Endocrine Abstracts

JOINT2119

Background and Aim: Psychological stress has been implicated in the development of various autoimmune diseases. The relation between depression, anxiety and thyroid dysfunction (TD) remains poorly understood. The aim of the study was to investigate the longitudinal association between mental health, anxiety, depression, and the risk of TD. We also determined whether the relation between mental distress and the onset of TD was influenced by genetic predisposition.

Methods: A total of 418,622 TD-free participants from the UK Biobank were enrolled in the study. The mental health score was measured at baseline using the Patient Health Questionnaire-4 (PHQ-4), which has been shown to be a reliable and valid screening tool to assess psychological distress and in particular anxiety and depression in the general population. The diagnosis of TD, which included hyperthyroidism and hypothyroidism, was made using medical records. Polygenic risk score for hyperthyroidism and hypothyroidism was created. Survival curves with the Kaplan-Meier method was used to compare the differences in the cumulative incidence of TD according to mental health states. Cox proportional hazards models were used in multivariate models.

Results: During a median follow-up of 12.3 years, 2,242, and 9,419 new cases of hyperthyroidism and hypothyroidism were documented respectively. There was a graded association between mental health score at baseline and the risk of incident TD over the follow-up. The adjusted hazard ratio (HR) per SD increase was 1.13 (95% confidence interval [CI]: 1.08, 1.18) P<0.001 for hyperthyroidism and 1.11 (95% CI: 1.09, 1.13) P<0.001 for hypothyroidism. Individuals with severe mental health score had an increased risk of developing either hyperthyroidism (adjusted HR: 1.70, 95% CI: 1.09-2.65) or hypothyroidism (adjusted HR: 1.70, 95% CI: 1.36-2.12) compared with those with a low mental health score. Anxiety and depression as considered separately was each significantly associated with the risk of TD. Results were unchanged when considering clinical diagnosis of depression or anxiety instead of the PHQ-4 questionnaire. There was no significant interaction between the mental health and genetic risk score for the association with the incidence of TD.

Conclusion: Mental health, anxiety and depression were strongly and independently associated with the onset of both hyperthyroidism and hypothyroidism in general population. These findings suggest considering the potential risk of TD in individuals who experienced psychological distress, anxiety or depression.