A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study
Abstract
OBJECTIVE: There have been conflicting reports on the relationship between thyroid function and mood between studies in subjects on T4 and the general population not on T4. We investigated this relationship in a large catchment area-based study. DESIGN: We analysed data on serum TSH levels and Hospital Anxiety and Depression Scale (HADS) scores from the HUNT 2 study (age > or = 40 years). Following a test for interaction, analyses were performed separately in females on T4 (n = 1265) and in people not on T4 (males n = 9319 and females n = 17 694). RESULTS: More females on T4 had high depression and anxiety scores than females not on T4 (depression 18.4%vs. 13.0%, P < 0.001, anxiety 23.4%vs. 18.7%, P < 0.001). In those not on T4, there was an inverse association between serum TSH and depression score in males (B coefficient = -0.61, 95% CI -0.91 to -0.24, P = 0.001) though not in females (B coefficient = -0.07, -0.33 to 0.19), and an inverse association between TSH and anxiety score in both genders (B coefficient for males = 0.68, 95% CI -1.04 to -0.32, P < 0.001; females -0.37, 95% CI -0.67 to -0.08, P = 0.01). In contrast, in females on T4, TSH was positively associated with both depression (B coefficient = +0.27, 95% CI 0.02 to 0.51, P < 0.05) and anxiety (B coefficient = +0.29, 95% CI 0.01 to 0.56, P < 0.05). CONCLUSIONS: There is a different relationship between thyroid function and depression and anxiety in females on T4 compared with individuals with no thyroid disease. This group also has a higher prevalence of depression and anxiety.
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In a Norwegian community-based study, more women on L-T4 had high HADS scores for depression (18.4% vs 12.8%, p < 0.001) and anxiety (23.4% vs 18.6%, p < 0.001) than women not on L-T4.
“More women on L-T4 had high scores (HADS 6 8) for depression and anxiety than women not on L-T4: depression 18.4 versus 12.8% (p !0.001), anxiety 23.4 versus 18.6% (p !0.001), respectively.”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [14]
In women not on L-T4, no significant associations with depression or anxiety were seen.
“In women not on L-T4, no significant associations with depression or anxiety were seen.”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [14]
In women on L-T4, serum TSH was positively associated with depression and anxiety; each 1 mU/l increase in serum TSH was associated with 3% more depression cases (p = 0.04) and 3% more anxiety cases (p = 0.046).
“In women on L-T4, serum TSH was positively associated with depression and anxiety.For each 1 mU/l increase in serum TSH there was 3% more depression cases (p = 0.04) and 3% more anxiety cases (p = 0.046).”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [14]
Approximately 10%-15% of subjects with hypothyroidism on L-thyroxine (LT4) alone have persistent symptoms affecting their quality of life (QoL).
“Approximately 10%–15% of subjects with hypothyroidism on L-thyroxine (LT4) alone have persistent symptoms affecting their quality of life (QoL).”
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Self-citation
- Authors
- Panicker, V., Evans, J., Bjøro, T., Åsvold, B. O., Dayan, C. M., & Bjerkeset, O.
- Affiliations
- The University of Western Australia (AU)
- University of Bristol (GB)
- University of Oslo (NO)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Dayan, Colin M.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2009-09-07
- Volume
- 71
- Issue
- 4
- Pages
- 574-580
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1936681872
- Cited by
- 121
- References
- 36
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 9 · 2022: 15 · 2021: 11 · 2020: 7 · 2019: 9 · 2018: 8 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 11 · 2013: 5 · 2012: 3
- FWCI
- 1.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (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 › Hormonal and reproductive studies
- Keywords
- thyroid function, levothyroxine, thyroid hormone replacement, depression, anxiety, serum TSH, sex differences, thyroid dysfunction, mood disorders, HUNT study
- MeSH terms
- Adult, Affect, Aged, Anxiety, Depression, Female, Humans, Male, Middle Aged, Norway, Psychiatric Status Rating Scales, Thyroid Diseases, Thyroid Gland, Thyrotropin, Thyroxine, Prevalence
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