Table 1 Characteristics of the included population
From: Thyroid hormone levels in patients with bipolar disorder: a systematic review and meta-analysis
Study | Location | Design type | Diagnostic criteria for BD | State | Number (Male/Female) | Average age(years) | Education(years) | Outcome indicators | THs measurement method | Thyroid function in BD | Treatments in BD | Rating scale (Mean ± SD) | Reference range of TH |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Zhang et al. 2024 [25] | China | Longitudinal prospective cohort | ICD-10 | BD-D | 2627 (126/136) | 37.18 ± 14.04 | NA | TSH, T4, T3, FT4, FT3 | Electrochemiluminescence | Those who had a history or current thyroid disease were excluded | Excluded of who received treatment for thyroid disease | MADRS (28.90 ± 11.92) | TSH: 0.27–4.2mu/L T4: 62–164 nmol/L T3: 1.3–3.1 nmol/L FT4: 12–22 pmol/L FT3: 3.60–7.50 pmol/L |
BD-M | 238 (120/118) | 36.70 ± 12.78 | YMRS (29.15 ± 14.02) | ||||||||||
HC | 119 (61/58) | 38.48 ± 9.37 | NA | ||||||||||
Song et al. 2023 [18] | China | Cross-sectional | ICD-10 | BD-D | 60 (0/60) | 29.9 ± 12.8 | NA | TSH, T4, T3, FT4, FT3 | Electrochemiluminescence | Exclusion of endocrine diseases | Not receiving lithium carbonate or quetiapine significantly affects the level of thyroid function before admission | HAMD (28.0 ± 4.9) | NA |
BD-M | 60 (0/60) | 31.3 ± 9.4 | YMRS (21.0 ± 3.2) | ||||||||||
HC | 60 (0/60) | 30.2 ± 6.4 | NA | ||||||||||
Chen et al. 2022 [40] | China | Cross-sectional | DSM-V | BD-D | 59 (23/26) | 23.81 ± 5.87 | 14.04 ± 2.44 | TSH, T4, T3, FT4, FT3 | Chemiluminescence | No description of thyroid function | All patients were either medication naïve or were not medicated for at least six months | HDRS (27.05 ± 5.87) | TSH: 0.49–4.91mIU/L T4: 69.97–152.52 nmol/L T3: 1.01–2.48 nmol/L FT4: 7.64–16.03 pmol/L FT3: 3.09–7.42 pmol/L |
HC | 52 (27/25) | 24.62 ± 5.55 | 15.58 ± 2.53 | HDRS (1.80 ± 2.34) | |||||||||
Zhao et al. 2021 [19] | China | Cross-sectional | ICD-10 | BD-D | 128 (53/75) | 26.91 ± 7.04 | NA | TSH, T4, T3, FT4, FT3 | TSH was detected by the electrochemical luminescence double antibody sandwich method, and T3, FT3, T4, and FT4 were determined by electrochemical luminescence | Exclusion of those who have a history of thyroid disease | Drug-naïve before hospitalization | MADRS (25.74 ± 11.79) | TSH: 0.27–4.20mIU/L T4: 62.00–164.00 nmol/L T3: 1.30–3.10 nmol/L FT4: 12.00–22.00 pmol/L FT3: 3.60–7.50 pmol/L |
BD-M | 136 (71/65) | 27.81 ± 8.62 | YMRS (28.57 ± 12.00) | ||||||||||
Lai et al. 2021 [12] | China | Cross-sectional | DSM-IV | BD-D | 69 (32/37) | 26.23 ± 8.98 | 13.62 ± 2.65 | TSH, T4, T3, FT4, FT3 | Direct chemiluminescence method | Excluded any physical illness demonstrated by personal history or clinical or laboratory examinations | Excluded a history of the use of any psychotropic medication, psychotherapy, or electroconvulsive therapy | HDRS (26.72 ± 5.76) | TSH: 0.49–4.91mIU/L T4: 69.97–152.52 μg/dl T3: 1.01–2.48 ng/ml FT4: 7.64–16.03 ng/dl FT3: 3.09–7.42 pg/ml |
HC | 53 (29/24) | 36.23 ± 13.95 | 14.49 ± 3.12 | HDRS (2.49 ± 2.05) | |||||||||
Han et al. 2021 [28] | China | Case–control | ICD-10 | BD-M | 70 (35/35) | 24.3 ± 5.1 | N/A | TSH, T4, T3, FT4, FT3 | Electrochemiluminescence immunoassay | Excluded history of thyroid diseases | Excluded (1) taking levothyroxine, antithyroid, glucocorticoid, estrogen, progestin, oral contraceptive, bromocriptine, or other medicine related to pituitary diseases in the past six months; (2) history of antipsychotic medications; (3) taking antipsychotic or mood stabilizer within two weeks | YMRS (28.2 ± 3.4) | TSH: 0.27–4.20mIU/L T4: 66–181 nmol/L T3: 1.3–3.1 nmol/L FT4: 12–22 pmol/L FT3: 2.8–7.1 pmol/L |
HC | 70 (35/35) | 24.7 ± 4.3 | NA | ||||||||||
Goyal et al. 2021 [29] | India | Cross-sectional | ICD-10 | BD-M | 40 (25/15) | 24.88 ± 6.10 | NA | TSH, FT4, FT3 | NA | Exclusion known case of thyroid disorder. Among a total of 40 patients of mania, 7.5% were found to be of hyperthyroidism while 5% had subclinical hyperthyroidism. In contrast, normal controls showed 5% and 10% prevalence of hypothyroidism and subclinical hypothyroidism, respectively | Excluded any past history of psychiatric illness and treatment; any history of taking psychotropic drug for other reasons | YMRS (35.85 ± 7.15) | TSH: 0.35–5.5 uIU/ml FT4: 0.89–1.76 ng/dl FT3: 2.3–4.2 pg/ml |
HC | 40 (25/15) | 27.23 ± 5.59 | NA | ||||||||||
Duval et al. 2020 [30] | France | Cross-sectional | DSM-IV | BD-D | 13 (13/0) | 34.3 ± 10.8 | N/A | TSH, FT4, FT3 | Immunoassay techniques based on enhanced luminescence | Without a history of endocrinopathy. All subjects had basal TSH, FT4, and FT3 values within the normal range | Before testing, patients were medication-free for at least 2 weeks. No patient had received long-acting neuroleptics, electroconvulsive therapy, lithium salts, fluoxetine, or monoamine oxidase inhibitor antidepressants within 2 years of testing | NA | NA |
HC | 13 (13/0) | 33.2 ± 9.2 | |||||||||||
Wu et al. 2020 [37] | China | Cross-sectional | ICD-10 | BD-D | 352 (129/123) | 34.59 ± 15.57 | N/A | TSH, T4, T3, FT4, FT3 | NA | No description on thyroid function | First hospitalization. No description of history of treatment prior to hospitalization | NA | TSH: 0.27–4.20 mIU/L T4: 66-181 nmol/L T3: 1.3–3.1 nmol/L FT4: 12-22 pmol/L FT3: 3.1–6.8 pmol/L |
BD-M | 476 (217/259) | 32.70 ± 12.60 | |||||||||||
Zhong et al. 2019 [39] | China | Cross-sectional | DSM-V | BD-D | 57 | 26.74 ± 8.73 | 14.03 ± 2.83 | TSH, T4, T3, FT4, FT3 | Direct chemiluminescence method | Excluded of any history/current thyroid disease | Excluded treatment of thyroid disease, such as anti-thyroid drug therapy, and 131I treatment. At the time of blood testing, all patients either had not been administered medication or were not medicated for at least 6 months | HDRS (27.10 ± 5.69) | TSH: 0.38–4.31mIU/L T4: 4.9–11.0 µg/dl T3: 0.79–1.58 ng/ml FT4: 0.82–1.63 ng/dl FT3: 2.10–3.80 pg/ml |
HC | 20 | 28.32 ± 9.01 | 14.72 ± 2.76 | NA | |||||||||
Su et al. 2019 [27] | China | Case–control | DSM-V | BD-D | 92 (42/50) | 24.76 ± 12.75 | NA | TSH, T4, T3, FT4, FT3 | NA | No description of thyroid function | Unmedicated patients | NA | NA |
HC | 89 (25/64) | 47.34 ± 13.05 | |||||||||||
Li et al. 2019 [20] | China | Case–control | DSM-V | BD-D | 58 (31/27) | 20.7 ± 6.7 | NA | TSH, T4, T3, FT4, FT3 | NA | The thyroid profiles of all BD-mania were within the normal limits. In the BD-depression, the baseline TSH value of three patients was lower than the normal below limit, and for one patient it was higher than the normal upper limit | Drug-naïve or medication-free for at least 3 months before hospitalization | N3A | TSH: 0.38–4.34mu/L T4: 55.47–161.25 nmol/L T3: 1.02–2.96 nmol/L FT4: 10.45–24.38 pmol/L FT3: 2.77–6.31 pmol/L |
BD-M | 28 (15/13) | 29.5 ± 8.9 | |||||||||||
Khaled et al. 2018 [17] | Egypt | Cross-sectional | DSM-IV | BD-M | 30 (21/9) | 23.6 ± 6.2 | NA | TSH, T4, T3 | Chemiluminescent immunoassay | No description of thyroid function | Not receiving any psychiatric treatment | NA | NA |
HC | 15 | 24.4 ± 6.5 | |||||||||||
Jin et al. 2017 [35] | China | Cross-sectional | ICD-10 | BD-D | 71 (27/44) | 25.62 ± 11.15 | NA | TSH, T4, T3, FT4, FT3 | Chemiluminescent immunoassay | Exclusion of endocrine diseases | Not receiving electroconvulsive therapy within one year; not receiving lithium treatment within 6 months | NA | NA |
BD-M | 62 (26/36) | 26.58 ± 13.12 | |||||||||||
HC | 203 (78/125) | 25.13 ± 8.62 | |||||||||||
Su et al. 2016 [38] | China | Cross-sectional | ICD-10 | BD-D | 109 | NA | NA | TSH, T4, T3, FT4, FT3 | Enzyme-linked immunosorbent assay | Excluded severe somatic diseases and endocrine disorders affecting TH levels | No lithium taken in six months | NA | NA |
BD-M | 86 | ||||||||||||
Adam et al. 2014 [33] | Poland | Cross-sectional | ICD-10 | BD-D | 203 (57/146) | 52.8 ± 18.4 | NA | TSH | Automatic analyzer Dirui CS-400 | The overall rate of patients with BD-D who were above or below the normal range of TH levels was 12.2%, and 11.4% for BD-M patients | No information regarding patients treatment | NA | TSH: (1) 0.4–5.0 lIU/Ml (2) 0.3–3.0 lIU/mL (3) 0.4–2.5 lIU/mL |
BD-M | 61 (25/36) | 45.3 ± 19.8 | |||||||||||
Li et al. 2003 [36] | China | Cross-sectional | CCMD-3 | BD-D | 25 (11/14) | 33 ± 9 | NA | TSH, FT4, FT3 | Enzyme-linked immunosorbent assay | Exclusion of endocrine diseases | No antipsychotics or antidepressants for at least 2 weeks at enrollment | NA | NA |
HC | 30 (13/17) | 34 ± 10 | |||||||||||
Sokolov et al. 1994 [26] | Canada | Case–control | DSM-III | BD-M | 13 (6/7) | 17.3 ± 1.2 | NA | TSH, T4, T3, FT4 | TSH-ImmunoEnzymatic Assay; T4, T3-Immunofluorescence; FT4-Radioimmunoassay | Thyroid indices within the normal laboratory reference range | Excluded those who had received any of the following medications within the month before admission: lithium carbonate, carbamazepine, valproic acid, any antidepressant, or the oral contraceptive pill; or if they had at any time received electroconvulsive therapy or thyroid hormone replacement | NA | NA |
HC | 13 (5/8) | 17.3 ± 1.6 | |||||||||||
Souetre et al. 1988 [31] | France | Cross-sectional | DSM-III | BD-D | 8 (2/6) | 52.8 ± 7.4 | NA | TSH | Radioimmunoassay | No description of thyroid function | The investigations took place after an initial 2-week period of drug withdrawal for the patients | HDRS (24.4 ± 3.8) | NA |
HC | 8 | N/A | HDRS (9.6 ± 4.9) | ||||||||||
Souetre et al. 1986 [32] | France | Cross-sectional | DSM-III | BD-D | 8 | 53.3 ± 4.49 | NA | TSH | Radioimmunoassay | Euthyroid status | The investigations took place after an initial 2-week period of drug withdrawal (no patient was previously under Lithium therapy) | HDRS (22.89 ± 4.7) | NA |
HC | 13 (8/5) | 48.85 ± 6.91 | HDRS (5.7 ± 2.3) | ||||||||||
Linnoila et al. 1982 [34] | America | Cross-sectional | RDC-III | BD-D | 9 (0/9) | 38.3 ± 17.6 | NA | T4, T3 | Radioimmunoassay | Serum T4 and T3 concentrations were within the normal range of the National Institutes of Health Clinical Chemistry Laboratory | All patients had been free of treatment with lithium for a minimum of 8 weeks, and they had not received any psychotropic drugs for 2 weeks | NA | NA |
BD-M | 7 (0/7) | ||||||||||||
HC | 8 (0/8) | 37.0 + 10.4 |