Brian Harris

Association between postpartum thyroid dysfunction and thyroid antibodies and depression.

OBJECTIVE--To define the relation between mood and autoimmune thyroid dysfunction during the eight months after delivery. DESIGN--Double blind comparison of the psychiatric status of women positive and negative for thyroid antibodies. Clinical examination and blood sampling for free triiodothyronine and thyroxine, thyroid stimulating hormone, and thyroid antibody concentrations at four weekly intervals. Psychiatric assessment at six, eight, 12, 20, and 28 weeks post partum. SETTING--Outpatient department of district hospital. PATIENTS--145 antibody positive women and 229 antibody negative women delivering between August 1987 and December 1989. MAIN OUTCOME MEASURES--Thyroid status. Number of cases of mental ill health by the general health questionnaire, research diagnostic criteria, Hamilton 17 item depression scale, hospital anxiety and depression scale, and Edinburgh postnatal depression scale. RESULTS--Six weeks after delivery the general health questionnaire showed 62 (43%) antibody positive women and 65 (28%) antibody negative women had mental ill health (chi 2 = 8.18, p less than 0.005). Follow up of 110 antibody positive and 132 antibody negative women showed significantly greater depression by research diagnostic criteria in antibody positive women (47%) than antibody negative women (32%) regardless of thyroid dysfunction. Antibody positive women showed higher mean scores for depression on the Hamilton (6.01 v 3.89, p = 0.0002), Edinburgh (7.45 v 5.92, p = 0.031), and hospital depression scales (4.95 v 3.79, p = 0.003). CONCLUSION--Depressive symptoms are associated with positive thyroid antibody status in the postpartum period.

Transient post-partum thyroid dysfunction and postnatal depression

In the course of a population study of thyroid dysfunction in pregnancy and the post-partum period, 65 women, considered to be antibody-positive (microsomal and thyroglobulin), and 82 antibody-negative women were assessed for postnatal depression at 6-8 weeks post partum. The women were also assessed for the development of post-partum thyroid dysfunction. Of the 147 women, 22 met DSM-III criteria for major depression. The presence of autoantibodies showed little association with depressed mood but there was a minor association of postnatal depression with actual thyroid dysfunction in that incidence of the latter condition was higher in depressed women (Raskin scale P less than 0.01; Edinburgh scale P less than 0.05; Montgomery-Asberg scale P less than 0.1). Three of eight mothers with thyroid dysfunction had major depression and were depressed on all three scales.

Cardiff Puerperal Mood and Hormone Study

Participants were 120 primaparous women who had vaginal delivery of a non-handicapped child. Saliva was collected twice daily through parturition to day 35 post-partum. In the prepartum, a highly sign

Changes in adrenal and testicular activity monitored by salivary sampling in males throughout marathon runs

SummaryMeasurement of cortisol and testosterone in saliva samples provided by marathon runners at 6.4 km (4-mile) intervals has been used for monitoring acute changes in adrenal and testicular activity, and the changes compared with mean values in timed samples on five rest days.The collection of mixed whole saliva was well accepted; the missed sample rate in the 8 runners in the Cardiff marathon was less than 10%. On rest days, salivary cortisol and testosterone were within the normal male range and showed a circadian rhythm; mean values at 08.00 h (23.5 nmol L−1; 258 pmol L−1p<0.001, p<0.001 respectively) were higher than at 22.00 h (2.8 nmol L−1; 130 pmol L−1). In samples collected at 09.00 h, immediately prior to the Cardiff marathon, cortisol (25.1 nmol L−1) and testosterone (304 pmol L−1) were higher than the mean values (14.9 nmol L−1; 209 pmol L−1) on non-run days. Concentrations of both steroids increased during the marathon; testosterone peaked (442 pmol L−1) at 21 miles, whereas cortisol continued to increase, being maximal (87.9 nmol L−1) at 30 min after completion of the run. Four of the runners in the Cardiff marathon also participated in the Bristol marathon and the changing patterns in salivary hormones were strictly comparable.Salivary sampling would appear to be of value in monitoring acute and rhythmic changes in endocrine function in marathon runners. The temporal relationship between changes in salivary cortisol and testosterone are consistent with direct inhibition of testicular secretion by high cortisol concentrations.

Salivary cortisol for monitoring adrenal activity during marathon runs.

In non-elite male runners (n = 8), changes in adrenal activity were monitored by measurement of salivary cortisol in samples collected at 4-mile intervals during marathon runs. These changes were compared with those in similarly timed samples collected on rest days. Immediately prior to the Cardiff marathon, at 09.00 h, mean salivary cortisol concentrations (21.5 nmol/l) were higher than those in similarly timed rest day samples (14.9 nmol/l). Cortisol concentrations increased during the marathon, and although values at 25 miles were high (79.4 nmol/l), maximum values (87.9 nmol/l) were observed in samples collected 30 min after completion of the run. Some Cardiff marathon runners also participated in the Bristol marathon (n = 4) and a non-competitive event (n = 3). The changing pattern in secretory activity was similar in all events. The easy collection of saliva without cessation of exercise is ideal for monitoring the hormonal response to exercise.

Thyroid status in senile dementia of the Alzheimer type (SDAT)

ABSTRACT: Thyroid function was investigated in a group of 21 patients with severe senile dementia of the Alzheimer type (SDAT) and in a group of 17 age and sex matched normal controls. Free thyroid hormone levels (triiodothyronine (T3) and thyroxine (T4) were measured, as were also the thyrotrophin (TSH), prolactin (PRL) and growth hormone (GH) responses to thyrotrophin releasing hormone (TRH)). When compared to controls, patients demonstrated a significantly lower free T3 value (but not free T4), a blunted TSH response to TRH, slightly elevated basal PRL and GH values and a small GH response to TRH. However, all differences were small in biological terms and were within the laboratorys normal range. This emphasizes the relative normality of neuroendocrine function, particularly thyroid status, in SDAT.

Is there an association between life events, postnatal depression and thyroid dysfunction in thyroid antibody positive women?

Background: Postnatal depression is more common in women positive for thyroid autoantibodies, independent of thyroid hormone dysfunction, but the basis of this association is unclear. Aims: The objective of the work reported here has been to investigate from data obtained from previously published research, a possible association between life events, postnatal depression and the development of thyroid dysfunction in women who are positive for thyroid autoantibodies. Method: A cohort of pregnant women whose thyroid antibody status was positive (N = 115), was identified at antenatal booking (approximately 16 weeks). These, and a group of women negative for thyroid antibodies (N = 123), were assessed for depression at six to eight weeks postpartum and then at 12, 20 and 28 weeks postpartum according to Research Diagnostic Criteria (RDC). The number and type of life events over the preceding year were also assessed at eight weeks postpartum using Paykels Life Event Schedule. At four weekly intervals postpartum until six months, thyroid antibody levels and thyroid function (plasma T3 T4 and TSH) were measured. Results: As anticipated, the thyroid antibody status remained the same throughout the study, and there was no difference in the number or type of life events reported in the preceding year, between antibody positive and antibody negative women. Postnatal depression was associated with an excess of both total and negative life events, independent of thyroid antibody status or actual thyroid hormonal status. Women who developed thyroid dysfunction did not report an excess of life events (total, negative or neutral) in the preceding year. Conclusion: There was an excess of reported total and negative life events in women with postnatal depression, but this was independent of thyroid antibody status or function.

GH responses to growth hormone releasing factor in depression

The growth hormone (GH), thyrotrophin (TSH) and prolactin response to growth hormone releasing factor (GRF) was investigated in 18 patients suffering from major depression with melancholia and in 18 age- and sex-matched normal controls. There was no significant difference in the GH response to GRF stimulation between the patients and controls and in neither subject group was there a demonstrable TSH or prolactin response to GRF. These findings indicate that the pathophysiology underlying the blunted GH response to pharmacological challenge, demonstrated in other studies, must lie at a suprapituitary level.

Hormonal aspects of postnatal depression

The evidence relating postpartum mood disorder to endocrine factors is reviewed, with particular reference to thyroid hormones, progesterone, cortisol and oestrogen. The findings on non-psychotic depression and thyroid dysfunction are the most robust, but such biological changes have to be seen as interacting with psychological and social factors to produce depression. Hormone treatment trials in specific subgroups of postnatal women would enhance our understanding of aetiology

Post-Partum Thyroid Dysfunction

Normal pregnancy is associated with two major series of alterations in the endocrine system. On the one hand hormonal changes necessary for the maintenance of pregnancy must occur and on the other pregnancy itself may influence the function of endocrine glands, such as the thyroid, which are not themselves directly involved in the maintenance of the pregnancy. In pregnancy therefore, and as a result of these normal physiological regulatory mechanisms, thyroid function must be interpreted with caution (Table 1). The situation is further complicated in those women with known (or previously unrecognised) thyroid disease, particularly if the aetiological basis of their disease is autoimmune (Table 1). In these women pregnancy may have a profound impact on their disease with amelioration during the pregnancy itself but with exacerbation in the post-partum period. In addition and as a result of their thyroid disease, alterations in the function of the foetal and neonatal thyroid may occur. Considerable interest has been focussed recently on alterations in thyroid function in pregnancy and the post-partum period in both normal women and women with known autoimmune thyroid disease and has been extensively reviewed (1-3). In the present study we have sought to examine prospectively the thyroid function of a group of normal women with no known history of thyroid disease, through pregnancy and the post-partum period. Our aim was to define the true prevalence of post-partum thyroid dysfunction (PPTD) in such women, to characterise the syndromes of PPTD developing and to determine the factors associated with their development.