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Historical Sexual Abuse and Current Thyroid Axis Profiles in Women With Premenstrual Dysphoric Disorder

From the Departments of Psychiatry (S.S.G., K.C.L., J.L., C.A.P., A.J.P.) and Psychology (S.S.G., K.S.T., K.C.L.), University of North Carolina at Chapel Hill, Chapel Hill, NC.

Address correspondence and reprint requests to Susan S. Girdler, PhD, University of North Carolina at Chapel Hill, CB #7175, Medical Research Bldg. A, Chapel Hill, NC 27599-7175. E-mail: susan_girdler{at}med.unc.edu

OBJECTIVE: This study investigated whether women with premenstrual dysphoric disorder (PMDD) who also had histories of sexual abuse differed from women with PMDD with no previous sexual abuse and from women without PMDD in hypothalamic-pituitary-thyroid (axis measures).

METHODS: Ten sexually abused women with PMDD were compared with 18 nonabused women with PMDD and 22 nonabused women without PMDD for hypothalamic-pituitary-thyroid axis hormone concentrations during the follicular and luteal phases of confirmed ovulatory cycles.

RESULTS: Compared with the women without PMDD, only the group of women with PMDD with sexual abuse showed greater variance in both cycle phases in thyroid-stimulating hormone concentrations and greater luteal phase variance in free and total thyroxine (T₄) and reverse tri-iodothyronine (T₃). In the group of nonabused women with PMDD, there was greater variance in follicular phase thyroxine-binding globulin concentrations compared with the group without PMDD. Women with PMDD with abuse had greater mean concentrations of total T₃ and thyroxine-binding globulin, greater total T₃/free T₄ and free T₃/free T₄ ratios, and lower ratios of free T₃/total T₃ and free T₄/total T₄ than either of the other 2 nonabused groups. Greater total T₃ concentrations and histories of major depression independently predicted premenstrual symptoms in all women with PMDD, together accounting for 31% to 38% of the variance in anxiety, anger, and depression ratings.

CONCLUSIONS: These results suggest increased conversion of T₄ to T₃ and increased binding of thyroid hormones in women with PMDD with previous sexual abuse. Abnormal total T₃ concentrations may have pathophysiological significance in PMDD.

Key Words: premenstrual dysphoric disorder, • thyroid axis hormones, • sexual abuse, • menstrual cycle.

Abbreviations: PMDD = premenstrual dysphoric disorder;; HPT = hypothalamic-pituitary-thyroid;; TSH = thyroid-stimulating hormone;; T₃ = tri-iodothyronine;; T₄ = thyroxine;; SA = sexual abuse;; PTSD = posttraumatic stress disorder;; TBG = thyroxine-binding globulin;; PRISM = Prospective Record of the Impact and Severity of Menstrual Symptoms;; SCID = Structured Clinical Interview for DSM-III-R Axis I disorders;; MDD = major depressive disorder;; PS = posttraumatic stress disorder scale of the Minnesota Multiphasic Personality Inventory-2;; MMPI-2 = Minnesota Multiphasic Personality Inventory-2;; rT₃ = reverse tri-iodothyronine;; RIA = radioimmunoassay;; SHBG = sex hormone-binding globulin.

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