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Hypothyroidism and depression — MRCPsych Paper A MCQ

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ModerateNeuroimaging, neuroendocrinology and psychoneuroimmunologyHypothyroidism and depressionMRCPsych Paper A

A 49-year-old man is referred for assessment of a possible depressive episode. Over 3 months he has developed low mood, impaired concentration and psychomotor slowing. He also reports constipation, increased sensitivity to cold and a 6 kg weight gain despite no change in diet. Examination shows dry skin and a pulse of 54 beats per minute. Which condition most likely accounts for the combined psychiatric and physical presentation?

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Correct answer: B — Hypothyroidism

Hypothyroidism is the best answer. It can produce depressive symptoms, impaired concentration and psychomotor slowing alongside characteristic systemic features such as cold intolerance, constipation, weight gain, dry skin and bradycardia. A primary depressive disorder may cause low mood, cognitive slowing and altered weight, but does not adequately explain this coordinated endocrine pattern. Hyperthyroidism more typically causes heat intolerance, weight loss, tremor, tachycardia and anxiety or irritability. Cushing syndrome can cause depression and weight gain but would be suggested by features such as proximal weakness, easy bruising, purple striae and hypertension. Phaeochromocytoma typically causes episodic headache, sweating, palpitations and hypertension rather than sustained metabolic slowing.

Reference: NHS, Underactive thyroid (hypothyroidism), Symptoms of an underactive thyroid, reviewed 28 April 2025. https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/