Unexplained Somatic Symptoms due to Depression and / or Subclinical Hypothyroidism

Abstract

Background: Unexplained somatic symptoms are common presentation of many diseases including subclinical hypothyroidism and depression. Subclinical hypothyroidism (mild thyroid failure) represents an early stage of thyroid disease that will commonly progress to overt hypothyroidism. Objectives: To assess the presence of depression and subclinical hypothyroidism (mild thyroid failure) in patients presenting with unexplained somatic symptoms aiming for better care provided to those patients. Special care should be provided to females as they are more likely to be affected by both conditions. Method: Patients were collected conveniently from those attended internal medicine clinic during the period from January to August 2013 complaining from multiple unexplained somatic symptoms. Patients with clinical hypothyroidism or anemia or other cause of their presenting somatic complaints were excluded from the study. Remaining 48 patients were having only unexplained somatic symptoms which proved after investigation to have subclinical hypothyroidism with high TSH while their T4 were normal. Then they were screened for depression byPatient Health Questionnaire 9 (PHQ-9), fatigue severity scale (FSS), Somatic Symptom Inventory (SSI), and Sheehan Disability Scale (SDS) for measurement of functional impairment. Results: Females (n=36) represent 75% of cases while males (n=12) represent only 25% of cases. FSS was significantly higher in females than males (t=2.373, p=0.023). Fatigue is the most common presenting symptom among all patients (n=21, 43.7%) followed by weight gain (n=16, 33.3%) and lastly generalized aches (n=11, 22.9%). More females presented with fatigue (n=15, 72.7%) than males (n=6, 28.6%). Females are earlier than males to seek medical advice. Only 19 patients (39.6%) were presented early and females were majority of them (n=17, 89.5%). There were positive correlations between severity of depression and (physical symptoms severity, fatigue, and degree of functional disability). There were significant negative correlations between T4 serum level and (depression severity and degree of functional disability). Conclusion: Mild thyroid failure frequently progresses to overt hypothyroidism. It may clearly be associated with somatic symptoms, depression, memory and cognitive impairment. It is common more in females than males regardless their age. Early detection & treatment of mild thyroid failure and depression has been reported to be cost-effective and can prevent further functional impairment.