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We have previously reported on the strong link between hypothyroidism and depression. A new study published in the International Journal of Academic Medicine and Pharmacy adds more data to this association. The study sought to determine the correlation between thyroid dysfunction and depression severity among 300 patients at a psychiatry outpatient clinic who were diagnosed with depression according to DSM-5 criteria. Patients on thyroid medication, those with a history of thyroidectomy or known autoimmune thyroid disease were excluded to avoid the possibility of pre-existing thyroid conditions confounding the results.
Nearly a quarter of the participants (22 percent) were identified as having hypothyroidism. An additional 8 percent were found to have hyperthyroidism, with the former being more common among females and the latter more common among males. (This is not surprising, given that hypothyroidism is as much as nine times more common in women than in men.)
A significant association was found between increased levels of thyroid stimulating hormone (TSH) and depression severity. For those with “mild” depression, mean TSH was 2.9 mIU/L, versus 4.1 mIU/L among those with “moderate” depression, and 5.6 mIU/L in those with “severe” depression. As we have covered in a past article, the TSH test is not always adequate for identifying hypothyroidism, but it is still noteworthy that the highest TSH values were correlated with the most severe depression. Levels of T4 and T3 were also assessed, with the mean T3 coming in at 1.2 ng/dL.
Considering the lackluster effects and undesirable side-effects of many antidepressant medications, routine thyroid testing (encompassing more than solely TSH) in psychiatric practice may lead to more fruitful results, at least for the many patients whose depression may be rooted in undiagnosed or inadequately treated hypothyroidism. And it’s worth noting that, in contrast to the “gold standard” treatment with levothyroxine (T4) monotherapy, refractory depression appears to respond well to T3 treatment, at least among some patients.
The study authors summed it up well:
“The implications of our findings for clinical practice are considerable. Present depression treatment guidelines mainly concentrate on antidepressant therapy, with minimal focus on endocrine assessment. Nonetheless, due to the significant similarity between symptoms of depression and hypothyroidism—like fatigue, cognitive issues, and lack of pleasure—there is concern regarding misdiagnosis or underdiagnosis of thyroid problems in patients with depression.”
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