Aim

To assess the thyroid allostasis in drug-free patients with affective disorder.

Methods

Patients with major depressive disorder or bipolar disorder as drug-free, defined as those without psychiatric drugs exposure for at least 4 months before admission, from a tertiary hospital were recruited in this cross-sectional study. The primary outcomes were “structure parameters of thyroid homeostasis”, which include “thyroid's secretory capacity” (SPINA-GT), “sum step-up activity of deiodinases” (SPINA-GD), the ratio of total to free thyroxine and “thyroid homeostasis central set point” (TSH index and “thyroid feedback quantile-based index” [TFQI]), calculated by TSH and thyroid hormones measured at admission. A healthy population and non-affective psychiatric disorder (schizophrenia) from the same catchment area were recruited as two comparison groups.

Results

A total of 1263 cases of major depressive disorder, 1619 cases of bipolar disorder, 1186 cases of schizophrenia, and 162 healthy controls were included in the study. Compared to healthy control, GD and ratio of total to free thyroxine were lower in affective disorders. Bipolar with mania episode had higher GT than bipolar with depressive episode and major depressive disorder (median level at 3.70 vs. 3.04 and 3.03, respectively). Compared with healthy control, schizophrenia had higher TSH index and TFQI, but no increase in these parameters in major depressive disorder and bipolar disorder.

Conclusion

Affective disorders have a unique profile of thyroid allostasis with impaired step-up deiodinase activity and reduced serum protein binding of thyroid hormones, but no change in thyroid homeostasis central set point. Mania episode may be associated with higher thyroid secretory capacity.

中文翻译：

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无药物情感障碍患者的甲状腺失衡

目的

评估未用药的情感障碍患者的甲状腺动态平衡。

方法

这项横断面研究招募了来自三级医院的重度抑郁症或双相情感障碍患者，即入院前至少 4 个月没有接触过精神药物的患者。主要结局是“甲状腺稳态的结构参数”，包括“甲状腺的分泌能力”（SPINA-GT）、“脱碘酶的升压活性总和”（SPINA-GD）、总甲状腺素与游离甲状腺素的比率以及“甲状腺素” 。稳态中心设定点”（TSH 指数和“基于甲状腺反馈分位数的指数”[TFQI]），通过入院时测量的 TSH 和甲状腺激素计算得出。来自同一学区的健康人群和非情感性精神障碍（精神分裂症）被招募为两个对照组。

结果

该研究共纳入1263例重度抑郁症患者、1619例双相情感障碍患者、1186例精神分裂症患者以及162名健康对照者。与健康对照相比，情感障碍患者的 GD 和总甲状腺素与游离甲状腺素的比率较低。患有躁狂发作的双相情感障碍患者的 GT 高于患有抑郁发作的双相情感障碍患者和重度抑郁症（中位水平分别为 3.70、3.04 和 3.03）。与健康对照相比，精神分裂症患者的TSH指数和TFQI较高，但重度抑郁症和双相情感障碍这些参数没有增加。

结论

情感障碍具有独特的甲状腺动态平衡特征，伴有升压脱碘酶活性受损和甲状腺激素血清蛋白结合减少，但甲状腺稳态中心设定点没有变化。躁狂发作可能与甲状腺分泌能力较高有关。