Elsevier

Psychoneuroendocrinology

Volume 31, Issue 1, January 2006, Pages 131-136
Psychoneuroendocrinology

Disorders of eating behavior: Correlation between hypothalamo-pituitary–thyroid function and psychopathological aspects

https://doi.org/10.1016/j.psyneuen.2005.06.003Get rights and content

Summary

Altered pituitary–thyroid (PT) function (TSH, FT4, FT3 plasma levels) was correlated with symptoms of Eating Disorders (ED) in 137 patients (65 ANR, 12 ANP, 19 ANBP, 26 BN, 8 EDNOS-AN, 7 EDNOS-BN) and 30 controls. PT hormone concentrations were assessed by immunofluorimetry and psychopathology by EDI-2 and HSCL-90. Values of TSH were decreased in ANP, BN, EDNOS-AN, of T4 in ANR, ANP, AN-BP, of T3 in ANR, ANP, ANBP, BN, EDNOS-AN, EDNOS-BN. TSH values correlated negatively with ineffectiveness in BN and EDNOS-AN, and with depression in EDNOS-AN. FT4 values correlated positively with perfectionism in ANR, ANP and ANBP, with interoceptive awareness in EDNOS-AN, and negatively with depression in EDNOS-AN and with body dissatisfaction in EDNOS-BN. FT3 values correlated positively with perfectionism in ANBP and BN, with ineffectiveness in ANR and ANP, with depression in EDNOS-AN, with hostility in ANR and EDNOS-BN, with interpersonal sensibility in ANP, with somatization in EDNOS-BN, and negatively with interpersonal distrust in EDNOS-AN. Prospective studies are needed to confirm whether or not altered PT parameters correlate with ED symptoms during the course of the diseases.

Introduction

Altered hypothalamo-pituitary–thyroid (HPT) function has been observed in Eating Disorders (ED). Decreased circulating concentrations of triiodothyronine (T3), free-triiodothyronine (FT3), with increased levels of biologically inactive reverse T3, and thyroxine-stimulating hormone (TSH) have been reported in Anorexia Nervosa (AN), while in Bulimia Nervosa (BN) lower than normal FT3, thyroxine (T4) and free-thyroxine (FT4) concentrations have been occasionally observed (Miyai et al., 1975, Travaglini et al., 1976, Wakeling et al., 1979, Pirke et al., 1985, Casper, 1986, Kiyohara et al., 1988, Kaplan et al., 1989, Spalter et al., 1993, Altemus et al., 1996, Gendall et al., 2003). Central modulation of TSH secretion is deranged in both AN and BN, as shown by lower than normal or even blunted and time-delayed TSH responses to exogenous administration of thyrotropin-releasing hormone (TRH) (Vigersky and Loriaux, 1977, Macaron et al., 1978, Wakeling et al., 1979, Casper and Frohman, 1982, Mitchell and Bantle, 1983, Gwirtsman et al., 1983, Norris et al., 1985, Kiriike et al., 1987, Fichter et al., 1990, Baranowska et al., 1999). Impaired HPT function has been tentatively connected with low hypothalamic secretion of TRH, as demonstrated by the low cerebrospinal fluid (CSF) concentrations of the hormone (Lesem et al., 1994). These alterations have been considered a consequence of starvation, in particular of carbohydrate deficiency, and of the decreased resting energy expenditure in AN and of malnutrition in BN, since they appear also in non-anorexic malnourished individuals and even in normal subjects after a few days of starvation without a really significant weight loss, and disappear after normalization of eating habits (Spaulding et al., 1976, Leslie et al., 1978, Wakeling et al., 1979, Moshang and Utiger, 1977, Vagenukis, 1977, Fichter and Pirke, 1984).

Impairments of HPT function are known to profoundly alter the developing and the mature brain, influencing cognition and emotions, in particular depression and anxiety, via a stimulatory effect on neuronal growth and differentiation, a modulation of neurotransmitter functions (mainly serotonine (5-HT), noradrenaline (NE), dopamine (DA), acethylcholine (Ach)), and on the pre–postsynaptic receptor sensitivity (Plotnikoff et al., 1975, Funatsu et al., 1985, Molchan et al., 1990, Molchan et al., 1991, Kasparov et al., 1994, Hauser, 1994, Larsen et al., 1998, Bauer et al., 2003, Strawn et al., 2004, Van Boxtel et al., 2004, Larisch et al., 2004). Despite the well-established relationship between HPT secretion and neurotransmitter functions, so far no data have been obtained in ED regarding the specific effects that impaired HPT can exert on the brain biochemistry of anorexic and bulimic patients, and, subsequently, on the development, course, prognosis of the disorders, and on the appearance and persistence of specific psychopathological symptoms in these patients.

In a preliminary, transversal study of a mixed group of ED patients, we measured pituitary–thyroid (PT) hormones plasma concentrations and in parallel we investigated the psychopathological aspects of the patients, to determine whether or not significant relationships could be observed between biological and psychological impairments. With our study we wanted to see whether or not the putative PT dysfunctions observed in AN and BN, and occasionally in Non Otherwise Specified Eating Disorders anorexic and bulimic type patients (EDNOS-AN and BN) could possibly be connected with the pathogenesis of specific symptoms of the disorders. In particular, we wanted to see whether or not PT dysfunctions could modulate depression, anxiety or some of the mood-related psychopathological aspects of ED, as demonstrated by Bauer et al. (2003) and Larisch et al. (2004) in endocrine and mental disorders. If so, then, PT dysfunction may need to be corrected as fast as possible, possibly through nutritional rehabilitation or other appropriate treatments, to separate the hormonal from the non-hormonal linked psychopathology and to direct treatments toward the correction of non-hormonal-dependent psychological impairments.

Section snippets

Subjects

Hundred and thirty-seven female patients with ED entered the study. They were 96 anorexics (65 restricted anorexics (ANR), 19 bingeing-purging anorexics (ANBP), 12 purging anorexics without bingeing (ANP), 26 bulimics ((BN) including purging and non-purging but not long-lasting dieting patients), 8 subjects with EDNOS-anorectic type (EDNOS-AN), and 7 with EDNOS-bulimic type (EDNOS-BN). The subjects were recruited over a period of 2 years at the Centers for the Study and Treatment of Eating

Results

Hormonal data and their statistical significance are reported in Table 2. Differences between patients and controls for concentrations of TSH, FT4 and FT3 were observed, and were particularly frequent for FT3 values.

Results of multiple regression analyses, including the covariate BMI to exclude the effect of malnutrition on the correlations, revealed significant correlations between hormonal and psychopathological data. EDI-2 parameters revealed that perfectionism correlated positively with FT4

Discussion

Even though our data are preliminary and will need to be confirmed by further investigations, they seem to point out that the thyroid dysfunctions so often observed in ED, and occurring in our patients, may be somehow correlated with specific psychopathological aspects of the disorders. These correlations do not necessarily mean a cause–effect relationship, but rather hint that the two phenomena may to some extent depend one from the other.

Thyroid dysfunctions have always been thought to be

References (41)

  • S.E. Molchan et al.

    The TRH stimulation test in Alzheimer's disease and major depression: relationship to clinical and CSF measures

    Biol. Psychiatr.

    (1991)
  • P.D. Norris et al.

    The TRH test in bulimia and anorexia nervosa: a controlled study

    J. Psychiatr. Res.

    (1985)
  • K.M. Pirke et al.

    Metabolic and endocrine indices of starvation in bulimia: a comparison with anorexia nervosa

    Psychiatr. Res.

    (1985)
  • N.P. Plotnikoff et al.

    Thyrotropin Releasing Hormone (TRH): DOPA potentiation and biogenic amine studies

    Pharmacol. Biochem. Behav.

    (1975)
  • A.R. Spalter et al.

    Thyroid function in bulimia nervosa

    Biol. Psychiatr.

    (1993)
  • M.P. Van Boxtel et al.

    Thyroid function, depressed mood, and cognitive performance in older individuals: the Maastricht Aging study

    Psychoneuroendocrinology

    (2004)
  • DSM IV

    Diagnostic and Statistical Manual of Mental Disorders

    (1994)
  • B. Baranowska et al.

    Neuroendocrine control of appetite and hormonal secretion in Anorexia Nervosa

    J. Endocrinol. Invest.

    (1999)
  • M. Bauer et al.

    Thyroid, brain and mood modulation in affective disorder: insights from molecular research and functional brain imaging

    Pharmacopsychiatry

    (2003)
  • R.C. Casper

    The pathophysiology of anorexia nervosa and bulimia nervosa

    Annu. Rev. Nutr.

    (1986)
  • Cited by (14)

    • Associations between pituitary-thyroid hormones and depressive symptoms in individuals with anorexia nervosa before and after weight-recovery

      2022, Psychoneuroendocrinology
      Citation Excerpt :

      In line with that, all aforementioned changes in the HPT axis tend to reverse more or less rapidly during weight-restoration (Table 1(A/B); Buehren et al., 2011; Leslie et al., 1978; Onur et al., 2005; Pahl et al., 1985; Reinehr et al., 2008; Swenne et al., 2009; Tamai et al., 1986). Previous, predominantly cross-sectional studies on HPT axis hormones and psychopathology in AN have generated inconsistent and often statistically non-significant findings regarding specific HPT axis elements in relation to neuropsychiatric symptom dimensions, most importantly depressive symptoms (Table 1(A); Andrés-Perpiña et al., 2011; Brambilla et al., 2006; Laessle et al., 1988; ŚmIarowska et al., 2014). Moreover, the scientific grounds for longitudinal relationships between HPT axis elements and depressive symptoms during weight-restoration of patients with AN are hitherto sparse (Buehren et al., 2011; Pahl et al., 1985).

    • TRH in the nucleus accumbens acts downstream to α-MSH to decrease food intake in rats

      2020, Neuroscience Letters
      Citation Excerpt :

      Our results suggested that the endogenous activity of TRH in the NAc is another target of α-MSHergic neurotransmission, adding evidence to the previously observed pharmacological effect of TRH on NAc regulation of feeding [7]. This is relevant because TRH may be involved in the pathophysiology of eating disorders due to the impairments in TRH-regulatory functions displayed by anorexic and bulimic patients [35,36]. The administration of α-MSH in the NAc decreased the expression of MC4R.

    • Do thyroid hormones mediate the effects of starvation on mood in adolescent girls with eating disorders?

      2010, Psychoneuroendocrinology
      Citation Excerpt :

      T3 was not independently related to depressed mood but correction of the model for T3 strengthened the relationship between T4 and depression. This is suggestive of that preformed, circulating T3 has a minor role for thyroid hormone status in the central nervous system and may explain why in a previous report a relationship between T3 and mood could be demonstrated (Brambilla et al., 2006). It is in this context noteworthy that in patients on replacement therapy with thyroxine psychological well-being is related to circulating fT4 but not to fT3 (Saravanan et al., 2006).

    View all citing articles on Scopus
    View full text