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Review

Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis

1
Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
2
Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN 55902, USA
3
Department of Medicine, MetroWest Medical Center, Tufts Medical School, Framingham, MA 01702, USA
4
Mayo Clinic Libraries, Mayo Clinic, Rochester, MN 55902, USA
5
Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
6
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
7
Central Arkansas Veterans Healthcare System, Medicine Service, Little Rock, AR 72205, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Manfredi Rizzo
Received: 27 June 2021 / Revised: 9 July 2021 / Accepted: 13 July 2021 / Published: 15 July 2021
Thyroid disease is a very common condition that influences the entire human body, including cognitive function and mental health. As a result, thyroid disease has been associated with multiple neuropsychiatric conditions. However, the relationship between thyroid dysfunction and suicide is still controversial. We conducted a systematic review and meta-analysis to describe the association of thyroid function with suicidal behavior in adults. We searched four data bases (MEDLINE, EMBASE, PsycINFO, and Scopus) from their inception to 20 July 2018. Studies that reported mean values and standard deviation (SD) of thyroid hormone levels [Thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), and total triiodothyronine (TT3)] in patients with suicidal behavior compared with controls were included in this meta-analysis. The abstracts and papers retrieved with our search strategies were reviewed independently and in duplicate by four reviewers for assessment of inclusion criteria and data extraction, as well as for evaluation of risk of bias. Random-effects models were used in this meta-analysis to establish the mean difference on thyroid function tests between groups. Overall, 2278 articles were identified, and 13 studies met the inclusion criteria. These studies involved 2807 participants, including 826 participants identified with suicidal behavior. We found that patients with suicide behavior had lower levels of FT3 (−0.20 pg/mL; p = 0.02) and TT4 (−0.23 µg/dL; p = 0.045) compared to controls. We found no differences in either TSH, FT4, or TT3 levels among groups. With our search strategy, we did not identify studies with a comparison of overt/subclinical thyroid disease prevalence between patients with and without suicide behavior. The studies included in this meta-analysis had a low-to-moderate risk of bias. In the available literature, the evidence regarding the association of thyroid disorders and suicidal behavior is limited. We found that patients with suicidal behavior have significantly lower mean FT3 and TT4 levels when compared to patients without suicidal behavior. The clinical implications and pathophysiologic mechanisms of these differences remain unknown and further research is needed. View Full-Text
Keywords: suicide; thyroid function; hypothyroidism; hyperthyroidism suicide; thyroid function; hypothyroidism; hyperthyroidism
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MDPI and ACS Style

Toloza, F.J.K.; Mao, Y.; Menon, L.; George, G.; Borikar, M.; Thumma, S.; Motahari, H.; Erwin, P.; Owen, R.; Maraka, S. Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis. Medicina 2021, 57, 714. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070714

AMA Style

Toloza FJK, Mao Y, Menon L, George G, Borikar M, Thumma S, Motahari H, Erwin P, Owen R, Maraka S. Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis. Medicina. 2021; 57(7):714. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070714

Chicago/Turabian Style

Toloza, Freddy J.K., Yuanjie Mao, Lakshmi Menon, Gemy George, Madhura Borikar, Soumya Thumma, Hooman Motahari, Patricia Erwin, Richard Owen, and Spyridoula Maraka. 2021. "Association of Thyroid Function with Suicidal Behavior: A Systematic Review and Meta-Analysis" Medicina 57, no. 7: 714. https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57070714

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