Affective disorders on the
 background of hypothyroidism.

Abstract

Introduction. Affective disorders are the most common psychopathological symptoms of hypothyroidism. Hypothyroidism greatly reduces the effectiveness of antidepressants and replacement L-thyroxine therapy is not enough to eliminate the anxiety and depressive disorders in hypothyroidism. Aim. The purpose of the research is study of psychosomatic and somatopsychical relationships in hypothyroidism and depression. Material and methods. Four hundred and six patients (78 men and 328 women) with affective disorders aged 51,3 ± 4,7 years were examined. The concentration of thyroid-stimulating hormone (TSH), thyroxine (T4), cortisol, adrenocorticotropic hormone (ACTH) in the blood, urinary excretion of norepinephrine and epinephrine was determined. Severity of depression was estimated by the Hamilton Depression Rating Scale (HDRS), alexithymia level - by the Toronto alexithymia scale (TAS-26). Results. In euthyroid patients TSH level was 2,7 ± 0,13 mU/l, in hypothyroid - 14,1 ± 1,21 mU / l (p<0.001), T4 level was 14,4 ± 1,36 and 7.1±1.16 pmol/l, respectively (p<0.001). Depressive disorders were revealed in 374 patients (92.1%), other affective disorders - in 32 patients (7.9%). Hypothyroid patients had more pronounced depression by the Hamilton Rating Scale for Depression and a higher average score by TAS-26 as compared to euthyroid patients (17,8 ± 2,1 vs 15,3 ± 1,9 points, p=0.001and 79,9 ± 4,6 vs. 71,1 ± 4,4 points; p<0.001 respectively). TSH level has a direct correlation with severity of depression (R=0,62; р<0,001). Severe depression was observed in hypothyroid patients more often than in euthyroid patients (9.5% vs. 5.0%; р=0,029). Patients with affective disorders and hypothyroidism have a higher cortisol level and lower ACTH level than euthyroid patients (503±12.1 vs. 420±10.9 nmol/l; р<0.001 and 12.9±3.07 vs. 15.3±3.4; р<0.001 respectively). Urinary excretion of epinephrine and norepinephrine in hypothyroid patients was higher than that in euthyroid patients: 37,8 ± 2,18 vs. 31,1 ± 2,06 nmol (p<0.001) and 39,2 ± 2,14 vs. 33,4 ± 2,1 nmol (p<0.001), respectively. Conclusions. Prevalence of hypothyroidism among patients with affective disorders is higher than in the general population. The severity of the depression has a direct correlation with TSH. Activity of the sympathetic division of the autonomic nervous system is higher in patients with hypothyroidism than in patients with euthyroidism.