Objectives

Behavioral disturbances in adolescence are potentially linked to aberrant functioning of the thyroid gland. Accordingly, alterations of the hypothalamic-pituitary-thyroid (HPT) axis might impact psychopathological development. Yet corresponding research in adolescents with nonsuicidal self-injury (NSSI) and comorbid mental disorders is scarce.

Methods

The present study examined HPT axis functioning in adolescents with NSSI compared to healthy controls (HC) using blood-based assays of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and the ratio of these hormones (fT3/fT4 ratio). Cortisol was additionally examined to contrast HPT axis functioning with a well-established biomarker of stress responsivity. Moreover, associations between clinical characteristics, HPT axis and HPA axis functioning were investigated. Female adolescents meeting NSSI criteria according to DSM-5 criteria (n = 117) were compared to adolescent HC (n = 41). Standardized serum-based endocrinological assays and interview- and questionnaire-based psychiatric assessments were used. Smoking status was included as covariate for all analyses.

Results

NSSI patients displayed altered HPT axis functioning as fT3/fT4 ratio values were blunted in comparison to HC. Negative correlations were further present between fT3, fT3/fT4 ratio and severity of BPD symptoms, depression scores and symptomatic distress. TSH correlated negatively with severity of BPD symptoms and symptomatic distress exclusively. Cortisol values differed neither significantly between experimental groups nor correlated significantly with clinical characteristics.

Conclusions

Longitudinal examinations, assessing links between psychopathology and endocrinological alterations, are warranted to address potential clinical implications of thyroid markers in child and adolescent psychiatry.

中文翻译：

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女性青少年非自杀性自伤的下丘脑-垂体-甲状腺轴功能及其与共病边缘型人格障碍和抑郁症的关系

目标

青春期的行为障碍可能与甲状腺功能异常有关。因此，下丘脑-垂体-甲状腺（HPT）轴的改变可能会影响精神病理学的发展。然而，对患有非自杀性自伤 (NSSI) 和合并精神障碍的青少年的相应研究却很少。

方法

本研究使用基于血液的促甲状腺激素 (TSH)、游离三碘甲状腺原氨酸 (fT3)、游离甲状腺素 (fT4) 和这些激素的比例来检测 NSSI 青少年与健康对照组 (HC) 的 HPT 轴功能（fT3/fT4 比率）。还检查了皮质醇，以对比 HPT 轴功能与公认的压力反应性生物标志物。此外，研究了临床特征、HPT 轴和 HPA 轴功能之间的关联。根据 DSM-5 标准（n  = 117）符合 NSSI 标准的女性青少年与青少年 HC（n = 41)。使用标准化的基于血清的内分泌检测以及基于访谈和问卷的精神病学评估。吸烟状况作为所有分析的协变量。

结果

NSSI 患者表现出改变的 HPT 轴功能，因为与 HC 相比，fT3/fT4 比率值变钝。fT3、fT3/fT4 比值与 BPD 症状严重程度、抑郁评分和症状性困扰之间进一步存在负相关。TSH 仅与 BPD 症状的严重程度和症状性窘迫呈负相关。皮质醇值在实验组之间既没有显着差异，也没有与临床特征显着相关。

结论

纵向检查，评估精神病理学和内分泌改变之间的联系，有必要解决儿童和青少年精神病学中甲状腺标志物的潜在临床意义。