Interactions between brain, psyche and thyroid^[*]

Summary

Interactions between brain, psyche and thyroid are known from historical descriptions of thyroidectomy (Kocher) and hyperthyroidism. However, their importance is often underscored in clinical routine. Thyroid hormone deficiency during pregnancy may result in irreversible mental retardation and requires levothyroxine substitution. TSH screening after delivery must identify newborns with congenital hypothyroidism: An early levothyroxine substitution and long term therapy control are required.

Hypothyroidism and depression have many symptoms in common. Cognitive deficits and depressive states are often found in overt hypothyroidism, psychotic derangements are rare. Levothyroxine improves hypothyroid symptoms and mental performance, mood and motivation. Psychic symptoms of hyperthyroidism include agitation, irritability, mood disturbances, hyperactivity, anxiousness and even panic attacks. Manic and delusional states are rare. In geriatric patients hyperthyroidism may be oligosymptomatic. In psychiatric patients more frequent but unspecific disturbances of thyroid laboratory values being reversible without specific therapy have to be distinguished from rather rare but causative organic thyroid diseases with therapeutic consequences. Some psychiatric drugs influence thyroid laboratory results. Hypothyroidism in depressive patients is a negative prognostic parameter and requires therapy. Psychiatric symptoms associated with hypothyroidism are usually reversible under levothyroxine within 4–8 weeks. The standard for hypothyroidism is mono-levothyroxine therapy.

Zusammenfassung

Interaktionen zwischen Gehirn, Psyche und Schilddrüse sind aus historischen Beschreibungen der Thyroidektomie (Kocher) und Hyperthyreose bekannt, finden aber in der Routine eine eher untergeordnete Beachtung. Schilddrüsenhormonmangel in der Schwangerschaft kann eine irreversible mentale Retardierung hervorrufen und ist mit Levothyroxin zu substituieren. Das TSH-Screening soll Neugeborene mit kongenitaler Hypothyreose identifizieren: Frühe Levothyroxin-Substitution und konsequente Therapieüberwachung sind indiziert.

Hypothyreose und Depression haben viele gemeinsame Symptome. Kognitive Veränderungen und depressive Zustände sind bei manifester Hypothyreose häufig, psychotische Störungen selten. Levothyroxin bessert Hypothyreosesymptomatik, Gedächtnisleistung, Stimmung und Antrieb. Psychische Symptome bei Hyperthyreose umfassen Unruhe, Reizbarkeit, Stimmungsschwankungen, Hyperaktivität und ängstlichkeit bis hin zu Panikattacken. Manische und wahnhafte Zustandsbilder sind selten. Hyperthyreosen bei geriatrischen Patienten können oligosymptomatisch verlaufen.

Bei psychiatrischen Patienten sind häufige unspezifische Schilddrüsenparameter-Veränderungen, die reversibel sind und keiner Therapie bedürfen, zu unterscheiden von ursächlich seltenen organischen Schilddrüsenerkrankungen mit Therapiekonsequenzen. Auch auf den Einfluss von Medikamenten auf Schilddrüsenparameter ist zu achten. Eine Hypothyreose wird als negativer prognostischer und somit behandlungsbedürftiger Faktor bei Patienten mit Depression angesehen. Hypothyreose-bedingte psychiatrische Symptome sind unter Substitutionstherapie meist binnen 4–8 Wochen reversibel. Standard bei Hypothyreose ist die Mono-Levothyroxintherapie.

Keywords

Hypothyroidism - hyperthyroidism - brain - psyche - depression

Schlüsselwörter

Hypothyreose - Hyperthyreose - Hirnentwicklung - Psyche - Kretinismus - Depression - Psychose

• Literatur

• 1 Abalovich M, Amino N, Barbour LA. et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92 (Suppl. 08) S1-S47.
• 2 Altshuler LL, Bauer M, Frye MA. et al. Does thyroid supplementation accelerate tricyclic antidepressant response ? A review and meta-analysis of the literature. Am JPsychiatry 2001; 158: 1617-1622.
• 3 Álvarez-Pedrerol M, Ribas-Fit N, Torrent M. et al. TSH concentrations within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers. Clin Endocrinol 2007; 66: 890-898.
• 4 Aronson R, Offman HJ, Joffe RT. et al. Triiodothyronine augmentation in the treatment of refractory depression. Arch Gen Psychiatry 1996; 53: 842-848.
• 5 Attia J, Margetts P, Guyatt G. Diagnosis of thyroid disease in hospitalized patients: a systematic review. Arch Intern Med 1999; 159: 658-665.
• 6 Bartalena L, Pellegrini L, Meschi M. et al. Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorders. Psychiatry Res 1990; 34: 13-17.
• 7 Bauer M, Heinz A, Whybrow PC. Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain. Mol Psychiatry 2002; 7: 140-156.
• 8 Bauer M, Whybrow P, Angst J. et al. WFSBP Task Force on Treatment Guidelines for Unipolar Depressive Disorders. World federation of societies of biological psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: acute and continuation treatment of major depressive disorder World J Biol Psychiatry 2002; b 1: 5-43.
• 9 Baumgartner A. Schilddrüsenhormone und depressive Erkrankungen-Kritische übersicht und Perspektiven. Teil I: Klinik. Nervenarzt 1993; 64: 1-10.
• 10 Bernal J. Thyroid hormone receptors in brain development and function. Nature Clin Pract Endocrinol Metab 2007; 3: 249-259.
• 11 Bjerke SN, Bjoro T, Heyerdahl S. Psychiatric and cognitive aspects ofhypothyroidism. Tidsskr Nor Laegeforen 2001; 121: 2373-2376.
• 12 Bocchetta A, Bernardi F, Pedditzi M. et al. Thyroid abnormalities during lithium treatment. Acta Psy- chiatr Scand 1991; 83: 193-198.
• 13 Bocchetta A, Loviselli A. Lithium treatment and thyroid abnormalities. Clin Pract Epidemiol Mental Health 2006; 2: 1-5.
• 14 Bono G, Fancellu R, Blandini F. et al. Cognitive and affective status in mild hypothyroidism and interactions with L-thyroxine treatment. Acta Neurol Scand 2004; 110: 59-66.
• 15 Brabant G, Kahaly GJ, Schicha H. et al. Milde Formen der Schilddrüsenfehlfunktion. Ursachen, Diagnostik, Vorgehen. Dtsch ärztebl 2006; 103: A2110-A2115.
• 16 Brent GA. Diagnosing thyroid dysfunction in pregnant women: is case finding enough ?. J Clin Endocrinol Metab 2007; 92: 39-41.
• 17 Brownlie BEW, Rae AM, Walshe JWB. et al. Psychoses associated with thyrotoxicosis-“thyroto- xic psychosis”. A report of 18 cases, with statistical analysis of incidence. Eur J Endocrinol 2000; 142: 438-444.
• 18 Chueire VB, Romaldini JH, Ward LS. Subclinical hypothyroidism increases the risk for depression in the elderly. Arch Gerontol Geriatr 2007; 44: 21-28.
• 19 Chueire VB, Silva ETB, Perotta E. et al. High serum TSH levels are associated with depression in the elderly. Arch Gerontol Geriatr 2003; 36: 281-288.
• 20 Davis JD, Tremont G. Neuropsychiatry aspects of hypothyroidism and treatment reversibility. Minerva Endocrinol 2007; 32: 49-65.
• 21 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (Hrsg). Behandlungsleitlinie affektive Errkrankungen. Reihe: Praxisleitlinien in Psychiatrie und Psychotherapie. Band 5. Steinkopff: Darmstadt; 2000
• 22 Dietlein M, Dederichs B, Kobe C. et al. Therapy for non-toxic multinodular goiter: radioiodine therapy as attractive alternative to surgery. Nuklearmedizin 2006; 45: 21-34.
• 23 Dietlein M, Kahaly G, Kobe C. et al. Adipositas, Stoffwechsel und Schilddrüse. Ist der grenzwertig hohe TSH-Spiegel Ursache oder Sekundärphänomen der Adipositas? Nuklearmedizin 2008; 47: 181-187.
• 24 Dietlein M, Wegscheider K, Vaupel R. et al. Management of multinodular goiter in Germany (Papillon 2005): Do the approaches of thyroid specialists and primary care practitioners differ?. Nuklearmedizin 2007; 46: 65-75.
• 25 Dratman MB, Futaesaku Y, Crutchfield FL. et al. Iosine-125-labeled triiodothyronine in rat brain: evidence for localization in discrete neuronal systems. Science 1982; 215: 309-312.
• 26 Dunkelmann S, Künstner H, Nabavi E. et al. Lithium as an adjunct to radioiodine therapy in Graves' disease for prolonging the intrathyroidal effective half-life of radioiodine. Useful or not? Nuklearmedizin 2006; 45: 213-218.
• 27 Duval F, Mokrani M-C, Ortiz JAM. et al. Neuroendocrine predictors of the evolution of depression. Dialogues Clin Neurosci 2005; 7: 273-282.
• 28 Easson WM. Myxedema psychosis-insanity defense in homicide. J Clin Psychiatry 1980; 41: 316-318.
• 29 Engum A, Bjoro T, Mykletun A. et al. Thyroid autoimmunity depression and anxiety; are there any connections ? An epidemiological study of a large population. J Psychosomatic Res 2005; 59: 263-268.
• 30 Forman-Hoffamn V, Philibert RA. LowerTSH and higher T4 levels are associated with current depressive syndromes in young adults. Acta Psychiatr Scand 2005; 114: 132-139.
• 31 Fountoulakis KN, Kantartzis S, Siamouli M. et al. Peripheral thyroid dysfunction in depression. World J Biol Psychiatry 2006; 7: 131-137.
• 32 Fraser SA, Kroenke K, Callahan CM. et al. Low yield of thyroid-stimulating hormone testing in elderly patients with depression. Gen Hosp Psychiatry 2004; 26: 302-309.
• 33 Frude N. Understanding abnormal psychology. Oxford: Blackwell; 1998
• 34 Geffken GR, Ward HE, Staab JP. et al. Psychiatric morbidity in endocrine disorders. Psychiatr Clin North Am 1998; 21: 473-489.
• 35 Gershenfeld HK, Philibert RA, Boehm GW. Looking forward in geriatric anxiety and depression. Implications of basic science for the future. Am J Geriatr Psychiatry 2005; 13: 1027-1040.
• 36 Glinoer D. The systematic screening and management ofhypothyroidism and hyperthyroidism during pregnancy. Trends Endocrinol Metab 1998; 9: 403-411.
• 37 Goldberg D, Hillier V. A scaled version of the General Health Questionnaire. Psych Med 1979; 9: 139-145.
• 38 Graves RJ. Clinical lectures, delivered by Robert J. Graves at the Meath Hospital during the session of 1834-35: Lecture XII: Newlyobservedaffecti- ons of the thyroid gland in females-its connections with palpitation and with fits of hysteria. Medical Classics 1940 5:25 ff. In: Schilddrüse: Pionierarbeiten aus eineinhalb Jahrhunderten. Hrsg. Henning; Berlin: 1987
• 39 Grozinsky-Glasberg S, Fraser A, Nahshoni E. et al. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypo- thyroidism: meta-analysis ofrandomized controlled trials. J Clin Endocrinol Metab 2006; 91: 2592-2599.
• 40 Grüters A, Liesenkötter KP, Zapico M. et al. Results of the screening program for congenital hypothyroidism in Berlin. Exp Clin Endocrinol Diabetes 1997; 105 (Suppl. 04) 28-31.
• 41 Gussekloo J, van Exel E, de Craen AJM. et al. Thyroid status, disability and cognitive function, and survivalinoldage. JAMA 2004; 292: 2591-2599.
• 42 Haddow JE, Palomaki GE, Allan WC. et al. Maternal thyroid defiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-555.
• 43 Haggerty Jr JJ, Stern RA, Mason GA. et al. Subclinical hypothyroidism: amodifiable risk factor for depression?. Am J Psychiatry 1993; 150: 508-510.
• 44 Hautzinger M, Bailer M, Worrall H. et al. Das Beck Depressionsinventar. Bern: Huber; 1995
• 45 Herrmann C, Buss U, Snaith RP. Hospital Anxiety and Depression Scale-deutsche Version (HADS-D). Bern: Huber; 1995
• 46 Höpfner S, Höpfner B, Rauterberg EW. Neonatal screening for congenital hypothyroidism in Hessen, Germany: efficiency of the screening program and school achievement of 129 children at an age of 8-12 years. J Perinat Med 2005; 33: 543-548.
• 47 Hutto B. Subtle psychiatric presentations of endocrine diseases. Psychiatr Clin North Am 1998; 21: 905-916.
• 48 Joffe RT, Nobrega JN, Kish SJ. et al. Regional thyroid hormone levels in rat brain. Psychneuroendo- crinol 1994; 19: 773-777.
• 49 Joffe RT. Is the thyroid still important in major depression. J Psychiatry Neurosci 2006; 31: 367-368.
• 50 Kalmijn S, Mehta KM, Pols HA. et al. Subclinical hyperthyroidism and the risk of dementia. The Rotterdam study Clin Endocrinol (Oxf) 2000; 53: 733-737.
• 51 Kendall EC. Transactions of the Association of American Physicians, Philadelphia 1915 30: 420ff. In: Schilddrüse: Pionierarbeiten aus eineinhalb Jahrhunderten. Hrsg. Henning; Berlin: 1987
• 52 Kessler RC, McGonagle KA, Zhao S. et al. Lifetime and 12-month prevalence ofDSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8-19.
• 53 Kobe C, Eschner W, Sudbrock F. et al. Graves' disease and radioiodine therapy Is success of ablation dependent on the achieved dose above 200 Gy?. Nuklearmedizin 2008; 47: 13-17.
• 54 Kobe C, Weber I, Eschner W. et al. Graves' disease and radioiodine therapy Is success of ablation dependent on the choice of thyreostatic medication?. Nuklearmedizin 2008; 47: 153-166.
• 55 Kocher ET. Ueber Kropfextirpation und ihre Folgen. Vortrag, gehalten am 1. Sitzungstage des XII. Congresses der Dt. Ges. für Chirurgie, Berlin, 4. April 1883. Archiv für klinische Chirurgie 1883. In: Schilddrüse: Pionierarbeiten aus eineinhalb Jahrhunderten. Hrsg. Henning; Berlin: 1987
• 56 Kooistra L, Crawford S, van Baar AL. et al. Neonatal effects of maternal hypothyroxinemia during earlypregnancy. Pediatrics 2006; 117: 161-167.
• 57 Larisch R, Kley K, Nikolaus S. et al. Depression and anxiety in different thyroid function states. Horm Metab Res 2004; 36: 650-653.
• 58 Lederbogen F, Hermann D, Hewer W. et al. Thyroid function test abnormalities in newly admitted psychiatric patients residing in an iodine-deficient area: patterns and clinical significance. Acta Psychiatr Scand 2001; 104: 305-310.
• 59 Lee S, Chow CC, Wing YK. et al. Thyroid abnormalities during chronic lithium treatment in Hong Kong chinese: acontrolled study. J Affect Disord 1992; 26: 173-178.
• 60 Lojko D, Rybakowski JK. L-thyroxine augmentation of serotonergic anti-depressants in female patients with refractory depression. J Affect Disord 2007; 103: 253-256.
• 61 Madhusoodanan S, Brenner R, Bavli S. et al. Thyroid function screening in acute geropsychiatric admissions. Ann Clin Psychiatry 2000; 12: 83-88.
• 62 Maes M, Meltzer HY, Cosyns P. et al. An evaluation of basal hypothalamic-pituitary-thyroid axis function in depression: results of a large-scaled and controlled study. Psychoneuroendocrinology 1993; 18: 607-620.
• 63 Mann JJ. The medical management of depression. N Engl J Med 2005; 353: 1819-1834.
• 64 Mc Carthy D. Manual for the Mc Carthy Scales of Children's abilities. New York: Psychological Corp; 1972
• 65 Meier C, Christ-Crain M, Keller U. et al. Psychische Veränderungen bei Hypo- und Hyperthy- reosen. Dtsch Med Wochenschr 2002; 127: 1145-1150.
• 66 Meier C, Staub JJ, Roth CB. et al. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab 2001; 86: 4860-4866.
• 67 Monzani F, Del Guerra P, Caraccio N. et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. Clin Investig 1993; 71: 367-371.
• 68 Narrow WE, Rae DS, Robins LN. et al. Revised prevalence estimates of mental disorders in the United States: using aclinical significance criterion to reconcile 2 surveys' estimates. Arch Gen Psychiatry 2002; 59: 115-123.
• 69 Negro R, Formoso G, Mangieri T. et al. Levothyro- xine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91: 2587-2591.
• 70 Nemeroff CB. Clinical significance of psychoneuroendocrinology in psychiatry: focus on the thyroid and adrenal. J Clin Psychiatry 1989; 50 (Suppl. 05) 13-20.
• 71 No Author listed Thyroid deficiency and mental health. Harv Ment Health Lett 2007; 23: 4-5.
• 72 Nystrom E, Caidahl K, Fager G. et al. A doubleblind cross-over 12-month study of L-thyroxine treatment of women with 'subclinical' hypothyroidism. Clin Endocrinol (Oxf) 1988; 29: 63-75.
• 73 Oliver C, Eskay RL, Ben-Jonathan N. et al. Distribution and concentration ofTRH in the rat brain. Endocrinology 1974; 95: 540-546.
• 74 Ordas DM, Labbate LA. Routine screening of thyroid function in patients hospitalized for major depression or dysthymia?. Ann Clin Psychiatry 1995; 7: 161-165.
• 75 Patten SB, Williams JVB, Esposito E. et al. Self-reported thyroid disease and mental disorder prevalence in the general population. Gen Hosp Psy- chiatry 2006; 28: 503-508.
• 76 Perrild H, Hegedus L, Baastrup PC. et al. Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment. Am J Psychiatr 1990; 147: 1518-1521.
• 77 Pop VJ, Kuijpens JL, van Baar AL. et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf) 1999; 50: 149-155.
• 78 Prange AJ. Novel uses of thyroid hormones in patients with affective disorders. Thyroid 1996; 6: 537-543.
• 79 Prange AJ. Psychoneuroendocrinology - A commentary. Psychiatr Clin North Am 1998; 21: 491-505.
• 80 Premachandra BN, Kabir MA, Williams IK. Low T3 syndrome in psychiatric depression. J Endocrinol Invest 2006; 29: 568-572.
• 81 Reiners C, Wegscheider K, Schicha H. et al. Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96278 unselected employees. Thyroid 2004; 14: 926-932.
• 82 Roberts LM, Pattison H, Roalfe A. et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction. Ann Intern Med 2006; 145: 573-581.
• 83 Ryan WG, Roddam RF, Grizzle WE. Thyroid function screening in newly admitted psychiatric inpatients. Ann Clin Psychiatry 1994; 6: 7-12.
• 84 Schmidt M, Gorbauch E, Dietlein M. et al. Incidence of postradioiodine immunogenic hyperthy- roidism/Graves' disease in relation to atemporary increase in thyrotropin receptor antibodies after radioiodine therapy for autonomous thyroid disease. Thyroid 2006; 16: 281-288.
• 85 Schreckenberger MF, Egle UT, Drecker S. et al. Positron emission tomography reveals correlations between brain metabolism and mood changes in hyperthyroidism. J Clin Endocrinol Metab 2006; 91: 4786-4791.
• 86 Shibusawa N, Hashimoto K, Yamada M. Thyrotropin-releasing hormone (TRH) in the cerebellum. Cerebellum. 2007 DOI 10.1080/14734220701561357.
• 87 Surks MI, Sievert R. Drugs and thyroid function. New Engl J Med 1995; 333: 1688-1694.
• 88 Sun Y, Lu X, Gershengorn MC. Thyrotropin-re- leasing hormone receptors - similarities and differences. J Mol Endocrinol 2003; 30: 87-97.
• 89 Suzuki T, Abe T. Thyroid hormone transporters in the brain. Cerebellum. 2007 DOI 10.1080/14734220701509851.
• 90 Taylor JW. Depression in thyrotoxicosis. Am J Psychiatry 1975; 132: 552-553.
• 91 Utiger RD. Maternal hypothyroidism and fetal development. N Engl J Med 1999; 341: 601-602.
• 92 Vaidya B, Anthony S, Bilous M. et al. Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding?. J Clin Endocrinol Metab 2007; 92: 203-207.
• 93 Von Basedow CA. Exophthalmos durch Hypertrophie des Zellgewebes in der Augenhöhle. Wochenschrift für die gesamte Heilkunde 1840. In: Schilddrüse: Pionierarbeiten aus eineinhalb Jahrhunderten. Hrsg. Henning; Berlin: 1987
• 94 Wenzel KW. Einfluss von pharmakologischen Substanzen auf die In-vitro-Tests der Schilddrüsenfunktionsdiagnostik: Anlaß zu diagnostischen Irrtümern. Therapiewoche 1980; 30: 6348-6365.
• 95 Wenzel KW. Schilddrüsenfunktionstests und Medikamente. Münchener Med Wochenschr 1996; 138: 658-661.
• 96 Wittchen HU, Zaudig M, Fydrich T. SKID. Strukturiertes Klinisches Interview für DSM-Iv. Achse I und II. Göttingen: Hogrefe; 1997
• 97 World Health Organization. Tenth Revision of the International Classification of Disease, Chapter V (F): Mental and Behavioural Disorders. Geneva: WHO; 1992