Subclinical Hypothyroidism and Depression

Researchers writing in the Archives of Gerontology and Geriatrics say that “subclinical hypothyroidism increases the risk for depression and emphasize the importance of thyroid screening tests in the elderly.”

Study abstract
Chueire VB, Romaldini JH, Ward LS. Subclinical hypothyroidism increases the risk for depression in the elderly. Arch Gerontol Geriatr. 2007 Jan-Feb;44(1):21-8. Epub 2006 May 5.

In order to determine if subclinical hypothyroidism is a risk factor for depression in the elderly, a total of 323 individuals over 60 years old were interviewed using the Structured Clinical Interview for Diagnosis and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for mood disturbances.

Patients were divided into Group I: 252 patients (184 females, 68 males; median age: 67 years, range: 60-89 years) with elevated serum thyrotropin (TSH) levels and Group II: 71 patients (45 females, 26 males; median age: 67 years, range: 60-92 years) with diagnosis of depression. Serum TSH and free thyroxine (fT4) were measured by sensitive assays. Thyroid antibodies were determined by IRMA. Depression was observed in 24 (9.5%)

Group I patients and was frequent in subclinical hypothyroidism patients (14/24 = 58.3%). On the other hand, elevated TSH levels were found in 22 (30.9%) Group II patients.

Depression was observed more frequently among individuals with subclinical (74/149 = 49.7%) hypothyroidism than among individuals with overt hypothyroidism (21/125 = 16.8%) (p < 0.001). Indeed, subclinical hypothyroidism increased the risk for a patient to present depression more than four times (OR = 4.886; 95% confidence interval = 2.768-8.627).

Our results demonstrate that subclinical hypothyroidism increases the risk for depression and emphasize the importance of thyroid screening tests in the elderly.

Thyroid Articles

Thyroid in Women Over 50
You are gaining weight and losing your hair, because of these “characteristics of aging,” you realize that you are getting older and now you have made yourself depressed. Is this aging or is it low-thyroid?

Estimates say that by age 50, 10% of women will be hypothyroid (not producing enough thyroid hormone) and by age 60 that number can nearly double.

You won’t need a scientific study to know that once over the age of 50, maintaining proper body weight becomes more difficult. When a person become hypothyroid staying trim and fit becomes nearly impossible.

The Evil Cycle of Weight Gain and Hypothyroidism
The Thyroid is a master gland participating and controlling the function of all the major body organs. When thyroid hormone is not produced in sufficient quantities to regulate our energy levels (hypothyroidism), our metabolism slows down to a crawl. This has the following weight gain effect.

1. Even on reduced calorie diets, your metabolism will not burn enough calories and you will retain weight.

2. A slow down in metabolism means a drop in energy and the inability to exercise or lead a sufficiently active life to stay trim.

3. Another consequence of hypothyroidism is constipation, accumulated fecal matter accounts for significant pounds.

4. Let’s add water retention for that bloated feeling.

Diagnosis of Hypothyroidism
Hypothyroidism is not easily diagnosed by physicians because the symptoms are that which are routinely attributed to old age, that is the loss of energy, weight gain, etc. A “Thyroid Panel,” measuring TSH, T3, and T4 levels should be part of a basic blood chemistry panel in everyone over 30 so this “old age issue,” may be treated.

Beyond the Blood Test
Sometimes a suspected Thyroid problem can show “normal blood tests” it is important for the women and the doctor who suspect that thyroid is a problem to look for the following besides those symptoms, weight gain, depression, thinning or losing hair mentioned above.

Especially significant are
* memory and mood disorders
* cold sensitivity
* and menstrual problems

Even after you are put on thyroid supplementation, it is important to monitor these symptoms and your general overall health so that you can guide your physician and together your thyroid the type and amount of thyroid supplementation can be altered to help you be the best you can.

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Thyroid Research

Selected research:
Hypothyroidim, quality of life and mental health
Larisch R, Kley K, Nikolaus S, et al. Depression and anxiety in different thyroid function states. Horm Metab Res. 2004 Sep;36(9):650-3

Study purpose: The researchers stated: “Previous studies on hypothyroid subjects have indicated serious psychiatric symptoms affecting the patients’ quality of life. The present prospective cross-sectional study’s aim was to examine these symptoms in thyroid patients with different functional states.”

They noted: “Hypothyroidism represents a widely underestimated functional condition that may severely affect mental health.”

Cognitive function
Prinz PN, Scanlan JM, Vitaliano PP, et al. Thyroid hormones: positive relationships with cognition in healthy, euthyroid older men. J Gerontol A Biol Sci Med Sci. 1999 Mar;54(3):M111-6.

Study: The researchers acknowledged the well know link between hypothyroidism and cognitive function. What they sought to uncover was thyroid levels and cognitive function in elderly men with “normal” thyroid function.

The Researchers stated: “Our data suggest that older subjects may require circulating thyroid hormones in middle to high levels in order to maintain optimal brain function.”

Heart Disease
Klein I, Ojamaa K. Thyroid hormone treatment of congestive heart failure. Am J Cardiol. 1998;81:443-7.

Study: An editorial discussing the effects of hypothyroidism on heart disease with special emphasis on T3.

T3 and T4 Supplementation
Hennemann G, Docter R, Visser TJ, et al. Thyroxine plus low-dose, slow-release triiodothyronine replacement in hypothyroidism: proof of principle. Thyroid 2004;14:271-275

Study: Examination of the effects of T4 and T3 supplementation in hypothyroid patients.

The researchers noted: “In the study reported here we show that treatment of hypothyroid subjects with a combination of T(4) plus slow-release T(3) leads to a considerable improvement of serum T(4) and T(3) values, the T(4)/T(3) ratio and serum TSH as compared to treatment with T(4)- only. Serum T(3) administration with slow-release T(3) did not show serum peaks, in contrast to plain T(3).”

Subclinical thyroid disease
Elte JW, Mudde AH, Nieuwenhuijzen Kruseman AC. Subclinical thyroid disease. Postgrad Med J. 1996;72:141-6

Study: A review article on the “clinical effects, prognostic significance and the need for and response to therapy,” of subclinical thyroid disease.

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Thyroid

The thyroid gland secretes the aptly named thyroid hormone. The over-production or under-production of this hormone can cause big problems in the body and lead to a myriad of symptoms that sometimes goes undiagnosed or misdiagnosed.

What does thyroid hormone do?
It regulates:
– heart rate
– metabolism & body temperature
– cholesterol levels
– weight
– vision
– menstrual regularity

As we age, and our glands, including the thyroid produce less hormone, we typically fall into a syndrome of hypothyroidism.

Some of the signs of hypothyroidism are:
– slow-down of metabolism
– loss of energy, excessive fatigue
– weight gain, even with extreme dieting
– memory and mood disorders
– cold sensitivity
– menstrual problems
– constipation
– generalized hair loss
– thinning nails

Because a patient with hypothyroidism is not producing enough thyroid, the pituitary gland, which monitors thyroid levels in the blood, starts secreting TSH (Thyroid Stimulating Hormone). TSH “cracks the whip,” forcing the thyroid to work harder. The strain and stress on the thyroid may cause enlargement of the thyroid—a “goiter.”

Diagnosis of hypothyroidism
Hypothyroidism is not easily diagnosed by physicians because the symptoms are that which are routinely attributed to old age, that is the loss of energy, weight gain, etc. A “Thyroid Panel,” measuring TSH, Free T3, and Free T4 levels should be part of a basic blood chemistry panel in everyone over 30 so this “old age issue,” may be treated.

Normal blood work and abnormal symptoms
Thyroid testing is broken up into the thyroid hormone components Free T3 and Free T4.

Briefly, the designations come from the number of iodine molecules connected to the thyroid hormone. In T3 (triiodothyronine), it’s three iodine molecules, in T4 (thyroxine), it’s four.

T3 is much more potent than T4 but considerably less abundant in our bodies. To counterbalance T3 and T4 levels, our bodies, especially the liver, collect T4 and convert it into the higher potency T3. If there is a problem in this conversion process, even though blood tests would be considered “normal,” the patient is considered “sub-clinically,” hypothyroid. There may be enough circulating Free T4 in the blood, it is just not being converted to T3. The indications from these blood tests will help differentiate which type of thyroid supplementation should be recommended in each individual’s case.

The ratio of T4 to T3 in the body is a little more than 9 to 1. When hypothyroidism is diagnosed, typically it is T4 (Levothyroxine) that is prescribed. Why? Because many doctors believe that the body will convert the T4 to T3 as it is needed. However, occasionally, T4 will convert to an excess of reverse T3 which is ineffective in up regulating metabolism, and little T3 is produced, leaving a patient hypothyroid in spite of high T4 levels and low TSH levels. It is very important that the patient is closely monitored to indeed make sure that this is not happening. Some physicians also prescribe Armour thyroid, which is a combination of T3 and T4, or a compounded version can be made. Some doctors do not like to prescribe Armour because the T3-T4 ratio is not exactly standardized. Again close monitoring by a physician can gauge if the desired result is being achieved.

Questions About Thyroid Supplementation

When To Take Your Thyroid Supplementation?
Take your medication before breakfast on an empty stomach.

Many physicians believe that you can best absorb your thyroid medication by taking it on an empty stomach.

Additionally, some foods or supplements (those contain calcium and iron) may prevent proper absorption.

Remember that it is important to check thyroid levels regularly to regulate dosage and absorption. If there is an absorption problem or your dose needs to be adjusted, regular blood tests will bear this out.

How Do You Know You Are Reaching Your “Best” Thyroid Levels?
Thyroid supplementation for low or hypothyroid conditions should start effecting the following:

– An increase in metabolism
– An increase in energy
– Increase in your ability to lose weight
– Improvements in memory and mood
– Better digestion and regular bowel movements
– Hair loss BECAUSE of HYPOTHYROIDISM is reversed
– Improved condition of skin and nails

If you are on thyroid medication and are not seeing a more positive improvement than you or your doctor anticipated, regular blood tests should be performed to check thyroid levels and adjustments in medication or in dietary habits maybe needed.

Hypothyroidism and Low Testosterone Levels
Recent research published in the International Journal of Andrology says that there is a direct association between subclinical hypothyroidism and a reduction in testosterone levels in men and further, “Testosterone deficiency and its symptoms should be kept in view while managing subclinical hypothyroidism in male patients.”

Hypothyroidism is not easily diagnosed by physicians because the symptoms are that which are routinely attributed to old age, that is the loss of energy, weight gain, etc. A “Thyroid Panel,” measuring TSH, Free T3, and Free T4 levels should be part of a basic blood chemistry panel in everyone over 30 so this “old age issue,” may be treated.

Briefly, the designations come from the number of iodine molecules connected to the thyroid hormone. In T3 (triiodothyronine), it’s three iodine molecules, in T4 (thyroxine), it’s four.

T3 is much more potent than T4 but considerably less abundant in our bodies. To counterbalance T3 and T4 levels, our bodies, especially the liver, collect T4 and convert it into the higher potency T3. If there is a problem in this conversion process, even though blood tests would be considered “normal,” the patient is considered “sub-clinically,” hypothyroid. There may be enough circulating Free T4 in the blood, it is just not being converted to T3. The indications from these blood tests will help differentiate which type of thyroid supplementation should be recommended in each individual’s case.

Symptoms of Suboptimal Thyroid
-Weakness
-Fatigue
-Dry, coarse skin
-Feeling cold
-Anxiety and tension
-Depression
-Thinning hair
-Weight Gain
-Poor memory
-Headaches

Thyroid Research
Other articles Thyroid
Focus on the Thyroid for Women over 50
Subclinical Hypothyrodism and Depression

Subclinical Hypothyroidism and Testosterone Deficiency

Researchers writing in the International Journal of Andrology say that there is “a direct association between subclinical hypothyroidism and hypoandrogenaemia. Testosterone deficiency and its symptoms should be kept in view while managing subclinical hypothyroidism in male patients.”

Kumar A, Chaturvedi PK, Mohanty BP. Hypoandrogenaemia is associated with subclinical hypothyroidism in men. Int J Androl. 2006 Jul 24

From the article abstract:
“Hypothyroidism has been shown to be associated with a reduction in serum testosterone level in males. This reduction in testosterone is reversible by thyroxine replacement therapy. However, to the best of our knowledge, it is not yet known, whether a similar reduction in serum testosterone level is observed in subclinically hypothyroid males [thyroid-stimulating hormone (TSH) < 10 mIU/L] in whom the benefits of thyroxine replacement therapy are still controversial.

Our goal was to investigate the putative connections between subclinical hypothyroidism and the circulating levels of gonadotrophins and gonadal steroids in males (ranging from 20 to 54 years).

The serum samples from patients showing normal euthyroid and subclinical hypothyroid profiles (TSH < 10 mIU/L) were further analysed for the levels of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, sex hormone-binding globulin, progesterone and oestradiol.

Subclinical hypothyroidism was associated with a decrease in the levels of serum testosterone and its precursor progesterone. The data suggest that serum testosterone declines because of the non-availability of its precursor progesterone.

The level of oestradiol was similar in both the groups, suggesting a greater conversion rate of testosterone to oestradiol in subclinically hypothyroid males, in order to maintain the oestradiol levels.

Prolactin levels were slightly but significantly increased in subclinical hypothyroidism. To the best of our information this is a novel report, which shows a direct association between subclinical hypothyroidism and hypoandrogenaemia. Testosterone deficiency and its symptoms should be kept in view while managing subclinical hypothyroidism in male patients. Further studies are needed in order to reveal the physiological and molecular mechanisms leading to hypoandrogenaemia in subclinical hypothyroidism (TSH < 10 mIU/L).