Frequency of Depression in Patient
Presenting with Thyroid Dysfunction
Original Article
20
MS No.: PJMDS/OA/035/2024
Pak J Med Dent Sci. 2025;2(1):20-26
INTRODUCTION
Thyroid disorders are among the most common endocrine
conditions worldwide and are known to exert widespread
effects on physical and psychological health. The thyroid gland
plays a crucial role in regulating metabolism, and disturbances
in its function have been increasingly linked to various
neuropsychiatric manifestations, particularly mood disorders
1,2
such as depression and anxiety .
Emerging evidence suggests a bidirectional relationship
between thyroid dysfunction and mental health disturbances.
Both hypothyroidism and hyperthyroidism can lead to
alterations in neurotransmitter activity, hypothalamic–
pituitary–thyroid (HPT) axis dysfunction, and structural brain
changes, contributing to the onset or exacerbation of
3,4
depressive symptoms . Subclinical thyroid dysfunction, often
overlooked due to its mild biochemical abnormalities, has also
been implicated as a significant risk factor for depression. A
5
meta-analysis by Tang et al. demonstrated that the prevalence
of depression was slightly higher among individuals with
subclinical hypothyroidism (SCH) compared to euthyroid
individuals (8.6% vs. 7.5%), reinforcing the subtle yet impactful
role of thyroid status in mental health outcomes.
Patients with hypothyroidism frequently report fatigue, lethargy,
and low mood—core features overlapping with clinical
In recent years, the prospective association between SCH and
13,14
depression has garnered increased scholarly attention .
However, the findings remain heterogeneous. Investigation of
depression has revealed the prevalence to be much higher in
4,15
thyroid dysfunction compared with euthyroid , while others
14,16
did not find a statistically significant difference .
6
depression . Conversely, those with hyperthyroidism may
experience heightened anxiety, irritability, and depressive
symptoms, often complicating the diagnostic and therapeutic
7,8
processes . Studies have shown a high prevalence of
depression and anxiety among patients with both overt and
9-11
subclinical thyroid dysfunction .
Moreover, thyroid-related conditions such as differentiated
thyroid cancer have also been associated with impaired quality
12
of life and increased rates of depression and anxiety .
Research utilizing large cohorts, including prospective data
from the UK Biobank, further supports the association between
thyroid abnormalities and depressive disorders, underscoring
2
the importance of early recognition and integrated care .
In low-resource settings and tertiary care centers, the
frequency of depression among patients presenting with
thyroid dysfunction may be underreported or misdiagnosed
due to overlapping symptoms and lack of routine mental health
13
screening . Given the clinical implications, assessing the
psychological well-being of patients with thyroid disorders is
essential for improving both endocrine and mental health
outcomes.
Due to the conflicting results from previously published studies,
we aim to determine the prevalence of depressive disorders in
patients with thyroid diseases visiting a tertiary care center. The
outcomes derived from this inquiry may yield pertinent local
evidence and facilitate the formulation of focused therapeutic
interventions. The prompt recognition and appropriate
management of concurrent psychological conditions have the
potential to markedly improve the overall quality of life for this
specific patient demographic.
ABSTRACT
Results: Among a cohort of 231 participants (mean age 37.52
± 11.38 years; 64.1% within the age range of 18–40), a
Objective: To determine the frequency of depression in patient
presenting with thyroid disorder at tertiary care hospital.
Methodology: This cross-sectional investigation was
executed over an eighteen-month period from December 2022
to June 2023 within the Department of Psychiatry at DUHS,
Karachi. A total of 231 subjects, ranging in age from 18 to 70
years, were recruited through non-probability consecutive
sampling methodology. The assessment of depression was
conducted utilizing the Hamilton Depression Rating Scale
(HAM-D). The data were subjected to analysis via SPSS
version 26.0. The evaluation of statistical significance was
performed employing the Chi-square test, with a p-value of
≤ 0.05 deemed indicative of significance.
Conclusion: The overall incidence of depression among
individuals diagnosed with thyroid dysfunction was significant;
nevertheless, no statistically meaningful association was
identified between the specific type of thyroid disorder and the
manifestation of depression. Marital status, particularly the
condition of being divorced, surfaced as a notable predictor of
depression within this demographic. Further longitudinal
studies are required to explore causality and the mediating role
of psychosocial factors in thyroid-related depression.
significant association with depression was exclusively
observed in relation to marital status, wherein individuals who
were divorced exhibited markedly elevated odds (OR=11.010,
P=0.000). Despite the predominance of male participants
(90.5%), neither age (P=0.363) nor gender (P=0.533)
demonstrated a significant association. Furthermore, thyroid
dysfunctions did not reveal any significant relationship with
depression (P=0.961).
1 2 3 4 5
Zoobia Ramzan , Sakina Naseer , Atif Raza , Sheema Mustafa , Maliha Ahmed
Keywords: Depression, Hamilton depression rating scale, Subclinical hyperthyroidism, Thyroid disorder
2,3,4,5
Postgraduate Resident
Corresponding Author
2
Sakina Naseer
Email: [email protected]
Affiliations:
Dr. Abdul Qadeer Khan Institute of Behavioral Sciences,
1,2,4
Dow International Medical College, Karachi
1
Assistant Professor
Submitted: October 02, 2024
Revised: March 17, 2025
Accepted: April 19, 2025
3,5
Abbasi Shaheed Hospital, Karachi
