{"title":"Neuropsychiatric comorbidities in hypothyroidism: A systematic review","authors":"Avinash Puchalapalli , Ahsan Mahmood","doi":"10.1016/j.npbr.2020.06.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>Impairment of thyroid function is implicated in different neuropsychiatric manifestations. This systematic review article will examine and discuss (1) the biochemistry of thyroid hormones, including structure, synthesis, and homeostasis, (2) the neurophysiological role of the hypothalamic-pituitary-thyroid (HPT) axis in development and maintenance of a euthymic state, (3) laboratory measures of thyroid function, (4) clinical staging of hypothyroidism, and (5) neuropsychiatric comorbidities of hypothyroidism.</p></div><div><h3>Data sources</h3><p>Data sources include a systematic review of English articles using Ovid (1950–2018). Search terms included hypothyroidism, depression, and bipolar disorder. Additional studies were identified and added by searching references of articles in this database. Included topics focused on treatment of neuropsychiatric disorders with psychiatric drugs and adjunctive thyroid hormone replacement.</p></div><div><h3>Methods</h3><p>We created the database by identifying articles from multiple sources. Sources included the Ovid database, references of collected articles, and manual retrieval of articles on focused topics. Clinical information was summarized towards review objectives. We include a summary of the relevant basic sciences to enhance a thorough review.</p></div><div><h3>Results</h3><p>We found use of adjunctive treatment with thyroid hormone an acceptable approach to treating treatment-refractory or otherwise atypical presentations of mood and cognitive disorders. Given the prevalence of neuropsychiatric symptoms in subclinical hyperthyroidism and the severity and treatment-resistant symptoms, clinicians should rule out thyroid disorders in presentations of a mood disorder. Clinicians should consider an endocrine disruption in psychiatric patients whose mood symptoms remain treatment-refractory.</p></div><div><h3>Limitations</h3><p>The article does not discuss hyperthyroidism, which may predicate episodes of hypothyroidism in patients. Only articles with English-language abstract or full text were included. No quantitative synthesis is included as no meta-analysis was conducted. Risks of bias across studies include publication bias and selective reporting.</p></div><div><h3>Conclusions</h3><p>Hypothyroidism should be investigated in patients with neuropsychiatric symptoms of mood disorders. Adjunctive thyroid hormone treatment should be considered as a possible option for patients with refractory mood disorders.</p></div>","PeriodicalId":49756,"journal":{"name":"Neurology Psychiatry and Brain Research","volume":"37 ","pages":"Pages 79-86"},"PeriodicalIF":0.0000,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.npbr.2020.06.005","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology Psychiatry and Brain Research","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0941950020300191","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 1
Abstract
Objectives
Impairment of thyroid function is implicated in different neuropsychiatric manifestations. This systematic review article will examine and discuss (1) the biochemistry of thyroid hormones, including structure, synthesis, and homeostasis, (2) the neurophysiological role of the hypothalamic-pituitary-thyroid (HPT) axis in development and maintenance of a euthymic state, (3) laboratory measures of thyroid function, (4) clinical staging of hypothyroidism, and (5) neuropsychiatric comorbidities of hypothyroidism.
Data sources
Data sources include a systematic review of English articles using Ovid (1950–2018). Search terms included hypothyroidism, depression, and bipolar disorder. Additional studies were identified and added by searching references of articles in this database. Included topics focused on treatment of neuropsychiatric disorders with psychiatric drugs and adjunctive thyroid hormone replacement.
Methods
We created the database by identifying articles from multiple sources. Sources included the Ovid database, references of collected articles, and manual retrieval of articles on focused topics. Clinical information was summarized towards review objectives. We include a summary of the relevant basic sciences to enhance a thorough review.
Results
We found use of adjunctive treatment with thyroid hormone an acceptable approach to treating treatment-refractory or otherwise atypical presentations of mood and cognitive disorders. Given the prevalence of neuropsychiatric symptoms in subclinical hyperthyroidism and the severity and treatment-resistant symptoms, clinicians should rule out thyroid disorders in presentations of a mood disorder. Clinicians should consider an endocrine disruption in psychiatric patients whose mood symptoms remain treatment-refractory.
Limitations
The article does not discuss hyperthyroidism, which may predicate episodes of hypothyroidism in patients. Only articles with English-language abstract or full text were included. No quantitative synthesis is included as no meta-analysis was conducted. Risks of bias across studies include publication bias and selective reporting.
Conclusions
Hypothyroidism should be investigated in patients with neuropsychiatric symptoms of mood disorders. Adjunctive thyroid hormone treatment should be considered as a possible option for patients with refractory mood disorders.
期刊介绍：
Neurology, Psychiatry & Brain Research publishes original papers and reviews in
biological psychiatry,
brain research,
neurology,
neuropsychiatry,
neuropsychoimmunology,
psychopathology,
psychotherapy.
The journal has a focus on international and interdisciplinary basic research with clinical relevance. Translational research is particularly appreciated. Authors are allowed to submit their manuscript in their native language as supplemental data to the English version.
Neurology, Psychiatry & Brain Research is related to the oldest German speaking journal in this field, the Centralblatt fur Nervenheilkunde, Psychiatrie und gerichtliche Psychopathologie, founded in 1878. The tradition and idea of previous famous editors (Alois Alzheimer and Kurt Schneider among others) was continued in modernized form with Neurology, Psychiatry & Brain Research. Centralblatt was a journal of broad scope and relevance, now Neurology, Psychiatry & Brain Research represents a journal with translational and interdisciplinary perspective, focusing on clinically oriented research in psychiatry, neurology and neighboring fields of neurosciences and psychology/psychotherapy with a preference for biologically oriented research including basic research. Preference is given for papers from newly emerging fields, like clinical psychoimmunology/neuroimmunology, and ideas.
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