Thyroid testing for older men with depressive symptoms unproductive

There could be a fundamental change to how depression is investigated in older Australians if the findings of new Australian research are adopted by healthcare professionals.

The new research has shown that the current practice of carrying out a routine thyroid function test in older men presenting to their doctors with depressive symptoms has been unnecessary as a routine.

Published in the September issue of the American Journal of Geriatric Psychiatry, the study, ‘Thyroid Hormones and Depression’ periodically surveyed and medically examined 3,932 men over a 10-year period at the West Australian Centre for Health and Ageing, Perth.

According to Dr Stan Goldstein, from the Bupa Health Foundation, “This research found almost no connection between depression and a dysfunctional thyroid in older men.  This may have significant implications for the healthcare system when investigating older men for depression, including potentially improving the delays that older men may experience before they eventually get the help they need.”

“In Australia, some 110,000 blood tests for thyroid hormones are conducted each year in men over 65, and if nothing changes this number will only increase as our population ages,” Dr Goldstein said.

He went on to say that for many years it has been reasonably standard practice for doctors to routinely test a patient’s thyroid function when they present with depression, irrespective of age.”

This research shows this practice may not be warranted in older men.”

The study used biochemical markers to measure the incidence of thyroid dysfunction and the geriatric depression scale was used to screen for clinically significant depression.

Professor Osvaldo Almeida, Chair of Geriatric Psychiatry at the University of WA and Director of Research at the WA Centre for Health and Ageing said that, although the research will need to be extended to see if the same result is replicated in women before he would recommend changes to current practice, “The results of this research show there appears to be no reason to either carry out, or wait for the results of, these thyroid tests before helping older depressed men get the support they need.

“Depression is a leading cause of disability worldwide and affects between five and 15 per cent of people over 65 years of age,” Professor Almeida said. “People need to be aware that depression is not a normal part of ageing.”

The study was supported by the Bupa Health Foundation and the National Health and Medical Research Council.

About thyroid testing and depression:

• The first link between the brain and the thyroid was observed by Caleb Parry in 1786. Doctors have long thought that depressive symptoms could be alleviated by the corrective utilisation of thyroid hormones.
• Testing a patient for a thyroid problem when they present with depressive symptoms is a long standing approach for doctors and there is no evidence that the practice has dropped away in recent years.
• Under the Medical Benefits Scheme (MBS) thyroid tests can be ordered to investigate psychological problems.
• In 2010 there were nearly 1.5 million thyroid function tests paid for under Medicare. Of these 438,000 were carried out on people over 65 years, of which 111,000 were for men over 65. We cannot be certain what percentage of these tests were carried out due to the patient presenting with symptoms of depression.

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About the Bupa Health Foundation

The Bupa Health Foundation helps build a healthier Australian community through its support of important health research, health education and other healthy living programs. Established as a charitable foundation in 2005, the Bupa Health Foundation has partnered in over 60 initiatives nationally, with a combined investment of around $17 million, across its key focus areas: promoting wellness, managing chronic disease, healthy ageing, empowering people about their health; and keeping healthcare affordable. www.bupa.com.au/foundation

ⁱ Almeida, OP, Helman, A, Flicker, L, Hankey, G, Chubb, P and Yeap, BB, (2011), Thyroid hormones and depression: the health in men study, American Journal of Geriatric Psychiatry, 19:9, September 2011, available http://www.ncbi.nlm.nih.gov/pubmed/21873831
ⁱⁱ Source: Saint-Clair Bahls; Gisah Amaral de Carvalho The relation between thyroid function and depression: a review Rev. Bras. Psiquiatr. vol.26 no.1 São Paulo Mar. 2004