Thyroid Function Screening in Children and Adolescents With Mood and Anxiety Disorders

Objective: To determine the prevalence of abnormal thyroid-stimulating hormone (TSH) measures in youth with severe mood and anxiety disorders and to examine clinical and demographic predictors of abnormal TSH measures. Methods: We retrospectively examined screening TSH concentrations in psychiatrically hospitalized children and adolescents (3-19 years) with mood/anxiety disorders (DSM-IV and DSM-5 criteria) at a large, urban, pediatric hospital between September 2013 and April 2017. Symptoms were extracted from the medical record using adaptive natural language processing algorithms, and the utility of demographic, clinical, and treatment variables as predictors of abnormal TSH measures was evaluated using logistic regression. Results: In this sample (N = 1,017, mean +/- SD age = 14.7 +/- 2.24 years), 62 patients had a TSH concentration > 3.74 mu IU/mL (5.3% [n = 6] of patients < 12 years of age and 6.2% [n = 56] of patients >= 12 years of age), and 7 patients had a TSH concentration < 0.36 mu IU/mL. Elevated TSH concentrations were associated with a recent weight gain (odds ratio [OR] = 3.60; 95% CI, 1.13-9.61; P=.017), a history of thyroid disease (OR = 6.88; 95% CI, 2.37-10.7; P=.0001), abnormal menstrual bleeding/menometrorrhagia (OR = 2.03; CI, 1.04-3.63; P=.024), and benzodiazepine treatment (OR = 2.29; 95% CI, 1.07-4.52; P=.02). No association was observed for sex, age, or body mass index z score. Among patients with elevated TSH measures, 12.9% (n = 8, mean +/- SD age = 16.5 +/- 1.5 years, 87.5% female) had an abnormal free/total thyroxine (T-4) level or other biochemical findings consistent with thyroid disease. Patients with thyroid disease (compared to those patients with elevated TSH and normal active thyroid hormone concentrations) were older (16.5 +/- 1.5 vs 14.6 +/- 2.3 years, P=.020) but did not differ in sex distribution (87.5% vs 63.6% female, P=.444). Conclusions: TSH concentrations are abnormal in approximately 6% of psychiatrically hospitalized youth, although thyroid disease was present in <1% of the total sample. Targeted screening should focus on patients with recent weight gain, those treated with benzodiazepines, and girls with a history of abnormal uterine bleeding/menometrorrhagia.