.46.1.37. [DOI] [PubMed] [Google Scholar]
- 9.Custro N., Scafidi V., Lo Baido R., Nastri L., Abbate G., Cuffaro M.P. Subclinical hypotiroidism resulting from autoinmune thyroiditis in female patients with endogenous depression. J Endocrinol Invest. 1994;17(8):641–646. doi: 10.1007/BF03349679. [DOI] [PubMed] [Google Scholar]
- 10.Fava M., Labbate L.A., Abraham M.E., Rosenbaum J.F. Hypothyroidism and hyperthyroidism in major depression revisited. J Cli Psychiatry. 1995;56:5. [PubMed] [Google Scholar]
- 11.Ordas D.M., Labbate L.A. Routine screening of thyroid function in patients hospitalized for major depression or disthymia. Ann Clin Psychiatry. 1995;7(4):161–165. doi: 10.3109/10401239509149621. [DOI] [PubMed] [Google Scholar]
- 12.Maes M., Meltzer H.Y., Cosyns P., Suy E., Schotte C.h. An evaluation of basal hypothalamic-pituitary-thyroid axis function in depression: results of a large-scaled and controlled study. Psychoneuroendocrinology. 1993;18(8):607–620. doi: 10.1016/0306-4530(93)90037-l. [DOI] [PubMed] [Google Scholar]
- 13.Wiersinga W.M. Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance. Neth J Med. 1995;46(4):197–204. doi: 10.1016/0300-2977(94)00089-r. [DOI] [PubMed] [Google Scholar]
- 14.De Mendoca L., Vandel S. Thyroid function in depressed patients. Encephae. 1996;22(2):85–94. [PubMed] [Google Scholar]
- 15.Prange A.J. Novel uses of thyroid hormones in patients with afective disorders. Thyroid. 1996;6(5):537–543. doi: 10.1089/thy.1996.6.537. [DOI] [PubMed] [Google Scholar]
- 16.Henley W.N., Koehnle T.J. Thyroid hormones and the treatment of geriatric depression: an examination of basic hormonal actions in the mature mammalian brain. Synapse. 1997;27(1):36–44. doi: 10.1002/(SICI)1098-2396(199709)27:1<36::AID-SYN4>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
- 17.Betterle C., Callegari G., Presotto F., Zanette F., Pedini B., Rampazzo T. Thyroid autoantibodies: a good marker for the study of symptomless autoinmune thyroiditis. Acta Endocrinol. 1987;114(3):321–327. doi: 10.1530/acta.0.1140321. [DOI] [PubMed] [Google Scholar]
- 18.Colim M., Gilbert H. Medical progress: chronic autoinmune thyroiditis. N Engl J Med. 1996;335(2):93–105. [Google Scholar]
- 19.Haggerty J.J., Jr., Silva S.G., Marquardt M., Mason G.A., Chang H.Y., Evans D.L. Prevalence of antithyroid antibodies in mood disorders. Depress Anxiety. 1997;5(2):91–96. [PubMed] [Google Scholar]
- 20.Pop V.J., Maartens L.M., Leusink G., Van Son M.J., Knottnerus A.A., Ward A.M. Are autoinmune thyroid dysfunction and depression related? J Clin Endocrinol Metab. 1998;83(9):3194–3197. doi: 10.1210/jcem.83.9.5131. [DOI] [PubMed] [Google Scholar]
- 21.Harris B., Othman S., Davies J.A., Weppner G.J., Richards C.J., Newcombe R.G. Association between postpartum thyroid dysfunction and thyroid antibodies and depression. BMJ. 1992;305(6846):152–156. doi: 10.1136/bmj.305.6846.152. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Bougerol T. Traitment d’un episode depressif resistant. Encephale. 1993;19(3):459–466. [PubMed] [Google Scholar]
- 23.Cavalieri R.R. The effects of nonthyroid disease and drugs on thyroid function tests. In: Greenspan F.S., editor. Thyroid diseases. Med Clin North Am. 1991. pp. 27–39. 75. [DOI] [PubMed] [Google Scholar]
- 24.Whybrow P.C. The therapeutic use of triiodothyronine and high dose thyroxine in psychiatric disorder. JAMA. 1994;2:47–51. [PubMed] [Google Scholar]