Psychosomatic conditions like anxiety (A) and depression (D) are often misinterpreted or ignored by medical professionals, causing possible chronification and complications, even a higher mortality of somatic diseases.Thyroid disease (TD) is often associated with impaired quality of life and psychological well-being. While hypothyroidism is mainly linked to D, contradicting evidence exists about A and D in euthyroid individuals, with or without Hashimoto´s thyroiditis (HT). We therefore performed a cross-sectional study on euthyroid patients with TD in January and February 2019 using the Hospital Anxiety and Depression Scale/German version, HADS-D.
Methods : HADS-D comprises of 14 items (scored 0-3), 7 each for A and D, captures psychological impairments in patients with primary somatic diseases and is validated to minimize somatic confounders.A score of ≥10 is considered an anxiety/depression `case´. 215 euthyroid TD patients age ≥18 years, their lab test ≤3 months, self-completed HADS-D. After assessment of individual HADS score, demographic data were collected. Statistical analyses were performed with PSPP.
191 (89%) participants were female, mean age 46.8±15.0 years. Mean A score was 6.78±4.06 compared to a D score of 4.68±4.11. 70 (33%) patients had antibody-positive HT with an A score of 7.26±4.23, D score of 4.17±4.15. A scores were significantly higher than D scores (p=0.0001), with no significant difference in severity in respective A or D. Analyses of `cases´/score ≥10` showed 50 individuals (23%) with prominent A scores, severity 12.4±2.4; 22 patients (10%) with a prominent D score, severity 13.18±3.6. In the HT group 18 participants (26%) had an A score of 12.6±2.5, 8 patients (11%) had a D score of 13.18±3.6. Significantly more `cases´ were found in the A groups than in the D groups (p=0.0001) with no significant differences in respective severities.
Discussion : Our study is the first to show that anxiety is the main complaint of euthyroid TD patients, regardless of HT. Thyroid hormones are essential for nervous system development and alterations may lead to central nervous malfunctions, resulting in mood and cognitive disorders. Our findings indicate that anxiety might have a pathological pathway different from depressive disorders. Interdisciplinary collaboration is needed to evaluate cause-and-effect relationships and potential risk factors for development of psychosomatic cofactors in chronic somatic diseases.
Conclusion : In our cross-sectional study significantly more euthyroid patients with TD suffer from anxiety compared to depression, regardless of HT autoimmunity.
Thyroid Center Bergstrasse
Training at the University of Homburg and Heidelberg, currently resident at the Thyroid Center Bergstrasse: Focussed on thyroid disorders, endocrine disorders and internal medicine. Speaker for patients and professionals, reviewer.
Thyroid Center Bergstrasse
Medical trainig at the Universities of Berlin, Heidelberg, UCR and UCLA. Visiting professor, MD,PhD. Director of the regional medical board, speaker for patients and professionals. Interest in thyroid disease, endocrinology, internal medicine.