Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis - A Systematic Review and Meta-analysis, 2018, Siegmann et al

Andy · May 16, 2018

Key Points
Question To what extent are depression and anxiety associated with autoimmune thyroiditis when estimated meta-analytically?

Findings In this systematic review and meta-analysis of 19 studies comprising 36 174 participants, patients with autoimmune thyroiditis showed significantly higher depression and anxiety disorder scores compared with healthy controls.

Meaning The evident association between autoimmune thyroiditis and depression and anxiety has important implications for the information of patients and could lead to the choice of early treatment—and not only psychotherapeutic treatment—of the organic disorder.

Abstract
Importance With a prevalence of 4% to 13% in the United States, autoimmune thyroiditis (AIT) is a major health problem. Besides somatic complications, patients with AIT can also experience psychiatric disorders. The extent of these organic psychiatric diseases in patients with AIT, however, is so far not commonly known.

Objective To provide meta-analytic data on the association of depression and anxiety with AIT.

Data Sources Google Scholar, the EBSCO Host databases, the Web of Knowledge, and PubMed were searched from inception through December 5, 2017. Articles identified were reviewed and reference lists were searched manually.

Study Selection Case-control studies that reported the association between AIT and either depression or anxiety disorders or both were included.

Data Extraction and Synthesis Data extraction was performed by multiple observers following the PRISMA guidelines. Two univariate random-effects meta-analyses were performed, and moderators were tested with Bonferroni-corrected meta-regression analysis. Heterogeneity was assessed with the I2 statistic. Sensitivity analyses tested the robustness of the results. Small study effects were assessed with funnel plots and the Egger test.

Main Outcomes and Measures The odds ratio of patients with AIT and depression compared with a healthy control group, as well as the odds ratio of patients with AIT and anxiety disorders compared with a healthy control group.

Results Nineteen studies comprising 21 independent samples were included, with a total of 36 174 participants (35 168 for depression and 34 094 for anxiety). Patients with AIT, Hashimoto thyroiditis, or subclinical or overt hypothyroidism had significantly higher scores on standardized depression instruments, with an odds ratio of 3.56 (95% CI, 2.14-5.94; I2 = 92.1%). For anxiety disorders, patients with AIT, Hashimoto thyroiditis, or subclinical or overt hypothyroidism had an odds ratio of 2.32 (95% CI, 1.40-3.85; I2 = 89.8%). Funnel plot asymmetry was detected for studies of depression. Study quality assessed with the Newcastle-Ottawa Scale for case-control studies (mean [SD] score: anxiety, 5.77 [1.17]; depression, 5.65 [1.14]; of a possible maximum score of 9) and proportion of females did not modulate the meta-analytic estimate, whereas mean age did.

Conclusions and Relevance This meta-analysis establishes the association between AIT and depression and anxiety disorders. Patients with AIT exhibit an increased chance of developing symptoms of depression and anxiety or of receiving a diagnosis of depression and anxiety disorders. This finding has important implications for patients and could lead to the choice of early treatment—and not only psychotherapeutic treatment—of the organic disorder.
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https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2679767

Medscape article about this study

NEW YORK (Reuters Health) - About 45% of people with depressive disorders and 30% of those with anxiety also have autoimmune thyroiditis (AIT), according to new findings.

"Autoimmune thyroiditis is present in a high percentage of cases with depression and anxiety, and this is so far not commonly known," Dr. Teja Groemer, a researcher at the University of Erlangen-Nuremberg and resident psychiatrist in Bamberg, Germany, told Reuters Health by phone.

There is mounting evidence that some psychiatric disorders are autoimmune-related, Dr. Groemer and his team note in JAMA Psychiatry, online May 2. The hypothyroid state has been linked to depression, and depressed patients often have thyroid disease, they add, but there is less evidence for a link between anxiety and AIT.
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https://www.medscape.com/viewarticle/896396

Invisible Woman · May 16, 2018

"Autoimmune thyroiditis is present in a high percentage of cases with depression and anxiety, and this is so far not commonly known," Dr. Teja Groemer, a researcher at the University of Erlangen-Nuremberg and resident psychiatrist in Bamberg, Germany, told Reuters Health by phone.
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Really? Depression is one of the symptoms of hypothyroidism.

If I take too much thyroid meds then I get some symptoms that could be confused with anxiety such as racing heartbeat & palpitations. Similarly, someone I know with an overactive thyroid gets similar symptoms if she forgets her meds.

I find it very strange that a psychiatrist wouldn't know this and would have thought that thyroid disease should be on a list of things to rule out before saddling people with a mental health diagnosis.

alktipping · May 17, 2018

if psychiatrists ruled out all so called mental health disorders because there are well known reasons for anxiety depression and even hallucinations auditory and visual that would put a lot of them out of work. hopefully medicine will eventually find the cause for each and every so called mental illness .

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Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis - A Systematic Review and Meta-analysis, 2018, Siegmann et al

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