Association between depression and anxiety disorders with euthyroid Hashimoto's thyroiditis: A systematic review and meta-analysis

Background: Hashimoto's thyroiditis (HT) affects up to 10 % of the population and is a common cause of hypothyroidism, which can lead to depression and anxiety. However, it remains unclear whether HT directly causes these conditions or if they arise due to HT-induced hypothyroidism. The present review aims to offer meta-analytic insights into the relationship between depression and anxiety in patients with euthyroid HT.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, SinoMed, and VIP from their inception through May 2024. Case-control or cross-sectional studies examining the association between euthyroid HT and either depression, anxiety disorders, or both were included.

Results: For depression, 1365 patients (694 HT vs. 671 controls) from 11 articles were analyzed; for anxiety, 1009 patients (516 HT vs. 493 controls) from 8 articles were included. HT patients had 2.5 times higher odds of anxiety disorders (OR = 2.52, 95 % CI: 1.66-3.82). The Beck Depression Inventory showed a WMD of 4.26 (95 % CI: 1.28-7.24) and the Beck Anxiety Inventory a WMD of 5.10 (95 % CI: 1.55-8.66).

Limitation: The findings should be interpreted cautiously due to heterogeneity, potential publication bias, and variability in assessment tools, which may limit generalizability.

Conclusions: Euthyroid HT patients exhibit a higher prevalence of anxiety disorders compared to healthy control groups, and more susceptible to anxiety and depression symptoms based on the Beck Inventory. Thyroid antibodies themselves are also associated with depression and anxiety disorder.