Interactions between brain, psyche and thyroid^[*]

Summary

Interactions between brain, psyche and thyroid are known from historical descriptions of thyroidectomy (Kocher) and hyperthyroidism. However, their importance is often underscored in clinical routine. Thyroid hormone deficiency during pregnancy may result in irreversible mental retardation and requires levothyroxine substitution. TSH screening after delivery must identify newborns with congenital hypothyroidism: An early levothyroxine substitution and long term therapy control are required.

Hypothyroidism and depression have many symptoms in common. Cognitive deficits and depressive states are often found in overt hypothyroidism, psychotic derangements are rare. Levothyroxine improves hypothyroid symptoms and mental performance, mood and motivation. Psychic symptoms of hyperthyroidism include agitation, irritability, mood disturbances, hyperactivity, anxiousness and even panic attacks. Manic and delusional states are rare. In geriatric patients hyperthyroidism may be oligosymptomatic. In psychiatric patients more frequent but unspecific disturbances of thyroid laboratory values being reversible without specific therapy have to be distinguished from rather rare but causative organic thyroid diseases with therapeutic consequences. Some psychiatric drugs influence thyroid laboratory results. Hypothyroidism in depressive patients is a negative prognostic parameter and requires therapy. Psychiatric symptoms associated with hypothyroidism are usually reversible under levothyroxine within 4–8 weeks. The standard for hypothyroidism is mono-levothyroxine therapy.

Zusammenfassung

Interaktionen zwischen Gehirn, Psyche und Schilddrüse sind aus historischen Beschreibungen der Thyroidektomie (Kocher) und Hyperthyreose bekannt, finden aber in der Routine eine eher untergeordnete Beachtung. Schilddrüsenhormonmangel in der Schwangerschaft kann eine irreversible mentale Retardierung hervorrufen und ist mit Levothyroxin zu substituieren. Das TSH-Screening soll Neugeborene mit kongenitaler Hypothyreose identifizieren: Frühe Levothyroxin-Substitution und konsequente Therapieüberwachung sind indiziert.

Hypothyreose und Depression haben viele gemeinsame Symptome. Kognitive Veränderungen und depressive Zustände sind bei manifester Hypothyreose häufig, psychotische Störungen selten. Levothyroxin bessert Hypothyreosesymptomatik, Gedächtnisleistung, Stimmung und Antrieb. Psychische Symptome bei Hyperthyreose umfassen Unruhe, Reizbarkeit, Stimmungsschwankungen, Hyperaktivität und ängstlichkeit bis hin zu Panikattacken. Manische und wahnhafte Zustandsbilder sind selten. Hyperthyreosen bei geriatrischen Patienten können oligosymptomatisch verlaufen.

Bei psychiatrischen Patienten sind häufige unspezifische Schilddrüsenparameter-Veränderungen, die reversibel sind und keiner Therapie bedürfen, zu unterscheiden von ursächlich seltenen organischen Schilddrüsenerkrankungen mit Therapiekonsequenzen. Auch auf den Einfluss von Medikamenten auf Schilddrüsenparameter ist zu achten. Eine Hypothyreose wird als negativer prognostischer und somit behandlungsbedürftiger Faktor bei Patienten mit Depression angesehen. Hypothyreose-bedingte psychiatrische Symptome sind unter Substitutionstherapie meist binnen 4–8 Wochen reversibel. Standard bei Hypothyreose ist die Mono-Levothyroxintherapie.

Keywords

Hypothyroidism - hyperthyroidism - brain - psyche - depression

Schlüsselwörter

Hypothyreose - Hyperthyreose - Hirnentwicklung - Psyche - Kretinismus - Depression - Psychose

^* Diese Übersichtsarbeit entstand in Vorbereitung des Vortrags ”Stimmungsmacher Schilddrüse: Interaktionen zwischen Schilddrüse, Hirn und Psyche“, der auf dem 22. Kölner Schilddrüsen- Seminar am 29.2.2008 gehalten wurde. Grundlage dieses Vortrags war die systematische Literaturrecherche in PubMed unter Nutzung der im Titel der Arbeit und in den Schlüsselwörtern genannten Suchbegriffe. Ergänzt wurde diese mit ausgewählten Arbeiten (vgl. Literatur).

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