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J Clin Psychiatry. 2019 Aug 6;80(5). pii: 18m12626. doi: 10.4088/JCP.18m12626.

Thyroid Function Screening in Children and Adolescents With Mood and Anxiety Disorders.

Author information

1
Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati and Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
2
Genetic Counseling Program, University of Cincinnati, Cincinnati, Ohio, USA.
3
Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
4
Divisions of Human Genetics and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
5
Department of Pediatrics, Cincinnati Children's Hospital, and Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
6
Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
7
Divisions of Research in Patient Services and Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
8
University of Cincinnati, Department of Psychiatry, Box 670559, Cincinnati, OH 45267-0559. strawnjr@uc.edu.

Abstract

OBJECTIVE:

To determine the prevalence of abnormal thyroid-stimulating hormone (TSH) measures in youth with severe mood and anxiety disorders and to examine clinical and demographic predictors of abnormal TSH measures.

METHODS:

We retrospectively examined screening TSH concentrations in psychiatrically hospitalized children and adolescents (3-19 years) with mood/anxiety disorders (DSM-IV and DSM-5 criteria) at a large, urban, pediatric hospital between September 2013 and April 2017. Symptoms were extracted from the medical record using adaptive natural language processing algorithms, and the utility of demographic, clinical, and treatment variables as predictors of abnormal TSH measures was evaluated using logistic regression.

RESULTS:

In this sample (N = 1,017, mean ± SD age = 14.7 ± 2.24 years), 62 patients had a TSH concentration > 3.74 μIU/mL (5.3% [n = 6] of patients < 12 years of age and 6.2% [n = 56] of patients ≥ 12 years of age), and 7 patients had a TSH concentration < 0.36 μIU/mL. Elevated TSH concentrations were associated with a recent weight gain (odds ratio [OR] = 3.60; 95% CI, 1.13-9.61; P = .017), a history of thyroid disease (OR = 6.88; 95% CI, 2.37-10.7; P ≤ .0001), abnormal menstrual bleeding/menometrorrhagia (OR = 2.03; CI, 1.04-3.63; P = .024), and benzodiazepine treatment (OR = 2.29; 95% CI, 1.07-4.52; P = .02). No association was observed for sex, age, or body mass index z score. Among patients with elevated TSH measures, 12.9% (n = 8, mean ± SD age = 16.5 ± 1.5 years, 87.5% female) had an abnormal free/total thyroxine (T₄) level or other biochemical findings consistent with thyroid disease. Patients with thyroid disease (compared to those patients with elevated TSH and normal active thyroid hormone concentrations) were older (16.5 ± 1.5 vs 14.6 ± 2.3 years, P = .020) but did not differ in sex distribution (87.5% vs 63.6% female, P = .444).

CONCLUSIONS:

TSH concentrations are abnormal in approximately 6% of psychiatrically hospitalized youth, although thyroid disease was present in < 1% of the total sample. Targeted screening should focus on patients with recent weight gain, those treated with benzodiazepines, and girls with a history of abnormal uterine bleeding/menometrorrhagia.

PMID:
31390496
DOI:
10.4088/JCP.18m12626

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