Influence of Thyroid Disorders upon the Incidence and the Severity of Psychosomatic Symptoms in Patients
,
Abstract
Background: Thyroid disorders are an area of public health concern worldwide. The study aimed to examine the incidence and severity of psychosomatic symptoms (distress, depression, anxiety and somatization) in patients with hypothyroidism, hyperthyroidism, Graves' disease and Hashimoto thyroiditis in relation to clinically healthy subjects.
Methods: This case control study was carried out from Feb to Jul 2019 in Serbia. Total sample consisted of 335 subjects, of both sex. The examined group included patients with thyroid disorders treated at the Special hospital for thyroid gland and metabolism disease. Control group included clinically healthy subjects. The Four Dimensional Symptom Questionnaire a self-assessment questionnaire for psychosomatic symptoms was the measuring instrument. Groups were compared using parametric (t-test) and nonparametric (Pearson chi-square test, Mann-Whitney U test, Kruskal-Wallis test) tests.
Results: The incidence of all psychosomatic symptoms was high in patients with thyroid disease. Distress was found in 59.8% of the patients in the examined group comparing to the control group (12.8±8.2 vs. 8.9±8.1). The score of depression was twice higher in the examined group (2.05±2.99 vs. 1.23±2.47). Anxiety was present in 46.2% patients in the examined group, while somatization was found in 69.7% subjects. In hypothyroidism there was no difference between the examined and the control group regarding the level of anxiety, likewise with the level of depression in the control group and subjects with Graves' disease and Hashimoto thyroiditis.
Conclusion: Psychosomatic symptoms were significantly more severe in patients with thyroid disorders compared to the control group.
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11. Talukdar B, Goswami HK (2018). Thyroid Profile in Drug Naive Cases of Depres-sion. J Depress Anxiety 7: 300. doi:10.4172/2167-1044.1000300.
12. Giynas Ayhan M, Uguz F, Askin R, et al (2014). The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis: a comparative study. Gen Hosp Psychiatry, 36(1):95-8. doi:10.1016/j.genhosppsych.2013.10.002.
13. Ittermann T, Volzake H, Baumeister S, et al (2015). Diagnosed thyroid disorders are associated with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol, 50(9):1417-25 doi:10.1007/soo127-015-1043-0.
14. Zafar M, Zahra F, Sharif S, et al (2015). Prevalence of depression, anxiety and associated risk factors among hyperthyroid patients in Karachi, Pakistan. Eur J Psychol Educ Studies 2:88-94. doi:10.4103/2395-2555.190478.
15. Medici M, Direk N, Visser WE, et al (2014). Thyroid function within the normal range and the risk of depression: a population-based cohort study. J Clin Endocrinol Metab, 99(4):1213‐1219. doi:10.1210/jc.2013-3589.
16. Carta MG, Hardoy MC, Carpiniello B, et al (2005). A case control study on psychiatric disorders in Hashimoto disease and Euthyroid Goitre: not only depressive but also anxiety disorders are associated with thyroid autoimmunity. Clin Pract Epidemiol Ment Health, 1:23. doi:10.1186/1745-0179-1-23.
17. Mussig K, Kunle A, Sauberlich AL, et al (2012). Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun, 26(4):559–63. doi:10.1016/j.bbi.2012.01.006.
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19. Terluin B, van Marwijk HW, Adèr HJ, et al (2006). The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry, 6:34. doi:10.1186/1471-244X-6-34.
20. Thapa DK, Upadhyaya TL, Lamichhane N, et al (2013). The study of psychiatric disorders in patients with thyroid disorder at the tertiary care centre in Western Region of Nepal. JPAN, 2(2):29-34. doi:10.3126/jpan.v2i2.9723.
21. Illiani SN, Azlina D, Sanisah S, et al (2017). Depression symptoms level among thyroid disorders patients at Central Region of Peninsular Malaysia. Malaysian Journal Psychiatry, 26(1). ISSN:2232-0385
22. Bali K, Gul D (2017). A Study of psychiatric co-morbidity in patients suffering from thyroid. JMSCR, 05(12):31711-16. doi:10.18535/jmscr/v5i12.72.
23. Gulseren S, Gulseren L, Hekimsoy Z, et al (2006). Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res, 37(1):133-9. doi:10.1016/j.arcmed.2005.05.008.
24. Zavareh AT, Jomhouri R, Bejestani SB, et al (2016). Depression and hypothyroidism in a population-based study of Iranian women. Rom J Intern Med, 54(4) 217–21. doi:10.1515/rjim-2016-0033.
25. Aslan S, Ersoy R, Kuruoglu AC, et al (2005). Psychiatric symptoms and diagnoses in thyroid disorders: a cross-sectional study. Int J Psychiatry Clin Pract, 9(3):187-92. doi:10.1080/13651500510029129.
26. Lee IT, Sheu WH, Liau YJ, et al (2003). Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population. Horm Res, 60(5):247-51. doi:10.1159/000074039.
27. van der Leeuw G, Gerrits MJ, Terluin B, et al (2015). The association between somatization and disability in primary care patients. J Psychosom Res, 79(2):117-22. doi:10.1016/j.jpsychores.2015.03.001.
28. Engum A, Bjoro T, Mykletun A, et al (2002). An association between depression, anxiety and thyroid function – A clinical fact or an artefact? Acta Psychiatr Scand, 106(1):27–34. doi:10.1034/j.1600-0447.2002.01250.x.
29. Suwalska A, Lacka K, Lojko D, et al (2005). Quality of life, depressive symptoms and anxiety in hyperthyroid patients. Rocz Akad Med Bialymst, 50 Suppl 1:61-3. PMID:16119629.
30. Kirim S, Keskek SO, Koksal F, et al (2012). Depression in patients with euthyroid chronic autoimmune thyroiditis. Endocr J, 59(8):705–8. doi:10.1507/endocrj.ej12-0035.
31. Bove KB, Watt T, Vagel A, et al (2014). Anxiety and depression are more prevalent in patients with Graves’ Disease than in patients with nodular goitre. Eur Thyroid J, 3(3):173–178 doi:10.1159/000365211.
32. Yalcin MM, Altinova AE, Cavnar B, et al (2017). Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto’s thyroiditis? Endocr J, 64(4):425-9. doi:10.1507/endocrj.EJ16-0418.
33. Delitala AP, Terracciano A, Fiorillo E, et al (2016). Depressive symptoms, thyroid hormone and autoimmunity in a population-based cohort from Sardinia. J Affect Disord, 191:82‐87. doi:10.1016/j.jad.2015.11.019.
2. Shahrani АSA, Metwally AE, Surimi KA, et al (2016). The epidemiology of thyroid diseases in the Arab world: A systematic review. J Public Health Epidemiol, 8(2):17-26. doi:10.5897/JPHE2015.0713.
3. Nila KM, Mekhana VD, Nair SR (2018). Anxiety, Depression, and self-care management among patients with hypothyroidisam. Asian J Pharma Clin Res, 11(1):337-40. doi:10.22159/ajpcr.2018.v11i1.21074.
4. Vigário P, Teixeira P, Reuters V, et al (2009). Perceived health status of women with overt and subclinical hypothyroidism. Med Princ Pract, 18(4):317–22. doi:10.1159/000215731.
5. Hage MP, Azar ST (2012). The Link between thyroid function and depression. J Thyroid Res, 2012:590648. doi:10.1155/2012/590648.
6. Feldman AZ, Shrestha RT, Hennessey JV (2013). Neuropsychiatric manifestations of thyroid disease. Endocrinol Metab Clin North Am, 42(3):453–76. doi:10.1016/j.ecl.2013.05.005.
7. Grabe HJ, Völzke H, Lüdemann J, et al (2005). Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatr Scand, 112(4):286-93. doi:10.1111/j.1600-0447.2005.00586.x.
8. Robertas B, Arthur J, Prange J (2010). Thyroid disease and mental disorders: cause and effect or only co morbidity? Curr Opin Psychiatry, 23(4):363-8. doi:10.1097/YCO.0b013e3283387b50
9. Brandt F, Thvilum M, Almind D, et al (2013). Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study. Eur J Endocrinol, 170(2):341–8. doi:10.1530/EJE-13-0708.
10. Ummar SI, Aarthi DR, Thirunavukarasu M (2017). Incidence of psychiatric morbidities in drug naive hypothyroid patients: a case control study. IJIP, 4(2):148-58. doi:10.25215/0402.037.
11. Talukdar B, Goswami HK (2018). Thyroid Profile in Drug Naive Cases of Depres-sion. J Depress Anxiety 7: 300. doi:10.4172/2167-1044.1000300.
12. Giynas Ayhan M, Uguz F, Askin R, et al (2014). The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis: a comparative study. Gen Hosp Psychiatry, 36(1):95-8. doi:10.1016/j.genhosppsych.2013.10.002.
13. Ittermann T, Volzake H, Baumeister S, et al (2015). Diagnosed thyroid disorders are associated with depression and anxiety. Soc Psychiatry Psychiatr Epidemiol, 50(9):1417-25 doi:10.1007/soo127-015-1043-0.
14. Zafar M, Zahra F, Sharif S, et al (2015). Prevalence of depression, anxiety and associated risk factors among hyperthyroid patients in Karachi, Pakistan. Eur J Psychol Educ Studies 2:88-94. doi:10.4103/2395-2555.190478.
15. Medici M, Direk N, Visser WE, et al (2014). Thyroid function within the normal range and the risk of depression: a population-based cohort study. J Clin Endocrinol Metab, 99(4):1213‐1219. doi:10.1210/jc.2013-3589.
16. Carta MG, Hardoy MC, Carpiniello B, et al (2005). A case control study on psychiatric disorders in Hashimoto disease and Euthyroid Goitre: not only depressive but also anxiety disorders are associated with thyroid autoimmunity. Clin Pract Epidemiol Ment Health, 1:23. doi:10.1186/1745-0179-1-23.
17. Mussig K, Kunle A, Sauberlich AL, et al (2012). Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun, 26(4):559–63. doi:10.1016/j.bbi.2012.01.006.
18. Thomsen AF, Kvist TK, Andersen PK, et al (2005). Increased risk of developing affective disorder in patients with hypothyroidism: a register-based study. Thyroid, 15(7):700-7. doi:10.1089/thy.2005.15.700.
19. Terluin B, van Marwijk HW, Adèr HJ, et al (2006). The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry, 6:34. doi:10.1186/1471-244X-6-34.
20. Thapa DK, Upadhyaya TL, Lamichhane N, et al (2013). The study of psychiatric disorders in patients with thyroid disorder at the tertiary care centre in Western Region of Nepal. JPAN, 2(2):29-34. doi:10.3126/jpan.v2i2.9723.
21. Illiani SN, Azlina D, Sanisah S, et al (2017). Depression symptoms level among thyroid disorders patients at Central Region of Peninsular Malaysia. Malaysian Journal Psychiatry, 26(1). ISSN:2232-0385
22. Bali K, Gul D (2017). A Study of psychiatric co-morbidity in patients suffering from thyroid. JMSCR, 05(12):31711-16. doi:10.18535/jmscr/v5i12.72.
23. Gulseren S, Gulseren L, Hekimsoy Z, et al (2006). Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res, 37(1):133-9. doi:10.1016/j.arcmed.2005.05.008.
24. Zavareh AT, Jomhouri R, Bejestani SB, et al (2016). Depression and hypothyroidism in a population-based study of Iranian women. Rom J Intern Med, 54(4) 217–21. doi:10.1515/rjim-2016-0033.
25. Aslan S, Ersoy R, Kuruoglu AC, et al (2005). Psychiatric symptoms and diagnoses in thyroid disorders: a cross-sectional study. Int J Psychiatry Clin Pract, 9(3):187-92. doi:10.1080/13651500510029129.
26. Lee IT, Sheu WH, Liau YJ, et al (2003). Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population. Horm Res, 60(5):247-51. doi:10.1159/000074039.
27. van der Leeuw G, Gerrits MJ, Terluin B, et al (2015). The association between somatization and disability in primary care patients. J Psychosom Res, 79(2):117-22. doi:10.1016/j.jpsychores.2015.03.001.
28. Engum A, Bjoro T, Mykletun A, et al (2002). An association between depression, anxiety and thyroid function – A clinical fact or an artefact? Acta Psychiatr Scand, 106(1):27–34. doi:10.1034/j.1600-0447.2002.01250.x.
29. Suwalska A, Lacka K, Lojko D, et al (2005). Quality of life, depressive symptoms and anxiety in hyperthyroid patients. Rocz Akad Med Bialymst, 50 Suppl 1:61-3. PMID:16119629.
30. Kirim S, Keskek SO, Koksal F, et al (2012). Depression in patients with euthyroid chronic autoimmune thyroiditis. Endocr J, 59(8):705–8. doi:10.1507/endocrj.ej12-0035.
31. Bove KB, Watt T, Vagel A, et al (2014). Anxiety and depression are more prevalent in patients with Graves’ Disease than in patients with nodular goitre. Eur Thyroid J, 3(3):173–178 doi:10.1159/000365211.
32. Yalcin MM, Altinova AE, Cavnar B, et al (2017). Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto’s thyroiditis? Endocr J, 64(4):425-9. doi:10.1507/endocrj.EJ16-0418.
33. Delitala AP, Terracciano A, Fiorillo E, et al (2016). Depressive symptoms, thyroid hormone and autoimmunity in a population-based cohort from Sardinia. J Affect Disord, 191:82‐87. doi:10.1016/j.jad.2015.11.019.
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| Issue | Vol 51 No 8 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i8.10264 | |
| Keywords | ||
| The four-dimensional symptom questionnaire (4DSQ) Psychosomatic symptoms Thyroid disorders | ||
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How to Cite
1.
Stanić G, Marinković S, Ristić Ignjatović D. Influence of Thyroid Disorders upon the Incidence and the Severity of Psychosomatic Symptoms in Patients. Iran J Public Health. 2022;51(8):1798-1806.
