DISFUNÇÃO TIREOIDIANA E SAÚDE MENTAL: UMA REVISÃO SISTEMÁTICA DOS SINTOMAS PSIQUIÁTRICOS ASSOCIADOS À HIPO E HIPERTIREOIDISMO
DOI:
https://doi.org/10.56238/levv16n53-091Palavras-chave:
Doenças da Tireoide, Transtornos do Humor, Disfunção Cognitiva, Transtornos PsicóticosResumo
Introdução: A disfunção tireoidiana, abrangendo estados hipo e hipertireoidianos, exerce profundos efeitos sistêmicos que se estendem ao humor, à cognição e ao comportamento. Manifestações psiquiátricas como depressão, ansiedade e psicose têm sido consistentemente relatadas, mas sua magnitude e mecanismos permanecem controversos.
Objetivo: Avaliar sistematicamente as evidências atuais sobre sintomas psiquiátricos associados à disfunção tireoidiana, enfatizando o espectro de alterações de humor e cognitivas em formas manifestas e subclínicas.
Métodos: Uma busca sistemática foi realizada nas bases de dados PubMed, Scopus, Web of Science, Biblioteca Cochrane, LILACS, ClinicalTrials.gov e ICTRP para estudos publicados de 2018 a 2025. Os estudos elegíveis incluíram ensaios clínicos randomizados, coortes e delineamentos caso-controle que avaliaram desfechos psiquiátricos em disfunção tireoidiana. Não foram aplicadas restrições de idioma. Os dados foram sintetizados qualitativamente, com risco de viés e certeza da evidência classificados de acordo com os critérios GRADE.
Resultados e Discussão: Entre 1.247 registros identificados, 52 estudos preencheram os critérios de inclusão. O hipotireoidismo esteve fortemente associado a sintomas depressivos e cognitivos, enquanto o hipertireoidismo correlacionou-se com ansiedade, irritabilidade e, em casos graves, estados psicóticos ou maníacos. Condições subclínicas demonstraram associações mais fracas, porém consistentes, com humor e comprometimento cognitivo. Mecanismos imunológicos e neurotransmissão serotoninérgica alterada emergiram como elos fisiopatológicos plausíveis. A heterogeneidade nos critérios diagnósticos e nas medidas de desfecho limitou a síntese meta-analítica.
Conclusão: Sintomas psiquiátricos são manifestações clinicamente relevantes da disfunção tireoidiana. O rastreamento rotineiro da tireoide em quadros psiquiátricos atípicos ou resistentes ao tratamento é justificado. O tratamento integrativo, abordando as dimensões endócrina e neuropsiquiátrica, melhora os desfechos dos pacientes.
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