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Low CSF/serum ratio of free T4 is associated with decreased quality of life in mild hypothyroidism – A pilot study : CSF/s-T4 associated with QoL in hypothyroidism

Funkquist, Anders ; Bengtsson, Anders ; Johansson, P. M. LU ; Svensson, Johan LU ; Bjellerup, Per ; Blennow, Kaj LU ; Wandt, Birger and Sjöberg, Stefan (2020) In Journal of Clinical and Translational Endocrinology 19.
Abstract

Background & Objective: Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). Methods: Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the... (More)

Background & Objective: Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). Methods: Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the questionnaires were related to serum and CSF levels of free- T4 and T3 as well as the ratios between them in CSF and in serum. Results: Self-reported health was considerably lower in hypothyroid subjects. MADRS was considerably higher than the normal range for healthy individuals. Low CSF/serum free-T4 ratio was correlated with an increased depressed state according to MADRS (p < 0.01), and in addition, CSF/serum free-T4 ratio correlated positively with the self-reported general health Likert scale (p < 0.05). Concentrations of TSH, or free-T3 in serum or CSF, were not associated with an increased depressed state or self-reported general health. Conclusions: Low CSF/serum ratio of free-T4 was correlated with impaired general health and mood, in contrast to serum measurements not showing any correlations. These findings might partly explain why some patients with hypothyroidism suffer from mental symptoms, despite adequate serum levels of free-T4. However, the findings need to be confirmed in further and larger studies.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
MADRS, Mild hypothyroidism, Quality of life, Subclinical hypothyroidism, Thyroxine, Triiodothyronine, Endocrinology, Thyroid hormone, QUALITY OF LIFE, Cognition, Neuropsychiatry
in
Journal of Clinical and Translational Endocrinology
volume
19
article number
100218
publisher
Elsevier
external identifiers
  • pmid:32154116
  • scopus:85080100300
ISSN
2214-6237
DOI
10.1016/j.jcte.2020.100218
language
English
LU publication?
yes
id
d072e5a5-513c-49fb-b462-29521970c90c
date added to LUP
2020-03-15 22:42:56
date last changed
2020-04-03 12:59:15
@article{d072e5a5-513c-49fb-b462-29521970c90c,
  abstract     = {<p>Background &amp; Objective: Patients with mild hypothyroidism often are depressed and have impaired quality of life despite serum free-T4 and T3 within reference values. Therefore, we investigated whether their symptoms were dependent on the concentrations of free -T4 and T3 in the circulation and cerebrospinal fluid (CSF). Methods: Twenty-five newly diagnosed, untreated hypothyroid subjects and as many age- and sex-matched healthy controls were investigated. Blood and CSF sampling was performed in the morning after an overnight fast. Quality of life (QoL) was assessed by a Likert scale. In the hypothyroid subjects, the MADRS rating scale was also used to evaluate symptoms of depression. Furthermore, the results obtained by the questionnaires were related to serum and CSF levels of free- T4 and T3 as well as the ratios between them in CSF and in serum. Results: Self-reported health was considerably lower in hypothyroid subjects. MADRS was considerably higher than the normal range for healthy individuals. Low CSF/serum free-T4 ratio was correlated with an increased depressed state according to MADRS (p &lt; 0.01), and in addition, CSF/serum free-T4 ratio correlated positively with the self-reported general health Likert scale (p &lt; 0.05). Concentrations of TSH, or free-T3 in serum or CSF, were not associated with an increased depressed state or self-reported general health. Conclusions: Low CSF/serum ratio of free-T4 was correlated with impaired general health and mood, in contrast to serum measurements not showing any correlations. These findings might partly explain why some patients with hypothyroidism suffer from mental symptoms, despite adequate serum levels of free-T4. However, the findings need to be confirmed in further and larger studies.</p>},
  author       = {Funkquist, Anders and Bengtsson, Anders and Johansson, P. M. and Svensson, Johan and Bjellerup, Per and Blennow, Kaj and Wandt, Birger and Sjöberg, Stefan},
  issn         = {2214-6237},
  language     = {eng},
  month        = {03},
  publisher    = {Elsevier},
  series       = {Journal of Clinical and Translational Endocrinology},
  title        = {Low CSF/serum ratio of free T4 is associated with decreased quality of life in mild hypothyroidism – A pilot study : CSF/s-T4 associated with QoL in hypothyroidism},
  url          = {http://dx.doi.org/10.1016/j.jcte.2020.100218},
  doi          = {10.1016/j.jcte.2020.100218},
  volume       = {19},
  year         = {2020},
}