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Thyroid function abnormal in some youth with mood, anxiety disorders

Thyroid-stimulating hormone concentrations were abnormal in about 6% of psychiatrically hospitalized youth with significant mood and anxiety disorders, but thyroid disease was present in less than 1% of the total sample, according to study findings.

“American Academy of Pediatrics guidelines (and others) recommend screening for and treating anxiety and depression in primary care settings.” Jeffrey Strawn, MD, of University of Cincinnati’s Anxiety Disorders Research Program, and colleagues wrote in Journal of Clinical Psychiatry. “However, the literature does not provide pediatricians with information to adequately estimate the prevalence of clinical features associated with thyroid disorders among anxious and depressed youth, making it difficult to determine when such evaluations are necessary.”

Researchers retrospectively examined thyroid-stimulating hormone (TSH) concentrations in youth aged 3 to 19 years with mood/anxiety disorders who were psychiatrically hospitalized to determine the prevalence of abnormal TSH measures as well as any clinical and demographic predictors of these measures. For patients with electronic medical record notes in the week before TSH testing, they used natural language processing algorithms to determine the presence of related symptoms like weight gain, drowsiness/tiredness and insomnia/dyssomnia.

Of 1,017 hospitalized youth, 62 patients had elevated and seven had suppressed TSH concentrations.

Strawn and colleagues reported that high TSH concentrations were linked to history of thyroid disease (OR = 6.88; 95% CI, 2.37-10.7), levothyroxine treatment (OR = 5.66; 95% CI, 1.51-18.02), recent weight gain (OR = 3.6; 95% CI, 1.13-9.61), benzodiazepine treatment (OR = 2.29; 95% CI, 1.07-4.52) and abnormal menstrual bleeding/menometrorrhagia (OR = 2.03; CI, 1.04-3.63). However, they found no association for sex, age or BMI.

In addition, eight patients with high TSH measures exhibited an abnormal free/total thyroxine (T4) level or other findings consistent with thyroid disease. Patients with thyroid disease were older than patients with high TSH and normal active thyroid concentrations, according to the results.

“The cost-effectiveness of screening might be increased if testing is performed in those youth with severe mood and anxiety disorders who report weight gain, abnormal uterine bleeding/menometrorrhagia or a history of thyroid disease as opposed to universal screening,” Strawn and colleagues wrote. “These patient-specific characteristics may inform targeted screening approaches and should be of high clinical interest to pediatricians, child and adolescent psychiatrists and other pediatric mental health providers.” – by Savannah Demko

Disclosures: Strawn reports research support from Allergan, Edgemont, Lundbeck, Neuronetics, the NIH and Shire, and consulting for/material support from Myriad Genetics. Please see the study for all other authors’ relevant financial disclosures.