Intellectual, school and occupational performance in patients with idiopathic hypothalamo-pituitary hypothyroidism and primary hypothyroidism

Intelligence quotient (IQ), school and professional performance were reviewed in 33 patients with idiopathic hypothalamo-pituitary hypothyroidism. Diagnosis was based on low T4 values and clinical signs. All were treated with growth hormone (HGH). In some, hypothyroidism became manifest only after HGH therapy. Birth history revealed breech delivery in 24 and perinatal asphyxia in 15 of them. Thyroid treatment was started at a mean age of 9.8 (range 4-18 years). The mean IQ was 103.4 +/- 16.7 (SD). 9 patients had IQs below 90, 8 of them were born by breech delivery, 3 had severe perinatal asphyxia, one recurrent symptomatic hypoglycemia, and one a micropenis. Of those patients who have reached the respective age, 7 attended college, 3 university, and 9 had skilled professions. Only 7 required special education. For comparison, 52 patients with primary hypothyroidism were studied. Their mean IQ was with 89.3 +/- 18.1 (SD) significantly lower (p < 0.001) than the mean IQ of patients with hypothalamo-pituitary hypothyroidism. The best IQ (96.8 +/- 16.9) was attained when thyroid treatment was started before the age of 4 months, the lowest IQ (78.2 +/- 19.2) was found in the group of patients in whom thyroid substitution was initiated between 5 and 12 months. Patients who were treated after one year of age, had a mean IQ of 90.0 +/- 15.7. This group includes patients with ectopic thyroid glands or acquired hypothyroidism such as Hashimoto's thyroiditis.

Thyroid-induced mania in hypothyroid patients

This retrospective study, based on 18 case reports, describes an organic affective syndrome, manic type, occurring shortly after the initiation of thyroid replacement in hypothyroid patients. The symptomatology and homogeneity of the syndrome offers insight into the relationship between thyroid activity and affective disturbance. The patients experiencing mania showed concurrent psychopathology at the time of replacement therapy, frequently had a past history of personal or familial psychiatric disorder and were given dosages in the high range of normal. The potential morbidity of the manic state was considerable. These findings suggest that a group of hypothyroid patients at risk can be identified. In such a group, lower initial dosages and gradual increases in dosage may be indicated.

Development of olfactory and thermal responsiveness in hypothyroid and hyperthyroid rat pups

Hypo- and hyperthyroid rat pups were tested for their responsiveness on an olfactory and a thermal gradient in an attempt to evaluate the effects of perinatal thyroid manipulation on the ability of the pups to use these cues in orientation. Hypothyroid pups showed a delay and hyperthyroid pups an acceleration in the development of orientation along the olfactory gradient, relative to controls. None of the pups was able to utilize a thermal gradient in directed orientation but pups moved less at the warm end of the gradient than at the cool end. This differential responsiveness was strongest in the hypothyroid pups, suggesting that these pups could utilize thermal cues in an orthokinetic orientation.

Development of home orientation in hypothyroid and hyperthyroid rat pups

In order to assess the effects of perinatal hypothyroidism or hyperthyroidism on the development of an integrated behavioral response, we tested hypothyroid, hyperthyroid, and control pups, as well as pups receiving thyroxine replacement therapy, for the development of the home orientation response. Hypothyroidism was induced in the pups by feeding the pregnant or lactating female a diet of .2% propylthiouracil from Day 15 of gestation to Day 22 postpartum. Pups receiving replacement therapy and pups made hyperthyroid were injected daily with thyroxine, starting at birth. The ability of the pups to initiate and maintain locomotion toward the nest was assessed between Days 4 and 22. Hyperthyroid, control, and replacement therapy pups behaved very similarly on the task, showing a peak in the percentage of pups homing between Days 12 and 16. Hypothyroid pups showed a delay in the peak percentage until Day 20, although the percentage of pups was similar to that found in other treatments. An integrated behavioral response can be delayed by hypothyroidism and still emerge apparently intact at a later age.

Alterations in the maternal behavior of rats rearing hypothyroid and hyperthyroid offspring

To determine whether maternal behavior could serve as a mediator for thyroid hormone effects on behavior, I assessed nesting, nursing, grooming, contact, and retrieval in mothers of hypothyroid, hyperthyroid, and control litters, as well as in mothers of litters receiving thyroxine replacement therapy. Females assigned to the hypothyroid and replacement therapy treatments were placed on a goitrogenic diet of .2% propylthiouracil from Day 15 of gestation to Day 22 postpartum. Hyperthyroid and replacement therapy pups were injected daily with thyroxine starting on the day of birth. The decline in nesting and nursing was delayed in hypothyroid litters whereas the decline in nesting was accelerated in hyperthyroid litters. Retrieval was not affected, but grooming of pups occurred less frequently in hypothyroid and replacement therapy litters. Maternal care received by hypothyroid pups was considered adequate. Maternal behavior may alleviate some of the effects of perinatal hypothyroidism,, but does not seem to be responsible for the more severe effects of hypothyroidism.

Psychiatric manifestations of the post-thyroidectomy bilateral abductor vocal cord paralysis syndrome. Cases and theoretical issues

Post-thyroidectomy bilateral abductor vocal cord paralysis (BAVCP) is a life-threatening syndrome characterized by serious psychiatric manifestations as well as by voice, airway, hypothyroid, and hypoparathyroid symptoms. Of the 128 patients with post-thyroidectomy BAVCP syndrome, 45 (35.2 per cent) had psychiatric complications: 21 of the 128 patients (16.4 per cent) had pre-existing psychiatric symptoms exacerbated by the post-thyroidectomy BAVCP syndrome, 16 (12.5 per cent) had psychiatric symptoms initiated by the syndrome, six (4.7 per cent) had psychiatric symptoms etiologically distinct from the syndrome, and two (1.6 per cent) were misdiagnosed. The role of psychiatric treatment is described. Theoretical aspects of laryngeal dysfunctions associated with psychiatric disorders and psychotropic medications are discussed.

Neuropsychological study in treated thyroid dysgenesis

Neuropsychological assessment was carried out in 57 patients aged 3.0 to 17.5 years (mean 8.5) with thyroid dysgenesis under adequate long-term therapy. Starting age of hypothyroidism as estimated by bone age at diagnosis was prenatal in 32 cases, close to birth in 13 cases and postnatal of 1-12 months in 12 cases. Hypothyroidism of prenatal onset results in severe neuropsychological disorders and mental retardation if not treated early. Only some signs of "minimal brain dysfunction" which compensate with advancing age and normal IQ are found in these children if therapy is started before one month of age. Hypothyroidism starting at birth does not result in mental retardation but neuropsychological disorders are found. They are more frequent if treatment is started after 6 months of age. Children who become hypothyroid between 1 and 12 months of age are usually not mentally retarded and show minor neuropsychological disorders.

Thyroid function screening in psychiatric patients

Abnormalities in levels of total thyroxine and thyroxine binding capacity were common in a group of 480 newly admitted psychiatric patients. The estimated free thyroxine (EFT4) level was elevated in 43 patients (9%). In 27 of these patients, the level of EFT4 became spontaneously normal, usually within a two-week period (acute "stress hyperthyroidism"). The level of EFT4 was decreased in 42 patients (9%). In 16 of these patients, the level became spontaneously normal; the etiology of this apparent acute hypolhyroidism is unclear. The yield of new cases of primary hyperthyroidism and hypothyroidism was low, but a presumptive diagnosis of secondary hypothyroidism was made in eight patients. In addition, nine patients with known thyroid disease were taking inadequate or excessive replacement therapy. Thyroid function screening tests are of value in psychiatric patients.

Congenital hypothyroidism and IQ increase: a quarter century follow-up

Ten patients with a history of congenital hypothyroidism were recalled for IQ evaluation 16 to 26 years after an original IQ test at age 5 to 6. From childhood through adulthood, the IQ (Wechsler) increased (mean full scale IQ increase = 21; range = -5 to 43 points). Serial testing in three instances showed the timing of the increase to be sudden and unpredictable. Life achievements, mental health, and sexual adjustment were concordant with the IQ attained. The data suggest that in hypothyroidism intellectual growth may not occur in equal annual increments; with effective hormonal replacement and educational experience it may be subject to spurts of growth, with a resultant improved prognosis.

Neurological abnormalities in patients treated for hypothyroidism from early life

Neurological and psycholocial assessment was carried out on 30 patients aged 2.7 to 21 years (mean 9.4) who were being treated for hypothyroidism starting before the age of 2 years. Their IQ scores lay in the normal range (71--122; mean 92.4) but 77% showed at least one sign of impaired brain function. Clumsiness was found in 33%, behaviour disorders in 23%, speech disorders in 20%, learning disorders in 26%, squint in 53%, nystagmus in 10%, and minor motor disorders in 50%. Many showed several of these features and hypothyroidism in early life appears to lead to widespeard impairment of brain function. These neurological findings were equally common in patients in whom treatment started between 4 and 10 weeks of age and patients treated after 10 weeks, suggesting that early detection of hypothyroidism by neonatal screening may be of limited benefit. Children who have been hypothyroid in early infancy require careful assessment to prevent further visual, emotional, scholastic, or vocational difficulties.

[Psychological development of children with hypothyroidism. II. Motor development and psychopathology (author's transl)]

In addition to a preceeding report the relation of motor development to ataxia and age at onset of symptoms and therapy as well as psychopathological symptoms in relation to intelligence and sex in 32 children with hypothyroidism are reported.

[Psychological development of children with hypothyroidism. I. Psychometric results in relation to clinical features (author's transl)]

Thirty-two children suffering from congenital or late acquired hypothyroidism were studied with respect to intelligence, motor development, visuo-motor coordination, and social maturity. Psychological test results are represented for the group as a whole as well as in their relation to age at onset of symptoms and therapy, ataxia, and speech disorders.