scholarly journals An individual participant data analysis of prospective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lea Wildisen ◽  
Cinzia Del Giovane ◽  
Elisavet Moutzouri ◽  
Shanthi Beglinger ◽  
Lamprini Syrogiannouli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Individual Participant Data ◽  
Subclinical Hyperthyroidism ◽  
Prospective Cohort Studies ◽  
Individual Participant ◽  
Prospective Cohorts

Abstract In subclinical hypothyroidism, the presence of depressive symptoms is often a reason for starting levothyroxine treatment. However, data are conflicting on the association between subclinical thyroid dysfunction and depressive symptoms. We aimed to examine the association between subclinical thyroid dysfunction and depressive symptoms in all prospective cohorts with relevant data available. We performed a systematic review of the literature from Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception to 10th May 2019. We included prospective cohorts with data on thyroid status at baseline and depressive symptoms during follow-up. The primary outcome was depressive symptoms measured at first available follow-up, expressed on the Beck’s Depression Inventory (BDI) scale (range 0–63, higher values indicate more depressive symptoms, minimal clinically important difference: 5 points). We performed a two-stage individual participant data (IPD) analysis comparing participants with subclinical hypo- or hyperthyroidism versus euthyroidism, adjusting for depressive symptoms at baseline, age, sex, education, and income (PROSPERO CRD42018091627). Six cohorts met the inclusion criteria, with IPD on 23,038 participants. Their mean age was 60 years, 65% were female, 21,025 were euthyroid, 1342 had subclinical hypothyroidism and 671 subclinical hyperthyroidism. At first available follow-up [mean 8.2 (± 4.3) years], BDI scores did not differ between participants with subclinical hypothyroidism (mean difference = 0.29, 95% confidence interval =  − 0.17 to 0.76, I2 = 15.6) or subclinical hyperthyroidism (− 0.10, 95% confidence interval =  − 0.67 to 0.48, I2 = 3.2) compared to euthyroidism. This systematic review and IPD analysis of six prospective cohort studies found no clinically relevant association between subclinical thyroid dysfunction at baseline and depressive symptoms during follow-up. The results were robust in all sensitivity and subgroup analyses. Our results are in contrast with the traditional notion that subclinical thyroid dysfunction, and subclinical hypothyroidism in particular, is associated with depressive symptoms. Consequently, our results do not support the practice of prescribing levothyroxine in patients with subclinical hypothyroidism to reduce the risk of developing depressive symptoms.

scholarly journals Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029716
Author(s):  
Lea Wildisen ◽  
Elisavet Moutzouri ◽  
Shanthi Beglinger ◽  
Lamprini Syrogiannouli ◽  
Anne R Cappola ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Individual Participant Data ◽  
Prospective Cohort Studies ◽  
Individual Participant

IntroductionProspective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms have yielded conflicting findings, possibly because of differences in age, sex, thyroid-stimulating hormone cut-off levels or degree of baseline depressive symptoms. Analysis of individual participant data (IPD) may help clarify this association.Methods and analysisWe will conduct a systematic review and IPD meta-analysis of prospective studies on the association between subclinical thyroid dysfunction and depressive symptoms. We will identify studies through a systematic search of the literature in the Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from inception to April 2019 and from the Thyroid Studies Collaboration. We will ask corresponding authors of studies that meet our inclusion criteria to collaborate by providing IPD. Our primary outcome will be depressive symptoms at the first available individual follow-up, measured on a validated scale. We will convert all the scores to the Beck Depression Inventory scale. For each cohort, we will estimate the mean difference of depressive symptoms between participants with subclinical hypothyroidism or hyperthyroidism and control adjusted for depressive symptoms at baseline. Furthermore, we will adjust our multivariable linear regression analyses for age, sex, education and income. We will pool the effect estimates of all studies in a random-effects meta-analysis. Heterogeneity will be assessed by I2. Our secondary outcomes will be depressive symptoms at a specific follow-up time, at the last available individual follow-up and incidence of depression at the first, last and at a specific follow-up time. For the binary outcome of incident depression, we will use a logistic regression model.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. Our findings will have considerable implications for patient care. We will seek to publish this systematic review and IPD meta-analysis in a high-impact clinical journal.PROSPERO registration numberCRD42018091627.

Racial/Ethnic Disparities of Depressive Symptoms in the United States A Systematic Review and Meta-Analysis of Individual Participant Data

2022 ◽  
Author(s):  
José M. Causadias ◽  
Kevin Michael Korous ◽  
Karina M Cahill ◽  
Eiko I Fried ◽  
Longfeng Li
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Meta Analysis ◽  
Ethnic Disparities ◽  
The United States ◽  
Individual Participant Data ◽  
Individual Participant ◽  
Nationally Representative ◽  
Minority Participants ◽  
Racial Ethnic

Although a growing body of research has documented racial/ethnic disparities in depressive symptoms in the United States, the precise magnitude of these differences is not known. We conducted a systematic review and meta-analysis of individual participant data to (1) estimate the average difference of depressive symptoms between Whites and racial/ethnic minorities, as well as differences between (i.e., Asian American, African American, Latinxs, Multiracial, Native American, other race) and within (i.e., Latinx: Central American, Cuban American, Mexican American, Puerto Rican, other Latinx) minority groups, and (2) determine if moderators account for these differences. We screened 2,425 nationally-representative studies from the Inter-university Consortium for Political and Social Research (ICPSR), and identified 127 datasets of studies conducted from 1971 to 2018. We included 73 datasets from 26 nationally-representative studies (N = 2,116,853). The average absolute difference was d = 0.09, 95% CI [0.07, 0.12] between White and minority participants; was d = 0.07, 95% CI [0.06, 0.09] between minority participants; and d = 0.10, 95% CI [0.06, 0.15] within minority Latinx participants. Increases in socioeconomic status exacerbated these disparities. Psychometric analyses showed that measure reliability was related to larger differences. We discuss the implications of these findings.

scholarly journals The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: study protocol of a systematic review and meta-analysis of individual participant data

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Ellen Driessen ◽  
Zachary D. Cohen ◽  
Myrna M. Weissman ◽  
John C. Markowitz ◽  
Erica S. Weitz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Acute Phase ◽  
Meta Analysis ◽  
Antidepressant Medication ◽  
Depression Treatment ◽  
Individual Participant Data ◽  
Individual Participant ◽  
Meta Analyses

Background Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, ‘conventional’ meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. Aims We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). Method We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. Conclusions This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.

Thyroid Dysfunction States and Incident Cardiovascular Events: The Tehran Thyroid Study

2017 ◽  
Vol 50 (01) ◽  
pp. 37-43 ◽  
Author(s):  
Maryam Tohidi ◽  
Arash Derakhshan ◽  
Samaneh Akbarpour ◽  
Atieh Amouzegar ◽  
Ladan Mehran ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Middle Eastern ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Subclinical Hyperthyroidism ◽  
Significant Difference ◽  
Middle Eastern Population

AbstractThe objective of the study was to investigate the relation of different thyroid function states with the incidence of cardiovascular disease (CVD)/coronary heart disease (CHD) among a Middle-Eastern population with a high incidence of CVD/CHD. A total of 3975 participants entered the study (43.6% men). According to their thyroid stimulating hormone (TSH) and free thyroxin (FT4) levels, the participants were categorized into 5 groups: euthyroid, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Multivariable Cox proportional hazard models were used to assess the relation of different thyroid function states with incident CVD/CHD, with euthyroid state as reference. The mean age (SD) of the participants was 46.5 (12.0) years. At baseline, no significant difference was observed in the frequency of prevalent CVD cases (n=201) between all groups. No significant interaction was found between prevalent CVD and different thyroid function states with outcomes, hence, we did not exclude participants with prevalent CVD from data analysis. A total of 400 CVD events (358 CHD cases) during a median follow-up of 11.2 years (inter-quartile range: 1.96) occurred. During the follow-up, even in the age and sex adjusted model, no association was observed between different states of thyroid dysfunction and incidence of CVD/CHD. The multivariable hazard ratios (95% CI) of subclinical hypothyroidism, hypothyroidism, subclinical hyperthyroidism, and hyperthyroidism for CVD events were 1.21 (0.77–1.88), 0.76 (0.33–1.69), 0.81 (0.46–1.41) and 1.48 (0.70–3.16), respectively. Both at baseline and during follow-up, no relation was observed between different states of thyroid function with prevalence and incidence of CVD/CHD.

scholarly journals Subclinical thyroid dysfunction and incident atrial fibrillation - a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Singh ◽  
MZ Shahid ◽  
SL Harrison ◽  
DA Lane ◽  
GYH Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Subgroup Analysis ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Subclinical Hyperthyroidism ◽  
Quality Of Evidence

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This project was supported by the MRes programme in the Institute of Life Course and Medical Sciences at The University of Liverpool. Thyroid hormones can act directly and indirectly on the cardiovascular system and studies have demonstrated associations between overt and subclinical thyroid dysfunction and adverse cardiovascular outcomes including heart failure, myocardial infarction, and coronary heart disease. The aim of this study was to assess the association between subclinical thyroid dysfunction and atrial fibrillation (AF).  The protocol was registered on PROSPERO (CRD42020221565). MEDLINE and Scopus were searched from inception to 13th November 2020 for studies investigating subclinical thyroid dysfunction and incident AF. Risk of bias was assessed using the Risk of Bias Assessment Tool (RoBANS). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. Subgroup analysis was performed for post-operative and non-post-operative AF. 5413 records were identified. Nine cohort studies were suitable for inclusion in the systematic review, of which seven studies were included in the meta-analysis. The meta-analysis comprised 595,058 patients. Subclinical hyperthyroidism was associated with a 99% increase in the risk of incident AF (Risk ratio (RR): 1.99; 95% confidence intervals (CI); 1.43 to 2.77; p < 0.0001; I² = 67%). Subclinical hypothyroidism was also associated with a greater risk of AF (RR: 1.24; 95% CI; 1.05 to 1.47; p = 0.01; I² = 65%). Subgroup analysis demonstrated a 76% increase in the risk of post-operative AF in patients with subclinical hypothyroidism compared to euthyroid post-operative patients (RR: 1.76; 95% CI; 1.36 to 2.28; p < 0.0001; I² = 0%). Six studies were rated as low risk of bias and three as medium risk of bias according to the RoBANS tool. The quality of evidence for AF in subclinical hyper- and hypothyroid patients was low. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with a higher risk of incident AF and post-operative AF, respectively. The quality of the current evidence is low and ideally a randomised controlled trial should be conducted to confirm these associations and assess impacts of treatments. Abstract Figure.

Protocol for a Systematic Review and Meta-Analysis of Individual Participant Data on the Magnitude of Racial Disparities of Depressive Symptoms in the United States

2018 ◽  
Author(s):  
José M. Causadias ◽  
Kevin Michael Korous ◽  
Karina M Cahill ◽  
Eiko I Fried ◽  
Longfeng Li
Keyword(s):  
United States ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Racial Disparities ◽  
Sex Education ◽  
Mexican Americans ◽  
Meta Analysis ◽  
The United States ◽  
Individual Participant Data ◽  
Individual Participant

A growing body of research has documented racial disparities in depressive symptoms in the United States, although the precise magnitude on these differences is less well understood. This issue has important implications for informing public health policy, and developing and administering prevention and intervention strategies. In this protocol, we propose a systematic review and meta-analysis of individual participant data from nationally representative studies from the United States drawn from Inter-university Consortium for Political and Social Research (ICPSR). Our three aims are to: 1) Estimate the overall average difference of depressive symptoms between Whites and minorities, as well as between- (e.g., African-Americans, Latinos) and within- (e.g., Latinos: Mexican-Americans, Cuban-Americans) minority groups; 2) Determine if age, sex, education, income, occupation, socioeconomic status, and other variables account for these differences; 3) Test the cultural differences and similarities hypotheses. We argue that these health disparities are the result of social inequalities.

scholarly journals The Relation Between Thyroid Function and Anemia: A Pooled Analysis of Individual Participant Data

2018 ◽  
Vol 103 (10) ◽  
pp. 3658-3667 ◽  
Author(s):  
Daisy M Wopereis ◽  
Robert S Du Puy ◽  
Diana van Heemst ◽  
John P Walsh ◽  
Alexandra Bremner ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Sensitivity Analyses ◽  
Overt Hypothyroidism ◽  
Individual Participant Data ◽  
Subclinical Hyperthyroidism ◽  
Thyroid Status ◽  
Increased Risk ◽  
Individual Participant ◽  
Overt Hyperthyroidism

Abstract Context Anemia and thyroid dysfunction often co-occur, and both increase with age. Human data on relationships between thyroid disease and anemia are scarce. Objective To investigate the cross-sectional and longitudinal associations between clinical thyroid status and anemia. Design Individual participant data meta-analysis. Setting Sixteen cohorts participating in the Thyroid Studies Collaboration (n = 42,162). Main Outcome Measures Primary outcome measure was anemia (hemoglobin <130 g/L in men and <120 g/L in women). Results Cross-sectionally, participants with abnormal thyroid status had an increased risk of having anemia compared with euthyroid participants [overt hypothyroidism, pooled OR 1.84 (95% CI 1.35 to 2.50), subclinical hypothyroidism 1.21 (1.02 to 1.43), subclinical hyperthyroidism 1.27 (1.03 to 1.57), and overt hyperthyroidism 1.69 (1.00 to 2.87)]. Hemoglobin levels were lower in all groups compared with participants with euthyroidism. In the longitudinal analyses (n = 25,466 from 14 cohorts), the pooled hazard ratio for the risk of development of anemia was 1.38 (95% CI 0.86 to 2.20) for overt hypothyroidism, 1.18 (1.00 to 1.38) for subclinical hypothyroidism, 1.15 (0.94 to 1.42) for subclinical hyperthyroidism, and 1.47 (0.91 to 2.38) for overt hyperthyroidism. Sensitivity analyses excluding thyroid medication or high levels of C-reactive protein yielded similar results. No differences in mean annual change in hemoglobin levels were observed between the thyroid hormone status groups. Conclusion Higher odds of having anemia were observed in participants with both hypothyroid function and hyperthyroid function. In addition, reduced thyroid function at baseline showed a trend of increased risk of developing anemia during follow-up. It remains to be assessed in a randomized controlled trial whether treatment is effective in reducing anemia.

scholarly journals Treatment of Thyroid Dysfunction and Serum Lipids: A Systematic Review and Meta-analysis

2020 ◽  
Vol 105 (12) ◽  
pp. 3683-3694
Author(s):  
Anupam Kotwal ◽  
Tiffany Cortes ◽  
Natalia Genere ◽  
Oksana Hamidi ◽  
Sina Jasim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Serum Lipids ◽  
Thyroid Dysfunction ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Subclinical Hyperthyroidism ◽  
Apo B ◽  
Lipid Parameters

Abstract Context Hyperthyroidism is associated with low levels of cholesterol and triglycerides, and hypothyroidism is associated with hypercholesterolemia and hypertriglyceridemia. Objective The aim of this systematic review was to investigate the impact of therapy for overt and subclinical hyper- and hypothyroidism on serum lipids. Data Sources We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus from 1970 through April 5, 2018. Study Selection Pairs of independent reviewers selected randomized and observational studies evaluating lipid parameters in patients undergoing treatment for hyper- or hypothyroidism. Data Extraction Pairs of independent reviewers extracted data and appraised studies. Data Synthesis Treatment of overt hyperthyroidism showed a significant increase in total cholesterol (TC) by 44.50 mg/dL (95% confidence interval [CI]: 37.99, 51.02), low-density lipoprotein cholesterol (LDL-C) by 31.13 mg/dL (95% CI: 24.33, 37.93), high-density lipoprotein cholesterol (HDL-C) by 5.52 mg/dL (95% CI: 1.48, 9.56), apolipoprotein A (Apo A) by 15.6 mg/dL (95% CI: 10.38, 20.81), apolipoprotein B (apo B) by 26.12 mg/dL (95% CI: 22.67, 29.57), and lipoprotein (Lp[a]) by 4.18 mg/dL (95% CI: 1.65, 6.71). There was no significant change in triglyceride (TG) levels. Treatment of subclinical hyperthyroidism did not change any lipid parameters significantly. Levothyroxine therapy in overt hypothyroidism showed a statistically significant decrease in TC by -58.4 mg/dL (95% CI: -64.70, -52.09), LDL-C by -41.11 mg/dL (95% CI: -46.53, -35.69), HDL-C by -4.14 mg/dL (95% CI: -5.67, -2.61), TGs by -7.25 mg/dL (95% CI: -36.63, 17.87), apo A by -12.59 mg/dL (95% CI: -17.98, -7.19), apo B by -33.96 mg/dL (95% CI: 41.14, -26.77), and Lp(a) by -5.6 mg/dL (95% CI: -9.06, -2.14). Levothyroxine therapy in subclinical hypothyroidism showed similar changes but with a smaller magnitude. The studies contained varied population characteristics, severity of thyroid dysfunction, and follow-up duration. Conclusions Treatment of overt but not subclinical hyperthyroidism is associated with worsening of the lipid profile. Levothyroxine therapy in both overt and subclinical hypothyroidism leads to improvement in the lipid profile, with a smaller magnitude of improvement in subclinical hypothyroidism.

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