Associations between pituitary-thyroid hormones and depressive symptoms in individuals with anorexia nervosa before and after weight-recovery. (March 2022)

• Record Type: Journal Article
• Authors: Wronski, Marie-Louis; Tam, Friederike I.; Seidel, Maria; Mirtschink, Peter; Poitz, David M.; Bahnsen, Klaas; Steinhäuser, Jonas L.; Bauer, Michael; Roessner, Veit; Ehrlich, Stefan
• Is Part Of: Psychoneuroendocrinology. Volume 137(2022)
• Publication Date: 2022-03
• Subjects: Anorexia nervosa -- Thyroid hormones -- Triiodothyronine -- Triiodothyronine to thyroxine ratio -- Depressive symptoms -- Psychiatric symptoms; Psychoneuroendocrinology -- Periodicals; Endocrinology -- Periodicals; Neurology -- Periodicals; Psychiatry -- Periodicals; Neuropsychoendocrinologie -- Périodiques; 616.8
• DOI: 10.1016/j.psyneuen.2021.105630
• Languages: English
• ISSNs: 0306-4530

Abstract

Abstract: Background: There is sound evidence that the hypothalamic-pituitary-thyroid axis plays a role in mood regulation. Alterations in this axis, particularly low triiodothyronine syndrome, are a common neuroendocrine adaptation to semi-starvation in patients with anorexia nervosa (AN), who also frequently suffer from co-existing depressive symptoms. We therefore aimed to investigate the associations between pituitary-thyroid function and psychopathology, in particular depressive symptoms, at different stages of AN using a combined cross-sectional and longitudinal study design. Methods: Pituitary-thyroid status (FT3, free triiodothyronine; FT4, free thyroxine; conversion ratio FT3/FT4; TSH, thyroid-stimulating hormone) was assessed in 77 young acutely underweight females with AN (acAN) and in 55 long-term weight-recovered individuals with former AN (recAN) in a cross-sectional comparison to 122 healthy controls (HC). Further, pituitary-thyroid status of 48 acAN was reassessed after short-term weight-restoration. We performed correlation analyses of pituitary-thyroid parameters with self-reported measures of psychopathology. Results: AcAN showed significantly lower FT3, FT4, FT3/FT4 ratio, and TSH levels compared to HC. Pituitary-thyroid alterations were partly reversed after short-term weight-restoration. RecAN still had lower FT3 concentrations than HC. Lower FT3 concentrations and FT3/FT4 ratios were associated with more severe depressive symptoms in acAN, occurring prominently in cases of manifest low triiodothyronine syndrome. Longitudinally increasing FT3/FT4 ratios (change scores) were inversely correlated with depressive and general psychiatric symptoms after short-term weight-restoration. Conclusions: Our results suggest a potential modulation of the severity of depressive symptoms by temporarily decreased FT3 concentrations and inhibited thyroid hormone conversion (FT3/FT4 ratios) in acutely underweight AN. Associations between conversion ratios FT3/FT4 and psychopathology seem to persist across short-term weight-restoration. The findings of our study might have relevant clinical implications, ranging from thyroid monitoring to experimental low-dose thyroid hormone supplementation in certain patients with AN showing severe psychiatric impairment and overt thyroid hormone alterations. Graphical Abstract: ga1 Highlights: Acute anorexia nervosa patients have lower FT3, FT4, FT3/FT4 ratio, and TSH levels. Slight FT3 and FT4 alterations persist after short-term weight-restoration. Lower FT3 is associated with more severe depressive symptoms in acute patients. Increasing FT3/FT4 ratios with weight-restoration relate to better symptom outcomes. Severely depressed patients with low FT3 might benefit from thyroid hormone treatment.