Plain language summary
Post-stroke depression (PSD) frequently occurs in stroke sufferers. Its occurrence slows recovery and increases the chance of death, therefore, early detection is key. Hormones produced in the thyroid gland have a controversial relationship with the occurrence of PSD and better clarity could aid diagnosis and prevention. This systematic review and meta-analysis of 13 observational studies aimed to determine the correlation between thyroid hormone levels, acute stroke, and PSD. The results showed that compared to people without PSD, those with it had lower levels of the thyroid hormone, TSH. Further analysis showed that this was especially apparent in people who had an ischaemic stroke but not in those with other stroke types. PSD was also especially prevalent in people from China. Levels of one thyroid hormone known as FT3 were also lower in individuals with PSD, but FT4 levels were higher. It was concluded that individuals with lower TSH and FT3, but higher FT4 directly following a stroke may be more susceptible to PSD. This study could be used by healthcare professionals to understand that thyroid hormone levels could be used to indicate individuals who may be susceptible to the development of PSD. However, more research is needed to understand the relationship.
Abstract
BACKGROUND Thyroid hormones have been indicated to be associated with depression, but their relationship with poststroke depression (PSD) remains controversial. Therefore, we performed a meta-analysis to explore the correlation between thyroid hormone levels in acute stroke and PSD. METHODS We searched databases for eligible studies. Standard mean differences (SMD) and 95% confidence intervals (CI) were applied to evaluate the association among levels of thyroid hormones, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), in acute stroke patients and the risk of PSD. RESULTS A total of 13 studies were included in the analysis. Compared to non-PSD patients, PSD patients had remarkably lower serum TSH and FT3 levels (TSH: SMD = -0.59, 95%CI = -1.04 to -.15, p = .009; FT3: SMD = -0.40, 95%CI = -.51 to -.30, p = .000) and higher serum FT4 levels (SMD = 0.33, 95%CI = .07-.59, p = .013). Subgroup analysis showed that there may be a more statistically significant association between FT3 and the risk of PSD compared to TSH and FT4. CONCLUSIONS Our results suggested that patients with lower serum TSH and FT3 levels as well as higher serum FT4 levels in the acute stage of stroke may be more susceptible to PSD.
Methodological quality
Jadad score
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Allocation concealment
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