Apparently subjects with higher suicide risk have lower thyroid function. Just to cheer us all up!
Annals of Thyroid Research. Austin Publishing - open access
Thyroid Axis Functioning in Patients with High Suicide Risk
Butkute-Sliuoziene K, Berentaite B and Steibliene V*Psychiatry Clinic at Lithuanian University of Health Sciences, Lithuania*Corresponding author: Steibliene V, Psychiatry Clinic, Lithuanian University of Health Sciences, Mickeviciaus str. 9, LT 43009, Kaunas, Lithuania
Received: April 09, 2018; Accepted: May 05, 2018; Published: May 18, 2018
Thyroid axis functioning in patients with high suicide risk | Request PDF. Available from: researchgate.net/publicatio... [accessed Oct 27 2018].
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Thanks for sharing. Many people with a low thyroid function are depressed, so it is not surprising that there is also a link to suicide!
I wonder, it would be very interesting to do a controlled study on how many depressed people with low thyroid hormone status would not need any 'anti-depressants', if their thyroid medication would be optimised to the correct levels??
Looking at the FT4/FT3 ratios in high risk versus controls, they were basically the same in both cases (ie FT4 and FT3 reduced proportionately). This means that the whole thyroid axis is depressed and is not activated by increasing TSH from the pituitary as would normally happen. This indicates the primary cause could be in the brain (which the pituitary inhabits) which damps TSH response to low thyroid hormone levels and TSH then cannot stimulate therefore more body T4-T3 conversion.
Obviously as thyroid function (FT4 and FT3 but not TSH) is linked to suicidal tendencies, it would be nice to know which is the chicken and which the egg. Does suicidal tendency suppress thyroid function or does thyroid function induce suicidal tendency? A study boosting FT4/3 would answer that question.
Oooops, I replied before reading your reply. It's vital, though, isn't it. We know of at least one person who ended their life after a long period of being under-medicated - and they blamed their poor treatment.
Well my depression (affecting me for decades) with suicidal ideation, vanished once I was optimised on NDT. I can’t believe it was just a coincidence. My money is on the thyroid being the egg and depression/suicidal thoughts the resulting chicken.
I just had a closer look at the study again - and I am wondering if they should have assessed the Vit D status of the participants in addition to the thyroid hormone levels. Lithuania is quite North and I would not be surprised that some if not most of the participants were low or even deficient in Vitamin D levels.
I found an article looking at depression and Vitamin D and the link between the two is quite interesting:
I will have to read the paper again - I only skipped through it. But my first reading makes me think that the researchers only considered causation in one direction i.e. being depressed and/or suicidal has a physical effect on thyroid function.
But I didn't see anything from the authors clearly suggesting that perhaps poor thyroid function increases the risk of depression and suicide - so fix the thyroid and you might fix the depression and the high suicide rates.
Or did I just not read it well enough?
The other thing I would have liked to see is a suggestion for future research that involves giving people with low thyroid function proper treatment with thyroid hormones to see if their depression and suicide risk decreases. But since they are only considering causation in the "wrong" direction, I doubt this would happen.
I also wonder how many of the patients involved were on anti-depressants, possibly even lithium (well known for trashing thyroid function).
This caught my eye :
"A Danish study in 2003 processed the data from four national longitudinal registers and 21169 persons who committed suicide in 1981-1997 and showed that suicide risk is strongly associated with mental illness, unemployment, low income, marital status, and family history of suicide; the effect of most risk factors differs signifcantly by gender"
There is a known hereditary risk in thyroid function issues. So, imagine you have a family that has a history, going back at least a couple of generations, of mental illness, unemployment, low income, and a family history of suicide, and females (the people with greatest risk for autoimmune disease) are the worst affected.
Perhaps this imaginary family has poor thyroid function that was never known about, and this increased the risk of being mentally ill, unemployed, having a low income and committing suicide.
If this imaginary family had thyroid function optimised, particularly during pregnancy, and (in children) from birth onwards, then the family might be able to escape the cycle of poverty, mental illness, depression and suicide. Yes, folks, my imagination has taken me into fantasy land. These things will never happen.
I have read before that Lithuania has the highest rate of suicide in Europe. It makes me wonder if there is something in the environment making poor thyroid function more likely than it would be in, say, Iceland.
Not at all surprising given that we are mostly undermedicated and treated by TSH so we have low T3 which leads to low mood etc and no hope of better treatment from NHS. Just treated like insane hypochondriacs. The situation is enough to make you want to jump off the nearest tall building.
As ever there will be many possibilities as to what caused what. There will be suicidal subjects who otherwise would have had normal thyroid function, and others whose reduced thyroid function is inducing such psychiatric problems. It is juts another case of treating people individually and not shovelling everyone into a grab-bag of assumptions.
Bit exposing for me but, I was undiagnosed and very suicidal before TT for cancer. It’s said there are no symptoms but I had so many. I sure had had enough .
I’m getting there now and much better physically. Thanks only to this forum and adding T3 . Sourced abroad by the way.
Suicidal thoughts resolved I need no convincing of it being the sole contributor at that time. Thanks.
Gcart, I'm also a thyroid cancer patient, and have experienced the suicidal thought that I am confident were entirely caused by low thyroid. Although mine was after the surgery when I was being treated with criminally low amounts of T3.
I can remember picking up my packets of painkillers and throwing them across the room (where I was too weak to move and reach them), because while they were on my bedside table I was just staring at them wanting to take them all.
It was an extraordinary feeling to have those thoughts, but still be able to access my 'real' thoughts and feelings at the same time, and know it wasn't the real me. I only experienced it for a few months. But I'm sure for much longer, and over the years some people have to experience it you'd get ground down.
The author is a psychiatrist. She is practically guaranteed to think that every health problem is psychiatric in origin and needs treatment with anti-depressants.
When all you have is a hammer everything starts to look like a nail.
Emile Durkheim was a French sociologist who wrote a book called Le Suicide in 1897.
I remember very little about the seminar I did on this subject aside from it being appropriate for how the students on my course felt due to impending ecams. 🤢
Gave up with the medics re both, & self-treated. I'm unsure whether hot flush murder was as much a potential issue as suicide before I was prescribed HRT!
Really great little paper. I feel like this is the kind of research and articles we'd see a lot of if the thyroid research world was free of the kind of prejudice and assumptions we have today. Just going in with an interesting question, and willing to believe thyroid function has a large effect on /relationship with lived experience.
A few thoughts:
1) I have to admit being overly interested in the thyroid panels of the controls! This is something we rarely see anywhere, a bit of description of a 'healthy' sample. Amazingly they had an average freeT3 of 5.17 (I was expecting a bit lower)! Even more amazingly with a top of the range of 5.14!
These apparently healthy people had above range freeT3, a result that would get a patient a dose reduction even with the most sympathetic doctor. The TSHs were a little higher than I'd expect, around 1.5 for both groups, and freeT4 also fairly low, just above halfway for the healthy controls, and a touch below halfway for the patients.
I was also a bit surprised by the ratio of freeT4 to freeT3. For the healthy group freeT3 is much higher in range than freeT4, so they are getting a combination of conversion and thyroid-made T3 much more favour able than us thyroid patients. They look far more like patients on NDT, or a substantial proportion of T3 for combination treatment. Absolutely nothing like patients on T4-only. I think if we saw the thyroid panel of the average person from this healthy sample (not that we know whether there is one single person with results like that) posted on the forum, we would find their results a little confusing. I do hope this isn't a systematically unusual sample, because there was so much to surprise me in it. It would be great to know these results reflect the population as a whole.
2) Why this question? I was really interested to get to the introduction to this paper and find out the reasons they'd put this question together. This is the kind of question we aren't surprised to see on the forum, a relation between thyroid function and a mental health emergency, but I hoped we'd get a lot of theoretical detail to back it up.
In fact all they do is narrow in on thyroid markers quite quickly, by saying that endocrine is the area of body regulation most specifically related to suicide, in an area where not much can be pinned down, and that the most clear markers for this are several thyroid tests. It was refreshing to see quite a simple story, not hampered by assumptions that impaired thyroid function is no big deal.
These researchers are psychiatrists, rather than thyroid specialists, so maybe that is part of the explanation. In psychiatry it seems to be well accepted that T3 in particular is a useful treatment.
3) Research design. A great thing about this paper is that they used a control group and a patient group. This was their DEFINITION of baseline thyroid function, they directly compared the patients to a sample that was assumed to have healthy thyroids. We might criticize that this sample is hardly described at all, and wasn't matched in any way to the patient sample. It's possible they were systematically different from the patients in other ways.
The great thing about this design, though, is that it's a pretty high and accurate bar for 'normal' thyroid function. The alternative to this kind of design would be using the blood test ranges or the kind of evaluation a GP would do on our own thyroid panels, giving a 'this looks fine to me' response. We see this in loads of thyroid study designs, where the study participants are grouped according to their TSH, in very wide bands, or are only considered to be suffering thyroids symptoms if their results are well out of range.
This study is much more interesting than that, because it finds something statistically significant and interesting with what would be considered a very tiny difference by those other studies. You can really see how crude they are when you compare them to the study at hand.
4) Another thing that interested me about this study question was to wonder whether huge proportions of the population are suffering from some kind of thyroid symptoms, or would benefit from thyroid hormone replacement.
There's a very clear assumption in thyroid research that if a large proportion of the population exhibit a certain symptom or blood marker, then that must be part of 'normal' life, and shouldn't be considered an illness or worthy of treatment. They rule out the idea that 10%, 20%, maybe even 40% of the population could benefit from hormone replacement with this idea.
I recently learned that over 50% of the population of the Western world wear eyeglasses or contacts, and that really got me thinking. No one would ever say to a person who isn't seeing well "Sorry, 40% of the population have worse vision than you do, so your eyes are 'normal' and don't need treatment.". We just give them the damn glasses. More and more I've started to think thyroid problems are just like vision problems. It's something that for many people doesn't work quite right. But because it's a bit harder to understand than vision, and the treatment is not something you can see, people are less willing to accept it.
Of course this study doesn't tell us whether the thyroid differences they found are a cause of the suicidality or an effect of it. And it also doesn't investigate how hormone replacement treatment would effect these patients. We could hope it might improve their mental health and life, but we don't get any evidence from this study that it would. Just adds to my overall musing on whether reduced thyroid function and the possible need for replacement, is hugely widespread.
5) Finally, I was very interested in the mention of socio-economic factors. The paper mentions that suicidality is associated with a several socio-economic factors, mental illness, unemployment, low income, marital status, family history of suicide, and all these vary by gender.
In terms of thyroid it made me wonder if all these could also be associated with low thyroid function, too. Particularly things like low income and unemployment. We know that other illnesses and stress can lower thyroid function, but this made me wonder if poverty and unemployment can, too.
I hope this is not too much rambling and that someone finds it interesting!
Great and illuminating reply. I found my depression and suicidal ideation reached its zenith on levothyroxine over two years at optimised levels (TSH 0.2-0.5 - and lower due to a bit of experimentation on my part - to no avail) but had been bad for decades, strangely punctuated by short bouts of euphoria & I did wonder if I was bipolar. A switch to NDT completely stopped the depression and suicidal thoughts (and sadly the euphoria went with levothyroxine never to return ☹️ but i can live with that) . Even as I swapped over, just a 1/4 grain caused huge psychological improvements. I have DIO2 reduced conversion T4 to T3. It is fascinating to read your comment about NDT and its affect on thyroid hormone ratios.
That euphoria is very interesting. I've had similar experiences at some times, and have also wondered if it's something like mania
Thinking about it at this monent I wonder if it could be cortisol-related. Running on cortisol must feel more exciting and euphoric than using the everyday, sensible energy generation. Just another guess to add to the pile, though.
My mind used to fill up with creative ideas until I felt like screaming at the avalanche I would also burst into tears with the intensity I felt looking at beautiful scenery - I do miss that intensity I felt so alive with it! It must have been some sort of mania. It was closely related to my menstrual cycle which of course I no longer have and points to something hormonal causing it.
After a good deal of thought, I've concluded the chicken is the brain and the egg the thyroid. The explanation is based on understanding how the thyroid reacts to failure. As the gland fails, TSH rises, T4 production declines, but T3 production by both gland and conversion in the body is maintained as well as possible. This means that the FT4/FT3 ratio becomes smaller. But in this case, the ratio remains the same though both FT4 and FT3 decline together. TSH does not change. This mimics secondary hypothyroidism produced by pituitary faliure where TSH does not respond to an otherwise normally functioning thyroid needs. So the evidence is overwhelmingly that it is the brain that is triggering the thyroid problem and not the other way round. This is NOT to say that thyroid function loss per se doesn't result in brain problems. But the link between the two can come from opposite directions.
I am not surprised either. My moods can jump from good to bad in a number of minutes and I somewhat have mine under control, so I can believe this information.
Not at all surprised as my family history is a bit iffy. My 2x great grandfather tried to murder his wife and then slashed is own throat-both survived but he was sentenced to be hanged! Later that year intent to murder was no longer to be treated as murder so he was sent to Gibraltar for 12 years, returned after 10 for good behaviour! But a couple of years later hanged himself. Apparently this was t the first attempted but hadn't succeeded before. I can't be upset or or disgusted about it as when he was tried there was a good description of his looks etc. Sadly photos weren't taken till later that year but several descriptions were Thyroid symptoms and I've often thought there but for the grace of God! His nephew also committed suicide years later though it was more common then. Drink was a big trigger it would seem and how many times have we seen posts re can't drink alcohol any more since been diagnosed.
OMG that is some history. One distant branch of mine have had several suicides - all men. That side of the family have hypothyroidism and glaucoma, and it would appear severe depression. Oddly the last one who committed suicide had the same birthday and death day as my brother who copped it of cancer. How weird is that?
Yes that could be fascinating. Unfortunately I know nothing of that branch except what my mother told me before she died. I think a cousin is working on a family tree so it would be good to know how she’s getting on with it and any interesting revelations.
I'm so not surprised . I'm just very disappointed that Medical Academia has not recognized the connections . Diogenes Thank You For Your Very Informative Posts as Always . We can Always Count On You for Very Valuable Information's .
That's an interesting thought and fits in with hanging when he got back! He returned in a census year and was apparently loving with his wife and two children who were babies when he left. I can't get me head around that other than if he turned up and said he'd been missed off but I would imagine he would have to have returned to an 'address' so may be told his wife in return to putting his name of the census he would 'disappear'. They were living in Brigg but he moved to Lincoln and wasfound hanging in his sister-in-laws pub so I was thinking all sorts of thingswhen I read that but he did have a house just up the road. Whatever the problem he was a troubled soul!
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