Stress Affects Thyroid Stimulating Hormone and Thyroid Hormone in the Patients Who Underwent Thyroidectomy
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: For recent decades, there have been many studies on the relationship with thyroid dysfunction and mood disorder, anxiety, or stress, but the results have been inconsistent. Also, few studies have examined the effects of psychological disorder on thyroid function in patients who underwent thyroidectomy. In this study, we investigated the relationship between stress and thyroid dysfunction in such patients. Methods: Twenty-eight patients were enrolled who underwent thyroidectomy from July 2007 to January 2016 and who experienced life events after thyroid surgery. Five patients underwent lobectomy. The mean follow-up period was 49 months. In this retrospective cohort study, thyroid stimulating hormone (TSH) and thyroid hormones (T4, T3) tested periodically were compared with PROC MIXED with SAS v9.4. The stressors were found by open questionnaire during outpatient’s visits. Results: The patients enrolled in this study took 3–8 thyroid function tests during the follow-up period (mean 49 months). Eight patients (28.5%) had mild to moderate hypothyroidism with TSH less than 10 μIU/mL and 14 patients (50.0%) had overt hypothyroidism with TSH >10 μIU/ mL. When the patients were under stress, free T4 decreased and TSH increased after adjusting the effect of decreased T4 (P<0.001), despite identical levothyroxine dose and good compliance. Conclusion: In the patients who underwent thyroidectomy, TSH increased under stress, because of the loss or lack of the compensatory response of thyroid. Therefore, for patients with thyroid cancer under stress, levothyroxine dose and frequency of outpatient visit will be needed to be adjusted during follow-up.
Abstract
Purpose: For recent decades, there have been many studies on the relationship with thyroid dysfunction and mood disorder, anxiety, or stress, but the results have been inconsistent. Also, few studies have examined the effects of psychological disorder on thyroid function in patients who underwent thyroidectomy. In this study, we investigated the relationship between stress and thyroid dysfunction in such patients. Methods: Twenty-eight patients were enrolled who underwent thyroidectomy from July 2007 to January 2016 and who experienced life events after thyroid surgery. Five patients underwent lobectomy. The mean follow-up period was 49 months. In this retrospective cohort study, thyroid stimulating hormone (TSH) and thyroid hormones (T4, T3) tested periodically were compared with PROC MIXED with SAS v9.4. The stressors were found by open questionnaire during outpatient’s visits. Results: The patients enrolled in this study took 3–8 thyroid function tests during the follow-up period (mean 49 months). Eight patients (28.5%) had mild to moderate hypothyroidism with TSH less than 10 μIU/mL and 14 patients (50.0%) had overt hypothyroidism with TSH >10 μIU/ mL. When the patients were under stress, free T4 decreased and TSH increased after adjusting the effect of decreased T4 (P<0.001), despite identical levothyroxine dose and good compliance. Conclusion: In the patients who underwent thyroidectomy, TSH increased under stress, because of the loss or lack of the compensatory response of thyroid. Therefore, for patients with thyroid cancer under stress, levothyroxine dose and frequency of outpatient visit will be needed to be adjusted during follow-up.
참고문헌 (29)
- Lazar MA, "Thyroid hormone receptors : multiple forms, multiple possibilities", Endocr Rev, 14, pp.184~193 (1993)
- Fontes R, "Reference interval of thyroid stimulating hormone and free thyroxine in a reference population over 60 years old and in very old subjects(over 80 years) : comparison to young subjects", Thyroid Res, 6, pp.13~ (2013)
- Dohrenwend BP, "The role of adversity and stress in psychopathology : some evidence and its implications for theory and research", J Health Soc Behav, 41, pp.1~19 (2000)
- Weiner H, "Perturbing the Organism : The Biology of Stressful Experience" (1992), University of Chicago Press
- McEwen BS, "The concept of allostasis in biology and biomedicine", Horm Behav, 43, pp.2~15 (2003)
- Hoermann R, "Homeostatic equilibria between free thyroid hormones and pituitary thyrotropin are modulated by various influences including age, body mass index and treatment", Clin Endocrinol(Oxf), 81, pp.907~915 (2014)
- Smallridge RC, "Effects of exercise and physical fitness on the pituitary-thyroid axis and on prolactin secretion in male runners", Metabolism, 34, pp.949~954 (1985)
- Hoermann R, "Homeostatic control of the thyroid-pituitary axis : perspectives for diagnosis and treatment", Front Endocrinol(Lausanne), 6, pp.177~ (2015)
- Prummel MF, "Ultra short-loop feedback control of thyrotropin secretion", Thyroid, 14, pp.825~829 (2004)
- Lechan RM, "Feedback regulation of thyrotropin-releasing hormone(TRH) : mechanisms for the non-thyroidal illness syndrome", J Endocrinol Invest, 27, pp.105~119 (2004)
- Joseph-Bravo P, "Advances in TRH signaling", Rev Endocr Metab Disord, 17, pp.545~558 (2016)
- Roef GL, "Triiodothyronine and free thyroxine levels are differentially associated with metabolic profile and adiposity-related cardiovascular risk markers in euthyroid middle-aged subjects", Thyroid, 24, pp.223~231 (2014)
- Knudsen N, "Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population", J Clin Endocrinol Metab, 90, pp.4019~4024 (2005)
- McEwen BS, "Central effects of stress hormones in health and disease : Understanding the protective and damaging effects of stress and stress mediators", Eur J Pharmacol, 583, pp.174~185 (2008)
- Wan W, "Pituitary resistance to thyroid hormone syndrome is associated with T3 receptor mutants that selectively impair beta2 isoform function", Mol Endocrinol, 19, pp.1529~1542 (2005)
- Feldman AZ, "Neuropsychiatric manifestations of thyroid disease", Endocrinol Metab Clin North Am, 42, pp.453~476 (2013)
- Medici M, "Thyroid function within the normal range and the risk of depression : a population-based cohort study", J Clin Endocrinol Metab, 99, pp.1213~1219 (2014)
- Fischer S, "Hypothalamic-pituitary-thyroid(HPT)axis functioning in anxiety disorders. A systematic review", Depress Anxiety, 35, pp.98~110 (2018)
- Uyar B, "The analysis of immunosuppressant therapy adherence, depression, anxiety, and stress in kidney transplant recipients in the post-transplantation period", Transpl Immunol, 75, pp.101686~ (2022)
- Vita R, "Stress triggers the onset and the recurrences of hyperthyroidism in patients with Graves’ disease", Endocrine, 48, pp.254~263 (2015)
- Panicker V, "A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4 : findings from the HUNT study", Clin Endocrinol(Oxf), 71, pp.574~580 (2009)
- Mizokami T, "Stress and thyroid autoimmunity", Thyroid, 14, pp.1047~1055 (2004)
- Sherman SI, "Absorption and malabsorption of levothyroxine sodium", Am J Ther, 2, pp.814~818 (1995)
- England ML, "Serum TSH concentration as an aid to monitoring compliance with thyroid hormone therapy in hypothyroidism", Am J Med Sci, 292, pp.264~266 (1986)
- DiStefano JJ 3rd, "Rat enterohepatic circulation and intestinal distribution of enterally infused thyroid hormones", Endocrinology, 123, pp.2526~2539 (1988)
- Stork PJ, "Crosstalk between cAMP and MAP kinase signaling in the regulation of cell proliferation", Trends Cell Biol, 12, pp.258~266 (2002)
- Zaballos MA, "Gbetagamma dimers released in response to thyrotropin activate phosphoinositide 3-kinase and regulate gene expression in thyroid cells", Mol Endocrinol, 22, pp.1183~1199 (2008)
- Lu C, "Growth activation alone is not sufficient to cause metastatic thyroid cancer in a mouse model of follicular thyroid carcinoma", Endocrinology, 151, pp.1929~1939 (2010)
- Knuiman MW, "A longitudinal analysis of the influence of the neighborhood built environment on walking for transportation : the RESIDE study", Am J Epidemiol, 180, pp.453~461 (2014)