Turkiye Klinikleri Journal of Pediatrics

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Tiroid Fonksiyonlarının Ergenlerde Depresyon Üzerindeki Etkisi: Olgu-Kontrol Çalışması
The Impact of Thyroid Functions on Depression in Adolescents: A Case-Control Study
Yeşim SAĞLAMa , Şükret ALEVa , Hasan KARAKAŞb , Gül KARAÇETİNa
aBakırköy Prof. Dr. Mazhar Osman Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Kliniği, İstanbul, Türkiye
bİstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Çocuk Endokrinolojisi BD, İstanbul, Türkiye
Turkiye Klinikleri J Pediatr. 2024;33(3):89-96
doi: 10.5336/pediatr.2024-106745
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışma, majör depresif bozukluk (MDB) tanılı hastalar ile sağlıklı kontroller arasında tiroid hormon düzeylerinin karşılaştırılması ve tiroid hormonları normal sınırlarda olan hastaların cinsiyet ve klinik ölçeklerle ilişkilerinin değerlendirilmesini hedeflemektedir. Gereç ve Yöntemler: Bu çalışmaya üçüncü basamak bir psikiyatri hastanesinde yatan ve MDB tanısı konulan toplam 86 hasta ve benzer sosyodemografik özelliklere sahip 87 sağlıklı bireyden oluşan kontrol grubu dâhil edilmiştir. Klinik semptomlar, Çocuk Depresyon Derecelendirme Ölçeği [Children's Depression Rating Scale (CDRS)] ve Klinik Global İzlenim (KGİ) Ölçeği ile değerlendirilmiştir. Serum tiroid uyarıcı hormon [thyroid-stimulating hormone (TSH)], serbest tiroksin [free thyroxine (fT4)] ve serbest triiyodotironin [free triiodothyronine (fT3)] düzeylerini ölçmek için kan örnekleri alınmıştır. Bulgular: Çalışmamızda, hasta ile kontrol grubu arasında yaş (p=0,296) ve cinsiyet (p=0,952) arasında anlamlı farklılık saptanmamıştır. Hasta ve kontrol grubunda tiroid hormon seviyeleri normal aralıkta ölçülmüştür. MDB grubunda fT4 (p=0,003) ve fT3 (p<0,001) seviyeleri anlamlı şekilde düşük bulunurken, TSH (p=0,167) seviyeleri arasında fark saptanmamıştır. Cinsiyetin fT4 (Fcinsiyet=5,7, p=0,018) ve fT3 (Fcinsiyet=21,4, p<0,001) seviyeleri üzerinde etkisi olduğu belirlenmiştir. Kadınlarda gruplar arasında fT4 ve fT3 seviyelerindeki farklılıklar erkeklerden belirgindir. fT4 (r=-0,206, p=0,065) ve fT3 (r=-0,235, p=0,057) seviyeleri ile KGİ-S arasında zayıf düzeyde negatif yönde korelasyon bulunurken, TSH ile KGİ-S ve CDRS-total puanları arasında bir ilişki saptanmamıştır. Sonuç: MDB tanılı hastalarda tiroid hormon seviyeleri sağlıklı kontrollere göre daha düşük bulunması, tiroid hormonlarının depresyonun patolojik sürecine katkıda bulunabileceğini düşündürmektedir. Ayrıca, kadınlarda TSH düzeylerinin erkeklere göre daha yüksek, fT3 ve fT4 seviyelerinin ise daha düşük olması, depresyon ve cinsiyetin tiroid hormon düzeyleri üzerinde anlamlı etkileri olduğunu göstermektedir.

Anahtar Kelimeler: Ergen; depresyon; tiroid hormonları
ABSTRACT
 Objective: This study aims to compare thyroid hormone levels between patients diagnosed with major depressive disorder (MDD) and healthy controls, and to evaluate the relationships between gender and clinical scales in patients with thyroid hormone levels within the normal range. Material and Methods: A total of 86 patients diagnosed with MDD and hospitalized in a tertiary psychiatry hospital, as well as a control group of 87 healthy individuals with similar sociodemographic characteristics, were included in the study. Clinical symptoms were assessed using the Children's Depression Rating Scale (CDRS) and the Clinical Global Impressions (CGI) scale. Blood samples were collected to measure serum thyroid-stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. Results: In our study, no significant differences in age (p=0.296) or gender (p=0.952) were found between the patient and control groups. Thyroid hormone levels were normal in both groups. The MDD group showed significantly lower levels of fT4 (p=0.003) and fT3 (p<0.001), while no difference was detected in TSH levels (p=0.167). Gender was found to affect fT4 (Fgender=5.7, p=0.018) and fT3 levels (Fgender=21.4, p<0.001). The differences in fT4 and fT3 levels between groups are more pronounced in women than in men. A low-level negative correlation was found between fT4 (r=-0.206, p=0.065) and fT3 (r=-0.235, p=0.057) levels and CGI-S while no relationship was detected between TSH and CGI-S or CDRS scores. Conclusion: Thyroid hormone levels were found to be lower in patients with MDD compared to healthy controls, suggesting that thyroid hormones may contribute to the pathological process of depression. Additionally, TSH levels were higher in females than males, while fT3 and fT4 levels were lower, suggesting that depression and gender significantly affect thyroid hormone levels.

Keywords: Adolescent; depression; thyroid hormones
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