Endocrine Abstracts

Background: Thyroid hormones have regulatory effect on serotonin and noradrenaline and thyroid dysfunction is closely linked to some mental disorders. Besides depression and anxiety, and increased risk for suicide is demonstrated in patients with Graves’ disease (GD).

The aim: of our research was to determine the symptomatology of depression in patients with hyperthyroidism and Graves’ orbitopathy (GO) and compare it with hyperthyroid patients without GO. We also studied the influence of GO as an additional stressful long-lasting disease, known to have a great impact on quality of life due to disfiguring and eye function reduction.

Material and method: The study group included 36 patients (10 males and 26 females; age range 33-72 years) with GO, and 20 patients (3 males and 17 females; age range 21-75 years) without GO. For the assessment of depressive symptoms, we used the 9-item Patient Health Questionnaire (PHQ-9) for all patients and a disease-specific GO-QOL questionnaire for 30 patients with GO. The total scores for both GO-QOL scales (visual functioning and appearance score) were 0-100%, the higher values, the better quality of life. The results do not represent a definitive diagnosis of depression. All subjects were euthyroid on thioamides. Patients with GO had active moderately severe disease.

Results: In the group with GO, 5.6% had minimal symptoms of depression, 44.4% mild, and 50% had moderate-to-severe symptoms of depression. In the group without GO, 35% of patients had no symptoms, 35% had minimal symptoms, 25% had mild, and 5% moderate symptoms of depression. The frequency of depressive symptoms was significantly higher in patients with GO than in the control group (P=<0.001). The majority of the patients (38.8%) had difficulty concentrating when doing things like reading newspapers or watching television. In the GO-QOL questionnaire, minimal changes in the visual functioning were found in 30% of GO patients, while 33.3% had moderate, and 36.6% severe changes in visual functioning. The appearance score showed that 43.3 % of patients thought to have minimal, 46.6 % moderate, and 10 % severe changes in appearance.

Conclusions: Hyperthyroidism may have a significant impact on the development of depressive symptoms (low mood and difficulty enjoying things, loss of appetite, disturbed sleep, etc.). Furthermore, our results indicate that patients with GO are at greater risk of experiencing depressive symptoms. Thus, psychotherapy should be included in the treatment of hyperthyroid patients, particularly in those with Graves’ orbitopathy.