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Am J Psychiatry 1997; 154:224-230
Copyright © 1997 by American Psychiatric Association
Inverse relationship of peripheral thyrotropin-stimulating hormone levels to brain activity in mood disorders
LB Marangell, TA Ketter, MS George, PJ Pazzaglia, AM Callahan, P Parekh, PJ Andreason, B Horwitz, P Herscovitch and RM Post
National Institutes of Health, Bethesda, Md. 20892, USA.
OBJECTIVE: The author's goal was to investigate relationships between
peripheral thyroid hormone levels and cerebral blood flow (CBF) and
cerebral glucose metabolism in affectively ill patients. METHOD:
Medication-free inpatients with major depression or bipolar disorder were
studied with oxygen-15 water and positron emission tomography (PET) to
measure CBF (N = 19) or with [18F] fluorodeoxyglucose and PET to measure
cerebral glucose metabolism (N = 29). Linear regression was used to
correlate global CBF and cerebral glucose metabolism with serum
thyrotropin-stimulating hormone (TSH), triiodothyronine (T3), thyroxine
(T4), and free T4 concentrations. Statistical parametric mapping was used
to correlate regional CBF and cerebral glucose metabolism with these
thyroid indexes. Post hoc t tests were used to further explore the
relationships between serum TSH and global CBF and cerebral glucose
metabolism. RESULTS: Serum TSH was inversely related to both global and
regional CBF and cerebral glucose metabolism. These relationships persisted
in the cerebral glucose metabolism analysis and, to a lesser extent, in the
CBF analysis after severity of depression had been controlled for. In
contrast, no significant relationships were observed between T3, T4, or
free T4 and global or regional CBF and cerebral glucose metabolism.
CONCLUSIONS: These data suggest that peripheral TSH (putatively the best
marker of thyroid status) is inversely related to global and regional CBF
and cerebral glucose metabolism. These findings indicate relationships
between thyroid and cerebral activity that could provide mechanistic
hypotheses for thyroid contributions to primary and secondary mood
disorders and the psychotropic effects of thyroid axis manipulations.
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