Indmedica Home | About Indmedica | Medical Jobs | Advertise On Indmedica
Search Indmedica Web
Indmedica - India's premier medical portal

Current Neurobiology

The relationship between cortisol and thyroid function tests in geriatric Patients with psychiatric disorder

Author(s): Vinayak W. Patil, Shahid A. Mujawar

Vol. 1, No. 2 (2010-10 - 2011-03)

Vinayak W. Patil, Shahid A. Mujawar

Department of Biochemistry, Grant Medical College and Sir J.J. Group of Govt. Hospitals, Byculla, Mumbai, Maharashtra, India

Abstract

The aim of this study was to investigate the relationship between serum cortisol and thyroid function tests in geriatric patients with psychiatric disorder. We assessed serum cortisol and thyroid function tests in newly admitted 35 geriatric age group patients in psychiatric ward and in 35 sex- and age matched controls. Study group included geriatric patients with psychiatric disorder diagnosed by a psychiatrist. Thyroid function tests contained serum con-centrations of total cortisol (TC) triiodothyronine (T3), thyroxine (T4) and thyrotropin (TSH). The serum concentration of TC was increased significantly in study group as com-pared with controls (P<0.001). T3 and T4 levels were slightly decreased in geriatric group as compared with controls (P<0.05). A positive and significant correlation was observed be-tween TC and TSH. We concluded that the hypothalamic–pituitary–thyroid (HPT) axis and the hypothalamic–pituitary–adrenal (HPA) axis are impaired in geriatric patients with psy-chiatric disorder.

Key words: Total cortisol, thyroid function tests, geriatric patients
Accepted March 01 2010

Introduction

Alteration in the hypothalamic–pituitary–thyroid (HPT) axis and the hypothalamic–pituitary–adrenal (HPA) axis is a main cause of depressive disorder. In the HPT axis make change in thyroid function tests have been reported by various authors [1,2]. The detection of antithyriod peroxidase (TPO-Ab), and anti-thyroglobulin (TG-Ab) antibodies an in the context of the clinical presentation of thyroid dysfunction, confirms the diagnosis of thyroid autoimmune disease [3,4]. Serum cortisol concentration elevated in patients with depression has been reported by many authors [5].

In old age, brain has diminished homeostatic reserve and is vulnerable to disturbances in internal milieu [6]. Geriatric subjects impair the interaction between the brain and the thyroid gland [7–10]. We therefore planned the pre-sent study with the aim to assess serum cortisol and thyroid function tests in geriatric patients.

Material and Methods

This study was carried out at Department of Biochemistry, Grant Medical College and Sir J.J. Group of Govern-ment Hospitals, Mumbai. Newly admitted 35 geriatric age group patients in psychiatric ward in the age group of more than 60 years were studied for estimation of serum total cortisol (TC) triiodothyronine (T3), thyroxine (T4), and thyrotropin (TSH) and in 35 sex- and age matched controls over a period of one year. Study group were included geriatric patients with psychiatric disorder and diagnosed by psychiatritian.

Inclusion criteria for control group was normal renal and liver function. Exclusion criteria were use of medications (therapy involving carbamazepine, phenytoin, 6-azauridine, anthopterin, antifolates, anticonvulsant agents, tamoxifen, and theophylline), diabetes mellitus, cancer, anemia, and systemic illness. The Institutional Ethical Committee at the Grant Medical College and Sir J.J. Group of Government Hospitals, Mumbai, India, ap-proved the study.

Blood sample collection:

Venous blood samples were collected in test tube with aseptic precautions. After 2 hours of collections sample was centrifuged at 3000 rpm for 5 minutes. Serum was separated and collected in polythene tube with cork. The sera with no sign of hemolysis used for the analysis of TC, T3, T4, TSH.

Biochemical Analysis

Serum TC estimated by the method of solid-phase, competitive chemiluminescent enzyme immunoassay. [11]. Serum triiodothyronine (T3) and Thyroxine (T4) were estimated by solid-phase, competitive chemiluminescent enzyme immunoassay method [12]. Serum thyrotropin (TSH) was estimated by the method of solid-phase, two-site chemiluminescent enzyme immunometric assay method [13]. We used fully automated enzyme amplified chemiluminescent immunoassay based Immulite 1000 analyzer.

Statistical Analysis

Numerical variables were reported in terms of mean and standard deviation. Statistical analysis of results was done by normal ‘z’ test. In this analysis, variables showing p value lower than 0.05 and 0.001 (p< 0.05 and P < 0.001) were considered to be statistically significant and highly significant respectively. Pearson correlation test was used to test correlation in MS-Excel XP 2000 software.

Results

On comparison, serum TC and TSH levels were found to be significantly (p< 0.001) higher in study group of geriatric patients with psychiatric disorder than the controls. Serum T3 and T4 concentrations were decreased signifi-cantly (p< 0.05) in geriatric study subjects as compared to controls (Table 1).

Table 1. Serum total cortisol and thyroid profile in controls and geriatric patients with psychiatric disorder.

Sr. No. Biochemical Parameters Control
(n=30)
Patients
(n=30)
1. Total cortisol (μg/dL) 6.59±2.41 22.1±7.69 ٭٭
2. Triiodothyronin (ng/dL) 108±12.6 99.1±11.2 ٭
3. Thyroxine (μg/dL) 11.5±3.84 9.17±1.80 ٭
4. Thyrotropin (μIU/mL) 3.01±1.59 13.2±5.67 ٭٭

The results were compared between control group and smoker group. The values are mean ± S.D. ٭p< 0.05, ٭٭p< 0.001.

Table 2. The correlation between serum TC and thyroid profile parameters in geriatric patients with psychiatric disorder.

Sr. No. Biochemical Parameters (n=30) r P
1. TC Vs T3 -0.0212 NS
2. TC Vs T4 -0.0566 NS
3. TC Vs TSH +0.5142 < 0.001

r = correlation coefficient, NS = not significant

Figure 1. Correlation between TC and TSH in geriatric patients with psychiatric disorder.

Discussion

Several previous studies investigated the relationship be-tween thyroid disease and psychiatric illness in Western countries but the present study was conducted on geriatric subjects of Mid-Western India. It has been recommended that thyroid function screening is a worthwhile procedure[14-16]. Many of the abnormal results in these studies, however, reflected a transient disturbance of thyroid func-tion, and all the study subjects showed a minimal hypo-thyroidism which was confirmed biochemically.

Our study is the first to elucidate the relationship between serum TC with thyroid profile in geriatric patients with psychiatric disorder. Increased TC levels in geriatric pa-tients indicate the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis activity. Various authors reported that elevated values of cortisol in geriatric subjects with psychiatric disorder were indication of Cush-ing’s syndrome [17-20]. The level of TC thyroid tests are higher in geriatric patients with psychiatric disorder than in age and sex-matched healthy subjects, which confirms results of a previous study [21,22]. Hypothyroid geriatric patients indicate the hypoactivity of the hypothalamic-pituitary-thyroid (HPT) axis.

In our study, a negative and minimal correlation (r = -0.0212) was observed between serum TC and T3 in study subjects. Correlation between the serum TC and T4 was analyzed statistically using MS-Excel. The serum TC was found to have slightly negative correlation with the serum T4 in all geriatric patients with (r = -0.0566). A significant, positive correlation (r=0.5142) was found between serum TC and TSH in geriatric cases is as per figure 1. The impairment of both HPA and HPT in our geriatric patients with psychiatric disorder support this good corre-lation between serum TC and TSH.

We concluded that in geriatric patients elevated cortisol and thyroid alterations are associated with psychiatric disorder. We propose that the alterations described in the literature are influenced by mental status of patient. Our data support these finding, that the hypothalamic–pituitary–thyroid (HPT) axis and the hypothalamic–pituitary–adrenal (HPA) axis is impaired in geriatric pa-tients with psychiatric disorder.

References

  1. Kirkegaard C, Faber J. The role of thyroid hormones in depression. European Journal of Endocrinology 1998; 138: 1-9.
  2. Jackson I. The thyroid axis and depression. Thyroid 1998; 8: 951-956.
  3. Pop V, Maartens L, Leusink G, van Son M, Knottnerus A, Ward A, Metcalfe R, Weetman A. Are autoimmune thyroid dysfunction and depression related? Journal of Clinical Endocrinology and Metabolism 1998; 83: 3194-3197.
  4. Nemeroff C, Simon J, Haggerty J Jr, Evans D. Antithyroid antibodies in depressed patients. American Jour of Psychr 1985; 142: 840-843.
  5. Holsboer F, Barden N. Antidepressants and hypothalamic-pituitary-adrenocortical regulation. Endocrine Reviews 1996; 17: 187-205.
  6. Svanborg MA. Aging, health and vitality: results from the Gothenburg longitudinal study [keynote address]. Canadian Association on Gerontology, 19th Annual Meeting; 1990 Oct 26.
  7. Gnam W, Flint AJ. New onset rapid cycling bipolar disorder in an 87 year old woman. Can J Psychiatry 1993; 38: 324-6. 8. Young RC, Klerman GL. Mania in late life: focus on age at onset.AmJ Psychiatry 1992; 149: 867-876.
  8. Alexopoulos GS, Young RC, Meyers BS. Late onset depression. Psychiatr Clin North Am 1988; 2: 101-115.
  9. Asher R. Myxoedematous madness. BMJ 1949; 2: 555-62.
  10. Foster L, Dunn R. Single antiboby technique for radio-immunoassay of cortisol in unextracted serum or plasma. Clin Chem 1974; 20: 365-368.
  11. Refetoff S. Thyroid function tests. In: DeGroot LJ, editor. Endocrinology, Philadelphia: Grune and Stratton, 1979; 1: 387-428.
  12. Babson AL. The Immulite automated immunoassay system. J Clin immunoassay 1991; 14 :83-88.
  13. Arem R, and Cusi K. Thyroid function testing in psychiatric illness: Usefulness and limitations. Trends in Endocrinology and Metabolism 1997; 8 (7): 282-287.
  14. Sagud M, Pivac N, Muck-Seler D, Jakovljevic M, Mi-haljevic-Peles A, Korsic M. Effects of sertraline Treat-ment on Plasma Cortisol, Prolactin and Thyroid Hor-mones in Female Depressed Patients Neuropsycho-biology 2002; 45: 139-143.
  15. Leo, Raphael J, Batterman-Faunce, Jennifer M, Pickhardt, Deborah, Cartagena, Maria, Cohen, Gary. Utility of Thyroid Function Screening in Adolescent Psychiatric Inpatients. J. Am. Acad. Child Adolesc Psychiatry, 1997, 36 (1): 103-111.
  16. Cushing H. Basophil adenomas of the pituitary body and their clinical manifestations. Bulletin of the Johns Hopkins Hospital 1932; 50: 137-195.
  17. Starkman MN, Schteingart DE. Neuropsychiatric manifestations of patients with Cushing’s syndrome: relationship to cortisol and adreno-corticotrophic hormone levels. Arch Intern Med 1981; 191: 215-219.
  18. Starkman MN. Hippocampal formation volume, memory dysfunction and cortisol levels in patients with Cushing’s syndrome. Biol Psychiatry 1992; 32: 756-765.
  19. Cleghorn RA. Adrenal cortical insufficiency: psychological and neurological observations. Can Med Assoc J 1951; 65: 449-454.
  20. Oquendo MA, Echavarria1 G, Galfalvy HC, Grunebaum MF, Burke A, et al. Lower Cortisol Levels in Depressed Patients with Comorbid Post-Traumatic Stress Disorder. Neuropsychopharmacology 2003; 28, 591-598
  21. Heinrich TW, Gram G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Primary care ompanion J Clin Psychiatry 2003; 5; (6) : 560-566.

Correspondence: E-mail: akbarson4(at)gmail.com
Patil/ Mujawar
Current Neurobiology Volume 1 Number 2

Access free medical resources from Wiley-Blackwell now!

About Indmedica - Conditions of Usage - Advertise On Indmedica - Contact Us

Copyright © 2005 Indmedica