The association between subclinical hypothyroidism (TSH 4.5–10 mIU/L) and the severity of depression in patients with depression
抑郁症患者亚临床甲状腺功能减退（TSH4.5～10mIU/L）与抑郁严重程度的关联

摘要

目的 探讨抑郁症患者亚临床甲状腺功能减退（TSH 4.5～10mIU/L）与抑郁严重程度的关联。方法 将62例精神性疾病患者纳入研究，测定其T3、FT3等指标水平，分析甲状腺功能减退（TSH 4.5～10mIU/L）与抑郁严重程度的关联。结果 ①两组基线资料：SCH组抑郁病程[（3.8±1.5）年]、抗抑郁药使用率（71.43%，20/28）与正常组[（2.5±1.2）年、52.94%，18/34]无显著差异（P>0.05），但SCH组年龄[（45.2±8.6）岁]略高于正常组[（39.5±7.8）岁]（P=0.018）；②甲状腺功能指标：SCH组FT3[（3.2±0.4）pmol/L]显著低于正常组[（3.6±0.5）pmol/L]（t=3.852，P<0.001），TSH显著高于正常组（P<0.001），FT4、T3、T4无显著差异（P>0.05）；③抑郁严重程度：SCH组HAMD-24评分[（26.8±4.5）分]显著高于正常组[（20.5±3.8）分]（t=6.258，P<0.001），其中重度抑郁占比（53.57%，15/28）显著高于正常组（20.59%，7/34）（χ²=8.652，P=0.003）；④关联性分析：Spearman分析显示TSH水平与HAMD-24评分呈正相关（r=0.528，P<0.001），FT3水平与HAMD-24评分呈负相关（r=-0.385，P=0.002）；多因素线性回归控制年龄、性别等混杂因素后，TSH仍为HAMD-24评分的独立影响因素（β=0.482，P<0.001）。结论 抑郁症患者中亚临床甲状腺功能减退（TSH4.5～10mIU/L）与抑郁严重程度显著相关，TSH水平升高、FT3水平降低可能与抑郁症状加重相关，临床中可考虑对抑郁症患者常规监测甲状腺功能，为高TSH患者制定个体化干预方案。

Abstract

Objective To explore the association between subclinical hypothyroidism (TSH 4.5–10 mIU/L) and the severity of depression in patients with depression.
Methods A total of 62 patients with psychiatric disorders were included in the study. Their T3, FT3, and other indicators were measured to analyze the relationship between hypothyroidism (TSH 4.5–10 mIU/L) and the severity of depression.
Results ① Baseline data: The duration of depression [(3.8±1.5) years] and the rate of antidepressant use (71.43%, 20/28) in the SCH group showed no significant difference compared to the normal group [(2.5±1.2) years, 52.94%, 18/34] (P>0.05). However, the age of the SCH group [(45.2±8.6) years] was slightly higher than that of the normal group [(39.5±7.8) years] (P=0.018); ② Thyroid function indicators: The FT3 level [(3.2±0.4) pmol/L] in the SCH group was significantly lower than that in the normal group [(3.6±0.5) pmol/L] (t=3.852, P<0.001), while TSH was significantly higher than in the normal group (P<0.001). No significant differences were observed in FT4, T3, or T4 (P>0.05); ③ Severity of depression: The HAMD-24 score [(26.8±4.5) points] in the SCH group was significantly higher than that in the normal group [(20.5±3.8) points] (t=6.258, P<0.001). The proportion of severe depression (53.57%, 15/28) was significantly higher than in the normal group (20.59%, 7/34) (χ²=8.652, P=0.003); ④ Correlation analysis: Spearman analysis revealed a positive correlation between TSH levels and HAMD-24 scores (r=0.528, P<0.001), while FT3 levels showed a negative correlation with HAMD-24 scores (r=-0.385, P=0.002). After multivariate linear regression adjusted for confounding factors such as age and gender, TSH remained an independent influencing factor for HAMD-24 scores (β=0.482, P<0.001).
Conclusion   Subclinical hypothyroidism (TSH 4.5–10 mIU/L) is significantly associated with the severity of depression in patients with depressive disorders. Elevated TSH levels and decreased FT3 levels may be linked to worsening depressive symptoms. Clinically, routine thyroid function monitoring is recommended for patients with depression, and individualized intervention plans should be developed for those with high TSH levels.