Investigation of thyroid dysfunction is more likely in patients with high psychological morbidity
Abstract
BACKGROUND: Mild or subclinical hypothyroidism [raised thyroid-stimulating hormone (TSH) but normal free thyroxine (T4)] affects 5-10% of adults. Symptoms are non-specific and TSH levels are needed for diagnosis. OBJECTIVES: We explore the relationship between thyroid function and psychological distress and investigate the usefulness of an expert-designed Thyroid Symptom Questionnaire (TSQ) in identifying hypothyroidism. METHODS: DEPTH (DEPression and THyroid) is a cross-sectional study of 325 patients recruited from general practices in Bristol, for whom thyroid function tests were requested by the GP. Subjects completed the TSQ, General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ) and had blood tests for TSH and free T4. RESULTS: The mean age was 45.7 years; 252 subjects (78%) were female; median TSH was 1.6. Psychological morbidity in this population is high: 54.2% have a GHQ-12 score >3, indicating psychological distress. We found no relationship between TSH and psychological distress [adjusted odds ratio 1.02 (95% confidence interval 0.91-1.13), P = 0.78]. The prevalence of hypothyroidism was 6.2% (95% confidence interval 3.8-9.5%). We found no evidence of an unadjusted association between TSQ score and subclinical hypothyroidism [adjusted odds ratio of 1.09 (95% confidence interval 0.95-1.24), P = 0.23]. CONCLUSIONS: Those referred for thyroid function tests, although no more likely than others to have hypothyroidism, have high rates of psychological distress. When mild (subclinical) hypothyroidism is detected in patients with psychological distress, it is important that GPs are aware that this is likely to be coincidental rather than causal and offer appropriate treatment.
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In primary care, typical thyroid symptoms and thyroid test results have low or no correlation.
“According to a study in the primary care setting, those referred for thyroid function tests have high rates of psychological stress and low (no) correlation of typical thyroid symptoms and thyroid test results [142].”
From Pharmacodynamic and Therapeutic Actions of Levothyroxine (2021) · cites this paper as [142]
In primary care, patients referred for thyroid function tests have high rates of psychological stress.
“According to a study in the primary care setting, those referred for thyroid function tests have high rates of psychological stress and low (no) correlation of typical thyroid symptoms and thyroid test results [142].”
From Pharmacodynamic and Therapeutic Actions of Levothyroxine (2021) · cites this paper as [142]
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“Having thyroid function tested is a marker of increased psychological morbidity.(49) In addition to borderline TSH levels at the initial prescription of levothyroxine,(20,21) this raises the distinct possibility that, at least in a proportion of individuals, dissatisfaction may be due to other coexisting health proble…”
BackgroundSelf-citationPharmacodynamic and Therapeutic Actions of Levothyroxine
Hennessey, J. V. (2021) · 70 Years of Levothyroxine · doi:10.1007/978-3-030-63277-9_3 · Cited by 4 · see citing works
- Authors
- Bould, H., Panicker, V., Kessler, D., Durant, C., Lewis, G., Dayan, C., & Evans, J.
- Affiliations
- University of Bristol (GB)
- Sir Charles Gairdner Hospital (AU)
- Cardiff University (GB)
- Corresponding author
- Bould, H.
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-09-02
- Volume
- 29
- Issue
- 2
- Pages
- 163-167
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2165488238
- Cited by
- 29
- References
- 19
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 3 · 2021: 5 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 1 · 2014: 2 · 2013: 1 · 2012: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- subclinical hypothyroidism, thyroid dysfunction, psychological distress, thyroid-stimulating hormone, free thyroxine, depression, general practitioner referral, thyroid function tests
- MeSH terms
- Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Humans, Hypothyroidism, Male, Middle Aged, Surveys and Questionnaires, Stress, Psychological, Thyroid Diseases, Thyroid Function Tests, Thyrotropin, Thyroxine, Young Adult
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