Extreme temperatures, PM2.5 and trajectories of impaired thyroid hormone sensitivity: A longitudinal study of patients with schizophrenia

• Two trajectories of impaired thyroid hormone sensitivity are identified. • Heat waves and cold spells are associated with the adverse trajectory. • The effect of heat waves and cold spells increases with frequency, intensity, and duration. • High concentrations of fine particulate matter increase the dangers of heat waves. • Men and elderly patients may be potentially susceptible. The climate change scenario has witnessed an increase in extreme temperature events (ETEs), including heat waves and cold spells, and a heightened occurrence of compounding with fine particulate matter (PM 2.5 ). However, the impact of this phenomenon on the sensitivity to thyroid hormones (THs) in humans is unclear, especially in a group as specific as schizophrenia. A longitudinal study was constructed using longitudinal measurements of thyroid function in schizophrenia in the Anhui Mental Health Center. The latent growth mixture model was applied to assess the optimal trajectory of change in impaired THs sensitivity. We then used logistic regression to explore associations between heat waves, cold spells, and PM 2.5 with impaired THs sensitivity trajectories in the total population and different gender and age subgroups. Furthermore, the effect of the frequency, intensity, and duration of ETEs in the above associations was explored, as well as an assessment of the interaction between ETEs and PM 2.5 . Among 931 participants, we identified two classifications of trajectories of impaired THs sensitivity: “Low-stable” (n = 836, 89.80 %) and “Rise-slight down” (n = 95, 10.20 %). Logistic regression showed significant associations between each additional day of heat waves (≥3 days with temperature thresholds above the 95th percentile) and cold spells (≥3 days with temperature thresholds below the 5th percentile) and “Rise-slight down” trajectory, with odds ratios (95 % confidence intervals) of 1.06 (1.02, 1.10) and 1.19 (1.14, 1.24), respectively, and the strength of this association increased with the intensity and duration of ETEs. Subgroup analyses indicated that the association was more pronounced in males and the age group above 40 years. Furthermore, PM 2.5 was found to interact with heat waves, with high concentrations exacerbating the effects of heat waves. Our findings suggest that mitigating both ETEs and PM 2.5 exposures may bring health co-benefits in preventing thyroid impairment in schizophrenia.