Thyroid hormone levels in patients with bipolar disorder: a systematic review and meta-analysis.

IF 2.8 3区医学 Q3 ENDOCRINOLOGY & METABOLISM BMC Endocrine Disorders Pub Date : 2024-11-18 DOI:10.1186/s12902-024-01776-1

Shanshan Liu, Xiaoai Chen, Xiaotao Li, Limin Tian

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Abstract

Purpose: To investigate the difference in blood (serum/plasma) thyroid hormone (TH) levels, including thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3), in bipolar disorder (BD) during different mood episodes (depression and mania) compared with healthy control (HC) and between manic episodes (BD-M) and depressive episodes (BD-D).

Methods: As of September 1, 2024, the electronic databases PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, China Science and Technology Journal Database, Wanfang Database, and Clinical Trials. Gov were systematically searched with no language limitations. Standardized mean differences (SMD) with 95% confidence interval (CI) were summarized using a random effects model. The chi-squared-based Q test and the I² test assessed the size of heterogeneity.

Results: The 21 studies included a total of 3696 participants, Of the 2942 BD patients, 1583 were in depressive episodes 1359 were in manic episodes. The status of measuring blood TH levels included 2 studies in plasma and 19 in serum. Combined with the results of the sensitivity analyses, we obtained the following relatively reliable results: serum T3 (SMD: -0.63, 95%CI: -1.09 to -0.17) and FT3 (SMD: -0.42, 95%CI: -0.83 to -0.00) levels decreased significantly in BD-D compared to HC; serum T3 (SMD: -0.91, 95%CI: -1.49 to -0.32) levels decreased significantly and serum FT4 (SMD: 0.37, 95%CI: 0.14 to 0.60) levels increased significantly in BD-M than in HC; serum T3 (SMD: 0.87, 95%CI: 0.24 to 1.49) and FT3 (SMD: 0.27, 95%CI: 0.13 to 0.42) levels demonstrated a significant elevation in BD-M compared to BD-D. In the group of euthyroidism, apart from serum FT4 (SMD: 0.21, 95%CI: -0.15 to 0.58) levels showed no significant difference between BD-M and HC, other results above remained consistent.

Conclusion: Serum T3 and FT3 levels decreased significantly in BD-D compared to HC. Serum T3 levels decreased significantly and serum FT4 levels increased significantly in BD-M compared to HC. Serum T3 and FT3 levels increased significantly in BD-M than in BD-D. The temporality of changes in TH levels and BD progression demands further longitudinal studies to illustrate.

Trial registration: Number and date of registration for prospectively registered trials No. CRD42022378530.

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双相情感障碍患者的甲状腺激素水平：系统综述和荟萃分析。

目的研究双相情感障碍患者在不同情绪发作期（抑郁和躁狂）的血液（血清/血浆）甲状腺激素（TH）水平，包括促甲状腺激素（TSH）、甲状腺素（T4）、三碘甲状腺原氨酸（T3）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）与健康对照组（HC）的差异、和游离三碘甲状腺原氨酸（FT3），与健康对照组（HC）相比，以及与躁狂发作（BD-M）和抑郁发作（BD-D）之间的比较。研究方法截至 2024 年 9 月 1 日，系统检索了 PubMed、Embase、Cochrane Library、Web of Science、中国国家知识基础设施、中国生物医学文献数据库、中国科技期刊数据库、万方数据库和 Clinical Trials.在没有语言限制的情况下，对所有文献进行了系统检索。采用随机效应模型总结了标准化平均差（SMD）及 95% 置信区间（CI）。基于卡方的Q检验和I2检验评估了异质性的大小：21 项研究共纳入 3696 名参与者，在 2942 名 BD 患者中，1583 人处于抑郁发作期，1359 人处于躁狂发作期。血液中 TH 水平的测量情况包括 2 项血浆研究和 19 项血清研究。结合敏感性分析的结果，我们得出了以下相对可靠的结果：与 HC 相比，BD-D 患者的血清 T3（SMD：-0.63，95%CI：-1.09 至 -0.17）和 FT3（SMD：-0.42，95%CI：-0.83 至 -0.00）水平显著下降；与 HC 相比，BD-D 患者的血清 T3（SMD：-0.91，95%CI：-1.49至-0.32）水平显著下降，血清FT4（SMD：0.37，95%CI：0.14至0.60）水平显著升高；与HC相比，BD-M的血清T3（SMD：0.87，95%CI：0.24至1.49）和FT3（SMD：0.27，95%CI：0.13至0.42）水平显著升高。在甲状腺功能正常组中，除了血清FT4（SMD：0.21，95%CI：-0.15至0.58）水平在BD-M和HC之间无明显差异外，上述其他结果保持一致：结论：与 HC 相比，BD-D 的血清 T3 和 FT3 水平明显下降。结论：与 HC 相比，BD-D 的血清 T3 和 FT3 水平明显下降；与 HC 相比，BD-M 的血清 T3 水平明显下降，血清 FT4 水平明显上升。与 BD-D 相比，BD-M 的血清 T3 和 FT3 水平明显升高。TH水平变化与BD进展的时间性需要进一步的纵向研究来说明：前瞻性注册试验的编号和注册日期编号：CRD42022378530。

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来源期刊

BMC Endocrine Disorders ENDOCRINOLOGY & METABOLISM-

CiteScore

4.40

自引率

0.00%

发文量

280

审稿时长

>12 weeks

期刊介绍： BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.