Psychopathological investigation of adolescent girls with autoimmune thyroid disease

Introduction and Aim: Clinical studies point to that an association between high levels of thyroid autoantibodies and psychiatric disorders independently of impairment of thyroid function. Therefore we aimed to investigate the association between thyroid autoimmunity and mental disorders in euthyroid girls with HT, in a case-control study. Material and Methots: 41 pubertal female patients with HT were recruited from our endocrine outpatient clinics of the University Hospital of Sakarya, between April 2018 and August 2018. Control group was consisted of 41 healthy pubertal school girls. Inclusion criteria were: age from 12 to 18 years, normal thyroid hormone levels, and serum TSH concentration of 0.3-5 mIU/L. Diagnosis of HT was based on high levels of anti-TPO and /or anti-Tg antibodies, associated with a hypoechogenic thyroid ultrasound pattern. Exclusion criteria comprised history of chronic diseases including immunological and rheumatological disorders, diabetes, hypercortisolism and known neuro-psychiatric illnesses, treatment with thyroid hormone, glucocorticoids, immunosuppressive or anti-psychotic agents. Other comorbidities known to affect psychic and physical well-being such as obesity, being with disabilities were also exclusion factors. All subjects underwent a complete thyroid evaluation including physical examination, measure of serum free T4, TSH, anti-TPO anti-Tg antibodies and thyroid ultrasonography. After the thyroid evoluation, all subjects were referred to psychiatric outpatient clinic. A standardized form was used to acquire information concerning demographic data. Psychiatric diagnosis was made by two steps: First, using the Turkish version of SCI and SCARED tests according to DSM-IV diagnostic criteria to be calculated. Afterwards, K-SAD-PL interview was done by the same psychiatrist who was unaware of children's data. Results: There was no significant difference on the CDI questionnaire scale (p=0.47). In both groups, the mean value was below the cut-off value. According to SCARED metric, the anxiety disorder points of patients with HT were significantly higher (p<0.05) and the mean values were above the cut-off value. In the SCARED test, in the subcategories of general anxiety disorders Separation Anxiety and Social Anxiety were found significantly higher in Hashimoto HT group (p=0.04 and p=0.01, respectively). There is no relationship between SCARED results and the duration of illness. There is no relationship between SCARED results and thyroid hormones and antibodies. As a result of the semi constructed meeting conducted with K-SADS by the attending psychiatrist: • While psychopathology was detected in 27 out of 41 patients (66%), psychopathology was detected in 8 out of 41 individuals (19.5%) in the control group. The prevalence of psychopathology was significantly higher in the patient group (p<0.01). • Depressive Disorder, Generalized Anxiety Disorder, ADHD and social phobia were significantly higher in the HT group compared to the control group (p<0.05). As many psychiatric disorders and thyroid function disorders have common symptoms and findings, we chose our patient and control groups among euthyroid individuals, therefore aiming to conduct an analysis independent of thyroid function. There was no significant difference among age, anthropometric measures (height, weight, BMI), and pubertal status. As expected, thyroid antibodies were very high in the HT group as a sign of autoimmunity. There are observations and findings that suggest that thyroid autoantibody positivity may have a role in the etiology of psychiatric diseases: • The relationship between autoimmune markers and depressive symptoms, • The relationship between thyroid antibody positivity during pregnancy and incidence of post partum depression, • Depression-like clinical states in healthy patients after autoantibody transfer, • Seeing improvement in behavioral performance tests while autoimmunity is suppressed after immunosuppressive therapy, • In animal models of autoimmunity, increased incidence of observing the presence of autoimmunity together with behavioral disorders and brain atrophy, • Both in humans and in mice, observing an increase in the severity of depressive symptoms in parallel to the increase in antibody titers, make us think that the relationship between autoimmunity and psychiatric disorders is not due to chance (Iseme, 2014). Conclusion: In conclusion, this study describes the severe psychometric impairment in patients with euthyroid Hashimoto's thyroiditis. This result has implications for clinical practice and highlights the importance to offer psychosocial services for these chronically ill patients. Key words: Hashimoto thyroiditis, Child, Psychometric Pathology, Child Psychiatry, Depression, Anxiety