1
|
Zhou H, Zhu H, Wang J, Gao X, Jiang C. Association between hypothyroidism subtypes and major depression: A two-sample Mendelian randomization study. J Affect Disord 2024; 351:843-852. [PMID: 38341154 DOI: 10.1016/j.jad.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/28/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The causal relationship between different hypothyroidism subtypes and the risk of major depression (MD) is yet to be fully elucidated. This study aimed to determine if there's a causal relationship between various hypothyroidism subtypes (and related factors) and the risk of MD. METHODS This genetic association study utilized a two-sample Mendelian Randomization (MR) approach to explore the causal relationships between various hypothyroidism subtypes and MD risk. Genome-Wide Association Study (GWAS) summary statistics were obtained from the FinnGen and the UK Biobank. Instrumental variables (IVs) were chosen based on single nucleotide polymorphisms (SNPs). RESULTS Among the analyzed hypothyroidism subtypes and related factors, "Hypothyroidism, strict autoimmune" (HTCBSA) and "Hypothyroidism, levothyroxin purchases" (HT/LP) demonstrated a statistically significant positive causal relationship with MD, with odds ratios of 1.020 (95 % CI: 1.004-1.037) and 1.022 (95 % CI: 1.005-1.040), respectively. The sensitivity analysis supported the robustness of these findings, showing no significant horizontal pleiotropy and confirming the stability of results when individual SNPs were removed. "Congenital iodine-deficiency syndrome/hypothyroidism" (CIDS/HT), "Postinfectious hypothyroidism" (PHT), "Hypothyroidism due to medicaments and other exogenous substances" (HDTDM and OES), "Thyroid Stimulating Hormone" (TSH), "Thyrotropin-releasing hormone" (THRH), and "Hypothyroidism, strict autoimmune, 3 medication purchases required" (HTCBSA/3MPR) showed no significant causal relationship with MD. LIMITATIONS The study population was limited to individuals of European ancestry, and there may be certain genetic differences between different ethnic groups. CONCLUSIONS This MR study suggests a potential causal relationship between certain hypothyroidism subtypes (specifically HTCBSA and HT/LP) and an increased risk of MD.
Collapse
Affiliation(s)
- Hongliang Zhou
- Department of Medical Psychology, The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China.
| | - Haohao Zhu
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jun Wang
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xuezheng Gao
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chenguang Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
2
|
Li P, Zhou J, Wang T, Li J, Wu W. Capsiate ameliorates secondary hyperparathyroidism by improving insulin sensitivity and inhibiting angiogenesis. J Cell Mol Med 2024; 28:e18202. [PMID: 38591872 PMCID: PMC11003359 DOI: 10.1111/jcmm.18202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Secondary hyperparathyroidism has a significant impact on the overall well-being of the body. Capsiates, known for their antioxidant and metabolic properties, have emerged as a promising alternative treatment for secondary hyperparathyroidism. This study aims to evaluate the effects and mechanisms of capsiates in the treatment of secondary hyperparathyroidism. To achieve our research objectives, we conducted a study on patients' serum and examined changes in metabolic markers using serum metabolomics. We induced secondary hyperparathyroidism in rat through dietary intervention and divided them into four groups. The first group, referred to as the Parathyroid Hormone (PTH) group, received a low-calcium and high-phosphate diet (0.2% calcium, 1.2% phosphorus). The second group served as the control group, receiving a standard phosphate and calcium diet (0.6% calcium, 0.6% phosphorus). The third group, called the capsiates group, consisted of rat from the control group treated with capsiates (intraperitoneal injection of 2 mg/kg capsiates for 2 weeks after 2 weeks of dietary intervention). The fourth group was the capsiates-treated PTH group. Subsequently, we conducted ribose nucleic acid (RNA) sequencing on parathyroid gland cells and evaluated serum thyroxine levels, oxidative stress, expression of proteins associated with vascular neogenesis, measurement of SOD, GSH and 3-nitrotyrosine, micro-CT and histological staining. The serum metabolomic data revealed a significant decrease in capsiate levels in the secondary hyperparathyroidism group. Administration of capsiates to PTH rat resulted in increased calcium levels compared to the PTH group. Additionally, the PTH + Capsiates group showed significantly lower levels of PTH and phosphate compared to the PTH group. The PTH group exhibited a notable increase in the quantity and size of mitochondria compared to the control group. Following capsiates administration to the PTH group, there was a significant reduction in the number of mitochondria and length of microvilli, but an increase in the size of mitochondria compared to the PTH group. Sequencing analysis revealed that vascular endothelial growth factor (VEGF) and Vascular Endothelial Growth Factor Receptor 1 (VEGFR1) play crucial roles in this process. Vascular-related variables and downstream signalling were significantly elevated in hyperthyroidism and were alleviated with capsaicin treatment. Finally, combining capsiates with the PTH group improved bone mineral density, Tb.N, BV.TV, Cs.Th, Tt.Ar, OPG, Ob.TV and Oc.TV, as well as the mineral apposition rate, but significantly decreased Tb.Sp and Receptor Activator for Nuclear Factor-κ B Ligand (RANKL) compared to the PTH group. The findings suggest that capsiates can improve secondary hyperparathyroidism and ameliorated osteoporosis outcomes by inhibiting angiogenesis and reducing oxidative stress.
Collapse
Affiliation(s)
- Peiting Li
- Department of Plastic SurgeryThe Third Xiangya Hospital, Central South UniversityChangshaChina
| | - Jianda Zhou
- Department of Plastic SurgeryThe Third Xiangya Hospital, Central South UniversityChangshaChina
| | - Tianyin Wang
- Transplantation CenterThe Third Xiangya Hospital, Central South UniversityChangshaChina
| | - Jun Li
- Department of Breast Thyroid SurgeryThe Third Xiangya Hospital, Central South UniversityChangshaChina
| | - Wei Wu
- Department of Breast Thyroid SurgeryThe Third Xiangya Hospital, Central South UniversityChangshaChina
| |
Collapse
|
3
|
Villa NAE, Wen C, Espiridion ED. Understanding the Complexity of Early-Onset Dementia. Cureus 2024; 16:e57897. [PMID: 38725758 PMCID: PMC11080675 DOI: 10.7759/cureus.57897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Dementia, particularly Alzheimer's disease, affects millions globally, with its prevalence increasing notably with age. Early-onset Alzheimer's disease, however, affects individuals under 65 years old. Unfortunately, diagnosing dementia in patients under 65 years old is quite challenging and is often delayed, missed, or wrong. Thus, we present the case of a 60-year-old female, with a medical history of hypothyroidism and presumed dementia on donepezil, who presented to the emergency department for agitation, dramatic change in personality and behavior, as well as cognitive decline that started in her late 50s. We discuss the importance of performing a thorough history and physical examination, as well as a comprehensive workup for patients who present with dramatic changes in behavior due to the wide range of potential diagnoses. While certain reversible causes, such as hypothyroidism, nutritional deficiencies, and polypharmacy, can be promptly identified and treated, chronic neurocognitive disorders such as Alzheimer's disease demand a timely evaluation for early multidisciplinary treatment to enhance patient outcomes.
Collapse
Affiliation(s)
| | - Charles Wen
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
| | - Eduardo D Espiridion
- Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital Tower Health Systems, West Reading, USA
| |
Collapse
|
4
|
Genç B, Aslan K, Avcı U, İncesu L, Günbey HP. Opposing effects of thyroid hormones on hypothalamic subunits and limbic structures in hyperthyroidism patients: A comprehensive volumetric study. J Neuroendocrinol 2024; 36:e13369. [PMID: 38326952 DOI: 10.1111/jne.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
Thyroid hormones play a critical role in brain development, but paradoxically, patients with hyperthyroidism often exhibit cognitive decline and irritability. This study aims to explore the pattern of atrophy in hyperthyroid patients, changes in specific areas of the brain, including hypothalamic subfields and limbic structures, and their relationships with hormonal levels and psychometric tests. This prospective cross-sectional study involves 19 newly diagnosed, untreated hyperthyroid patients, and 15 age and gender-matched control subjects. The participants underwent psychometric and cognitive tests and volumetric MRI. The hypothalamic subfield (anterior-inferior, anterior-superior, superior-tubular, inferior-tubular, and posterior hypothalamus) and limbic structures (fornix, basal forebrain, nucleus accumbens, and septal nucleus) were segmented using voxel-based morphometry, surface-based morphometry, and deep learning algorithms. The groups were compared using the t-test, and correlation analyses were performed between clinical parameters and volumetric measurements. The correlation between hormonal parameters and volumetric measurements in patient and control groups was assessed with the Meng test. Hyperthyroid patients displayed widespread grey matter loss and sulcal shallowing in the left hemisphere. However, no local gyrification index changes or cortical thickness variations were detected. The limbic structures and hypothalamic subunits did not show any volume discrepancies. Free thyroxine in the patient group negatively correlated with bilateral anterior-inferior and right septal nucleus, but positively correlated with left anterior-inferior in the control group. Thyroid stimulating hormone in the patient group showed a positive correlation with bilateral fornix volume, a correlation absent in the control group. Disease duration negatively correlated with right anterior-inferior, right tubular inferior, and right septal nucleus. Changes in cognitive and psychometric test scores in the patient group correlated with the bilateral septal nucleus volume. Hyperthyroidism primarily leads to a reduction in grey matter volume and sulcal shallowing. Thyroid hormones have differing volumetric effects in limbic structures and hypothalamic subunits under physiological and hyperthyroid conditions.
Collapse
Affiliation(s)
- Barış Genç
- Department of Radiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Kerim Aslan
- Department of Neuroradiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Uğur Avcı
- Department of Endocrinology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Lütfi İncesu
- Department of Neuroradiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hediye Pınar Günbey
- Department Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| |
Collapse
|
5
|
Davidson TL, Stevenson RJ. Vulnerability of the Hippocampus to Insults: Links to Blood-Brain Barrier Dysfunction. Int J Mol Sci 2024; 25:1991. [PMID: 38396670 PMCID: PMC10888241 DOI: 10.3390/ijms25041991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The hippocampus is a critical brain substrate for learning and memory; events that harm the hippocampus can seriously impair mental and behavioral functioning. Hippocampal pathophysiologies have been identified as potential causes and effects of a remarkably diverse array of medical diseases, psychological disorders, and environmental sources of damage. It may be that the hippocampus is more vulnerable than other brain areas to insults that are related to these conditions. One purpose of this review is to assess the vulnerability of the hippocampus to the most prevalent types of insults in multiple biomedical domains (i.e., neuroactive pathogens, neurotoxins, neurological conditions, trauma, aging, neurodegenerative disease, acquired brain injury, mental health conditions, endocrine disorders, developmental disabilities, nutrition) and to evaluate whether these insults affect the hippocampus first and more prominently compared to other brain loci. A second purpose is to consider the role of hippocampal blood-brain barrier (BBB) breakdown in either causing or worsening the harmful effects of each insult. Recent research suggests that the hippocampal BBB is more fragile compared to other brain areas and may also be more prone to the disruption of the transport mechanisms that act to maintain the internal milieu. Moreover, a compromised BBB could be a factor that is common to many different types of insults. Our analysis indicates that the hippocampus is more vulnerable to insults compared to other parts of the brain, and that developing interventions that protect the hippocampal BBB may help to prevent or ameliorate the harmful effects of many insults on memory and cognition.
Collapse
Affiliation(s)
- Terry L. Davidson
- Department of Neuroscience, Center for Neuroscience and Behavior, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | | |
Collapse
|
6
|
Yashkin AP, Kolpakov S, Ukraintseva S, Yashin A, Akushevich I. Graves disease is associated with increased risk of clinical Alzheimer's disease: evidence from the Medicare system. Clin Diabetes Endocrinol 2024; 10:11. [PMID: 38317215 PMCID: PMC10840251 DOI: 10.1186/s40842-024-00170-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Identification of modifiable risk factors for Alzheimer's Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. METHODS Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 19,798 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65 + over the 1991-2020 period. RESULTS Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.19; 95% Confidence Interval [CI]:1.13-1.26). Competing risk estimates were consistent with these findings (HR:1.14; CI:1.08-1.20) with the magnitude of associated risk varying across subgroups: Male (HR:1.25; CI:1.07-1.47), Female (HR:1.09; CI:1.02-1.16), White (HR:1.11; CI:1.03-1.19), and Black (HR:1.23; CI:1.02-1.49). CONCLUSIONS Our results indicate a robust and consistent association between a diagnosis of GD and a subsequent diagnosis of AD in later stages of life. The precise biological pathways that could potentially connect these two conditions remain unclear as is the role of treatment in this relationship. Replications of these findings on datasets with both biomarkers and laboratory test results, especially in underrepresented groups is vital.
Collapse
Affiliation(s)
- Arseniy Pavlovich Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA.
| | - Stanislav Kolpakov
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Anatoliy Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Room A115 Bay A, Erwin Mill Building, 2024 W. Main St., PO Box 90420, 27708, Durham, NC, USA
| |
Collapse
|
7
|
Zhang X, Wang Y, Wang H, Zhang X. Trends in Prevalence of Thyroid Dysfunction and its Associations With Mortality Among US Participants, 1988-2012. J Clin Endocrinol Metab 2024; 109:e657-e666. [PMID: 37738422 DOI: 10.1210/clinem/dgad558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
CONTEXT Various dynamic factors could influence the prevalence and distribution of thyroid dysfunction. OBJECTIVE To provide national estimates and temporal trends in prevalence of thyroid dysfunction over the past 3 decades in United States and determine the impact of thyroid dysfunction on mortality in US adults. METHODS A cross-sectional analysis of data from 33 117 participants aged 12 years or older in the National Health and Nutrition Examination Survey III (1988-1994), 1999-2002, and 2007-2012. RESULTS The weighted mean age was 41.6 years, and 48.3% were men. In 2007 through 2012, the prevalence of subclinical and overt hypothyroidism, subclinical and overt hyperthyroidism was 4.3%, 0.33%, 3.2%, and 0.2% respectively. Eighty percent of individuals with thyroid dysfunction were previously undiagnosed. The prevalence of subclinical hypothyroidism and hyperthyroidism was stable, whereas overt hypothyroidism (0.54% [95% CI, 0.35-0.8] vs 0.33% [95% CI, 0.23-0.48]) and hyperthyroidism (0.8% [95% CI, 0.58-1.1] vs 0.2% [95% CI, 0.12-0.33]) were less prevalent in 2007-2012 compared to 1988-1994. Older age, White Americans, obesity, and positivity for thyroid peroxidase antibody and thyroglobulin antibody were risk factors for hypothyroidism, whereas older age, women, and Black Americans were risk factors for hyperthyroidism. Over a median follow-up of 17.2 years, no significant association was observed between any type of thyroid dysfunction with the risk of total or cardiovascular mortality. However, among individuals aged 65 years or older, subclinical hypothyroidism was associated with a higher risk of total mortality (hazard ratio, 1.17; 95% CI, 1.00-1.37; P = .05) and cardiovascular mortality (HR, 1.29; 95% CI, 1.04-1.62; P = .02). CONCLUSIONS The prevalence of subclinical thyroid dysfunction remained relatively unchanged, whereas that of overt thyroid dysfunction decreased. Subclinical hypothyroidism was associated with a higher mortality among individuals aged 65 years or older.
Collapse
Affiliation(s)
- Xiaowen Zhang
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
- Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
| | - Yong Wang
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing University School of Medicine, Nanjing 210093, China
| | - Hongwei Wang
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing University School of Medicine, Nanjing 210093, China
| | - Xinlin Zhang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
| |
Collapse
|
8
|
Song M, Sun W, Liu Q, Wang Z, Zhang H. Global scientific trends on thyroid disease in early 21st century: a bibliometric and visualized analysis. Front Endocrinol (Lausanne) 2024; 14:1306232. [PMID: 38298184 PMCID: PMC10829784 DOI: 10.3389/fendo.2023.1306232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Background Bibliometrics has been used to analyze the literature in the field of thyroid disease studies in the early 21st century, indicating the changes in current international study trends. Methods In this study, a bibliometric analysis of data retrieved from the Web of Science (WoS) database was conducted, and the publication trends and thematic evolution in the field of thyroid disease research from January 1, 2000, to November 16, 2022, were analyzed. A total of 69283 articles related to thyroid diseases were evaluated for their characteristics, including annual publication volume, countries, journals, institutions, authors, keywords, and references. VOSviewer was utilized to perform the analysis of co-authorship, co-citation, co-occurrence and descriptive. Results The annual publication volume of thyroid disease research literature showed a fluctuating upward trend from 2000 to 2021, exceeding 5,000 articles for the first time in 2021. The United States (16120 counts, 678255 cities) ranks first in terms of publication volume and citation. Thyroid (n=3201) and Journal of Clinical Endocrinology&Metabolism (n=140399) are the most prolific and cited journals, respectively. The organization with the highest publication volume and citation frequency is Harvard University (1011 counts, 59429 cities), Miyauchi Akira (n=422), Schlumberger, and Martin (n=24839) possess the highest publication volume and citation frequency, respectively. Co-occurrence analysis of 307 keywords with frequencies of more than 20 resulted in 6 clusters (1): Thyroid dysfunction and diseases (2); mechanism of occurrence and development of thyroid cancer (3); autoimmune thyroiditis (4); scope and postoperative management of thyroid surgery (5); fine needle aspiration of thyroid nodules (6); radioactive iodine therapy for thyroid cancer. Active monitoring, thermal ablation, Lenvatinib, and long noncoding RNA refer to the latest keywords. Discussing the six clusters helps scholars to determine the scope and direction of studies. Conclusion Over the past two decades, the literature related to thyroid diseases has increased year by year, with closer collaboration between countries, institutions, and authors. In this study, the global trends, research hotspots, emerging subjects, and basic knowledge of literature related to thyroid diseases were respectively elucidated, which will facilitate researchers in this field to seek better development.
Collapse
Affiliation(s)
- Mingyuan Song
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Qi Liu
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhongqing Wang
- Department of Information Center, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
9
|
Zhu S, Pang Y, Zhang X, Yang C, Gao J, Fang P, Zhang Y, Yao Y, Ju F, Ye F, Zhu H, Liao P, Yao L, Dai L, Xu J, Wu B, Pan J, Wu Y. Alteration of Thyroid Hormones in Mouse Models of Alzheimer's Disease and Aging. Neuroendocrinology 2024; 114:411-422. [PMID: 38228117 DOI: 10.1159/000536089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Aging is characterized by the deterioration of a wide range of functions in tissues and organs, and Alzheimer's disease (AD) is a neurodegenerative disease characterized by cognitive impairment. Hypothyroidism occurs when there is insufficient production of thyroid hormones (THs) by the thyroid. The relationship between hypothyroidism and aging as well as AD is controversial at present. METHODS We established an animal model of AD (FAD4T) with mutations in the APP and PSEN1 genes, and we performed a thyroid function test and RNA sequencing (RNA-Seq) of the thyroid from FAD4T and naturally aging mice. We also studied gene perturbation correlation in the FAD4T mouse thyroid, bone marrow, and brain by further single-cell RNA sequencing (scRNA-seq) data of the bone marrow and brain. RESULTS In this study, we found alterations in THs in both AD and aging mice. RNA-seq data showed significant upregulation of T-cell infiltration- and cell proliferation-related genes in FAD4T mouse thyroid. In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed that upregulated genes were enriched in the functional gene modules of activation of immune cells. Downregulated energy metabolism-related genes were prominent in aging thyroids, which reflected the reduction in THs. GSEA showed a similar enrichment tendency in both mouse thyroids, suggesting their analogous inflammation state. In addition, the regulation of leukocyte activation and migration was a common signature between the thyroid, brain, and bone marrow of FAD4T mice. CONCLUSIONS Our findings identified immune cell infiltration of the thyroid as the potential underlying mechanism of the alteration of THs in AD and aging.
Collapse
Affiliation(s)
- Siyuan Zhu
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidan Pang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunying Yang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fang
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaohui Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunjin Yao
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangyu Ju
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Ye
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Liao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lufeng Yao
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Lulu Dai
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Xu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Wu
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Pan
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
10
|
Fiore V, Barucca A, Barraco S, Triggiani D, Carbotta G, Giagulli VA, Piazzolla G, Lisco G, Triggiani V. Hypothyroidism in Older Adults: A Narrative Review. Endocr Metab Immune Disord Drug Targets 2024; 24:879-884. [PMID: 37641994 DOI: 10.2174/1871530323666230828110153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The prevalence of hypothyroidism increases along with aging, resulting in one of the most common comorbidities among patients over 75 years. The leading causes of hypothyroidism in older adults are iatrogenic, Hashimoto's thyroiditis, and medications. The narrative review aimed to discuss the clinical characteristics of hypothyroidism in older adults and the impact of hormonal replacement therapy on survival rates. Thyroid function declines over time due to physiological changes in the thyroid stimulating hormone signaling, iodine absorption and metabolism, thyroid hormone metabolism, and activity at peripheral sites. A serum TSH value over the upper limit of the normal reference range is not necessarily attributable to hypothyroidism. However, an appropriate diagnostic work-up is required to rule out true hypothyroidism and discriminate the etiology (i.e., thyroid autoimmune diseases, iodine deficiency, drug-induced hypothyroidism). Levothyroxine treatment should be considered in cases of overt hypothyroidism. A complete risk-to-benefit assessment, particularly considering the overall health status, life expectancy, cognitive function, mood, and cardiovascular and neurological background, should be considered before treating subclinical hypothyroidism with more potential benefits in patients under 75 years old. Levothyroxine formulations facilitating hormone absorption and increasing compliance to long-term treatment should be preferred. TSH target should usually be set over 3 mIU/ml. Defining optimal diagnostic approaches and targeted therapeutic strategies should be considered in the personalized management of aged patients with hypothyroidism.
Collapse
Affiliation(s)
- Vincenzo Fiore
- UOSD Diabetologia – Endocrinologia, ASL RM5, Rome, Italy
| | | | - S Barraco
- UOSD Diabetologia – Endocrinologia, ASL RM5, Rome, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | | | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| |
Collapse
|
11
|
Tong R, Wu T, Chen J. Chinese Medicine Supplementing Qi and Activating Blood Circulation Relieves the Progression of Diabetic Cardiomyopathy. Endocr Metab Immune Disord Drug Targets 2024; 24:163-171. [PMID: 37138487 DOI: 10.2174/1871530323666230501151924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/06/2023] [Accepted: 03/15/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Diabetic cardiomyopathy (DCM) is the leading cause of diabetic death as the final occurrence of heart failure and arrhythmia. Traditional Chinese medicine is usually used to treat various diseases including diabetes. OBJECTIVE This study sought to investigate the effects of Traditional Chinese medicine supplementing Qi and activating blood circulation (SAC) in DCM. METHODS After the construction of the DCM model by streptozotocin (STZ) injection and high glucose/fat diet feeding, rats were administered intragastrically with SAC. Then, cardiac systolic/diastolic function was evaluated by detecting left ventricular systolic pressure (LVSP), maximal rate of left ventricular pressure rise (+LVdp/dtmax), and fall (-LVdp/dtmax), heart rate (HR), left ventricular ejection fraction (EF), LV fractional shortening (FS) and left ventricular end-diastolic pressure (LVEDP). Masson’s and TUNEL staining were used to assess fibrosis and cardiomyocyte apoptosis. RESULTS DCM rats exhibited impaired cardiac systolic/diastolic function manifested by decreasing LVSP, + LVdp/dtmax, -LVdp/dtmax, HR, EF and FS, and increasing LVEDP. Intriguingly, traditional Chinese medicine SAC alleviated the above-mentioned symptoms, indicating a potential role in improving cardiac function. Masson’s staining substantiated that SAC antagonized the increased collagen deposition and interstitial fibrosis area and the elevations in protein expression of fibrosis-related collagen I and fibronectin in heart tissues of DCM rats. Furthermore, TUNEL staining confirmed that traditional Chinese medicine SAC also attenuated cardiomyocyte apoptosis in DCM rats. Mechanically, DCM rats showed the aberrant activation of the TGF-β/Smad signaling, which was inhibited after SAC. CONCLUSION SAC may exert cardiac protective efficacy in DCM rats via the TGF-β/Smad signaling, indicating a new promising therapeutic approach for DCM.
Collapse
Affiliation(s)
- Ruxi Tong
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P.R. China
- National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, P.R. China
| | - Tianmin Wu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P.R. China
- National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, P.R. China
| | - Jinshui Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P.R. China
- National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, P.R. China
| |
Collapse
|
12
|
van Heemst D. The ageing thyroid: implications for longevity and patient care. Nat Rev Endocrinol 2024; 20:5-15. [PMID: 37923847 DOI: 10.1038/s41574-023-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/06/2023]
Abstract
Thyroid hormones have vital roles in development, growth and energy metabolism. Within the past two decades, disturbances in thyroid hormone action have been implicated in ageing and the development of age-related diseases. This Review will consider results from biomedical studies that have identified the importance of precise temporospatial regulation of thyroid hormone action for local tissue maintenance and repair. Age-related disturbances in the maintenance of tissue homeostasis are thought to be important drivers of age-related disease. In most iodine-proficient human populations without thyroid disease, the mean, median and 97.5 centile for circulating concentrations of thyroid-stimulating hormone are progressively higher in adults over 80 years of age compared with middle-aged (50-59 years) and younger (20-29 years) adults. This trend has been shown to extend into advanced ages (over 100 years). Here, potential causes and consequences of the altered thyroid status observed in old age and its association with longevity will be discussed. In about 5-20% of adults at least 65 years of age, thyroid-stimulating hormone concentrations are elevated but circulating concentrations of thyroid hormone are within the population reference range, a condition referred to as subclinical hypothyroidism. Results from randomized clinical trials that have tested the clinical benefit of thyroid hormone replacement therapy in older adults with mild subclinical hypothyroidism will be discussed, as well as the implications of these findings for screening and treatment of subclinical hypothyroidism in older adults.
Collapse
Affiliation(s)
- Diana van Heemst
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands.
| |
Collapse
|
13
|
Han S, Jeong S, Choi S, Park SJ, Kim KH, Lee G, Cho Y, Son JS, Park SM. Association of Thyroid Hormone Medication Adherence With Risk of Dementia. J Clin Endocrinol Metab 2023; 109:e225-e233. [PMID: 37515589 DOI: 10.1210/clinem/dgad447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/18/2023] [Accepted: 07/28/2023] [Indexed: 07/31/2023]
Abstract
CONTEXT Recent studies suggest that hypothyroidism is a risk factor for dementia. Based on existing literature, it is unclear if treatment or compliance to treatment is associated with decreased dementia risk in hypothyroidism patients. OBJECTIVE To determine the association between thyroid hormone medication adherence and risk of dementia. METHODS A population-based cohort study following patients with newly diagnosed hypothyroidism until incidence of dementia, death, or December 31, 2020, whichever came earliest. The study comprised 41 554 older adults age 50 and above with newly diagnosed hypothyroidism between 2004 and 2008 who underwent health screening. Risk of dementia was evaluated using multivariable-adjusted Cox proportional hazards regression. RESULTS Among 5188 men (12.5%) and 36 366 (87.5%) women, 2120 cases of incident dementia were identified. After stratification of the participants according to the interquartile range of the medication possession ratio (MPR), the fourth quartile (highest adherence) showed a 14% lower risk of overall dementia compared with the first quartile (lowest adherence) (adjusted hazard ratio 0.86; 95% CI 0.76-0.97). No consistent association was observed between thyroid hormone medication adherence and vascular dementia. After a dichotomous stratification of the MPR, higher MPR (≥0.8) showed a lower risk of Alzheimer disease (adjusted hazard ratio 0.91; 95% CI 0.84-0.99) than lower MPR (<0.8). CONCLUSION Better adherence to thyroid hormone medication may be beneficial in preventing incident dementia, especially Alzheimer disease, in older adults with newly diagnosed hypothyroidism. Along with the resolution of hypothyroid symptoms and the reduction of cardiovascular risk factors, the reduction of dementia risk may be another potential benefit of thyroid hormone medication.
Collapse
Affiliation(s)
- Saemi Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam 13448, Korea
| | - Seulggie Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Yoosun Cho
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, South Korea
| | - Joung Sik Son
- Department of Family Medicine, Korea University Guro Hospital, Seoul 08308, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
| |
Collapse
|
14
|
Chen H, Hu J, Yang X, Zhou Q, Hu Y, Tang X, Tang J, Zeng L, Yang J. Low levels of free triiodothyronine are associated with risk of cognitive impairment in older euthyroid adults. Sci Rep 2023; 13:22133. [PMID: 38092827 PMCID: PMC10719249 DOI: 10.1038/s41598-023-49285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
Accumulated evidence showed that thyroid diseases induced cognitive decline. However, the relationship between thyroid hormones (THs) and cognition in older euthyroid people is still unclear. Our study aimed to estimate the association between THs within the euthyroid range and cognition in community-dwelling older adults in China. Data were extracted from a cohort study on the health status of rural older adults from the Guizhou province in China (HSRO). Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured using the electrochemiluminescence immunoassay. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). Linear regression and a binary logistic regression model were used to explore the relationship between THs and cognition in euthyroidism (TSH level of 0.27 ~ 4.20mIU/L). A total of 957 euthyroidism individuals were included in this study, with a mean (SD) age of 71.34 (6.35) years. In individuals with euthyroidism, serum TSH and FT3 levels were positively associated with cognition (TSH:β = 0.06, 95% CI 0.01 ~ 0.11, P = 0.03; FT3:β = 0.07, 95% CI 0.01 ~ 0.12, P = 0.01); and serum FT3 and TSH levels were significantly associated with cognitive domains (P < 0.05). Further, euthyroid individuals in the lowest serum FT3(OR = 1.96; 95% CI 1.27 ~ 3.03) quartile had a twofold increased risk of cognitive impairment compared to those in the highest quartile after adjusting for potential confounding factors. These findings suggested that low levels of FT3 could be an independent risk factor for cognitive impairment in older euthyroid adults. Additionally, a positive linear association exists between serum FT3 levels and cognitive domains (such as immediate memory, language, and attention). Further studies are needed to determine the underlying mechanisms and the community significance of these findings.
Collapse
Affiliation(s)
- Hao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
- The Third People's Hospital of Guizhou Province, Guiyang, China
| | - Jin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Xing Yang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, China
| | - Quanxiang Zhou
- Department of Clinical Medicine, Qinnan Medical College for Nationalities, Qiannan, China
| | - Yuxin Hu
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Xiaoyan Tang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Ji Tang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Li Zeng
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China
| | - Jingyuan Yang
- Department of Epidemiology and Health Statistics, School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Guizhou Medical University, Guiyang, China.
| |
Collapse
|
15
|
Adams R, Oh ES, Yasar S, Lyketsos CG, Mammen JS. Endogenous and Exogenous Thyrotoxicosis and Risk of Incident Cognitive Disorders in Older Adults. JAMA Intern Med 2023; 183:1324-1331. [PMID: 37870843 PMCID: PMC10594176 DOI: 10.1001/jamainternmed.2023.5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/15/2023] [Indexed: 10/24/2023]
Abstract
Importance Thyroid hormone is among the most common prescriptions in the US and up to 20% may be overtreated. Endogenous hyperthyroidism may be a risk factor for dementia, but data are limited for iatrogenic thyrotoxicosis. Objective To determine whether thyrotoxicosis, both endogenous and exogenous, is associated with increased risk of cognitive disorders. Design, Setting, and Participants This cohort study performed a longitudinal time-varying analysis of electronic health records for patients receiving primary care in the Johns Hopkins Community Physicians Network between January 1, 2014, and May 6, 2023. Patients 65 years and older with at least 2 visits 30 days apart to their primary care physicians were eligible. None of the 65 931 included patients had a history of low thyrotropin (TSH) level or cognitive disorder diagnoses within 6 months of their first visit. Data analysis was performed from January 1 through August 5, 2023. Exposure The exposure variable was a low TSH level, characterized based on the clinical context as due to endogenous thyrotoxicosis, exogenous thyrotoxicosis, or unknown cause, excluding those attributable to acute illness or other medical factors such as medications. Main Outcomes and Measures The outcome measure was cognitive disorders, including mild cognitive impairment and all-cause dementia, to improve sensitivity and account for the underdiagnosis of dementia in primary care. Results A total of 65 931 patients were included in the analysis (median [IQR] age at first visit, 68.0 [65.0-74.0] years; 37 208 [56%] were female; 46 106 [69.9%] were White). Patients exposed to thyrotoxicosis had cognitive disorder incidence of 11.0% (95% CI, 8.4%-14.2%) by age 75 years vs 6.4% (95% CI, 6.0%-6.8%) for those not exposed. After adjustment, all-cause thyrotoxicosis was significantly associated with risk of cognitive disorder diagnosis (adjusted hazard ratio, 1.39; 95% CI, 1.18-1.64; P < .001) across age groups. When stratified by cause and severity, exogenous thyrotoxicosis remained a significant risk factor (adjusted hazard ratio, 1.34; 95% CI, 1.10-1.63; P = .003) with point estimates suggestive of a dose response. Conclusions and Relevance In this cohort study among patients 65 years and older, a low TSH level from either endogenous or exogenous thyrotoxicosis was associated with higher risk of incident cognitive disorder. Iatrogenic thyrotoxicosis is a common result of thyroid hormone therapy. With thyroid hormone among the most common prescriptions in the US, understanding the negative effects of overtreatment is critical to help guide prescribing practice.
Collapse
Affiliation(s)
- Roy Adams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esther S. Oh
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sevil Yasar
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S. Mammen
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
16
|
Papaleontiou M, Brito JP. Disentangling the Association Between Excess Thyroid Hormone and Cognition in Older Adults. JAMA Intern Med 2023; 183:1332-1333. [PMID: 37870840 DOI: 10.1001/jamainternmed.2023.5618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute of Gerontology, University of Michigan, Ann Arbor
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
17
|
Zhang X, Li Y, Jin J, Wang H, Zhao B, Wang S, Shan Z, Teng W, Teng X. The different outcomes in the elderly with subclinical hypothyroidism diagnosed by age-specific and non-age-specific TSH reference intervals: a prospectively observational study protocol. Front Endocrinol (Lausanne) 2023; 14:1242110. [PMID: 38075041 PMCID: PMC10701677 DOI: 10.3389/fendo.2023.1242110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/19/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Subclinical hypothyroidism (SCH) is a common endocrine disorder characterized by elevated thyroid-stimulating hormone (TSH) levels and normal free thyroxine (FT4) levels. The overdiagnosis and overtreatment of SCH in elderly patients have become concerns as TSH levels naturally increase with age. Studies have shown that many elderly patients with SCH can recover without treatment, and the administration of levothyroxine (L-T4) does not improve their prognosis. Therefore, It is necessary to establish age-specific reference ranges for TSH in elderly individuals to aid in clinical decision-making and prevent overdiagnosis. Methods This is a multicenter prospective study that focuses on Chinese elderly patients with SCH who have TSH levels below 10 mU/L. After obtaining the informed consent of the patients, their initial diagnosis information will be registered, and they will be asked to fill out questionnaires such as the Montreal Cognitive Assessment-Basic (MoCA-B), Hamilton Depression Scale (HAMD), Hypothyroidism Symptom Questionnaire (SRQ), frail scale(FRAIL), fatigue scale, and EQ-5D. In addition, thyroid function tests, blood lipid analysis, carotid artery ultrasound, and thyroid ultrasound examinations will be conducted. Patients will also be grouped according to FT4 levels, the changes in FT4 and its relationship with TSH can also be described. For patients over 80 years old, a decrease in FT4 will be used as an endpoint event, while for patients between 60-80 years old, TSH levels greater than or equal to 10mIU/L or a decline in FT4 will be used as the endpoint event. The TSH reference intervals of the general and elderly populations will be used to calculate medical costs associated with multiple follow-ups of patients, and a social-economic analysis will also be conducted. Discussion This study will prospectively observe elderly patients with SCH who are screened using both age-specific and non-age-specific TSH reference ranges for the elderly population. We will compare the results of elderly patients diagnosed with SCH using different reference ranges and analyze their association with FT4 to identify meaningful SCH patients and reduce over diagnosis and over treatment of elderly SCH. Ethics The Medical Science Research Ethics Committee of the First Affiliated Hospital of China Medical University approved this study (ID: AF-SOP-07-1.1-01). The results will be published in an open-access journal. Clinical trial registration https://www.chictr.org.cn/, identifier ChiCTR2300070831.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaochun Teng
- Department of Endocrinology and Metabolism, Institute of Endocrine, National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
18
|
Yazdaan HE, Jaya F, Sanjna F, Junaid M, Rasool S, Baig A, Natt MZ, Maurya N, Iqbal S, Yeldo BA, Khan AS, Varrassi G, Kumar S, Khatri M, Awan SK. Advances in Thyroid Function Tests: Precision Diagnostics and Clinical Implications. Cureus 2023; 15:e48961. [PMID: 38111456 PMCID: PMC10726078 DOI: 10.7759/cureus.48961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
This narrative review explores the evolving field of thyroid function testing, explicitly highlighting the significance of precision diagnostics and their substantial impact on clinical practice. Commencing with a comprehensive examination of the historical progression of thyroid diagnostics, the discourse proceeds to explore recent developments, highlighting the paramount importance of accuracy in testing methods. The primary issue under consideration is the crucial requirement for accuracy in the field of therapeutic practice. The review critically examines the problems related to the interpretation, standardization, and ethical considerations in examining advanced laboratory techniques, novel biomarkers, and state-of-the-art technologies like immunoassays, molecular testing, and automation. The focus on the paradigm shift towards precision diagnostics brings attention to the complex connection between test results and their direct influence on patient care. This investigation expands upon the incorporation of imaging and molecular diagnostics, highlighting the rising significance of precision in customizing treatment strategies. In summary, the study provides a prospective viewpoint, recognizing the persistent obstacles and highlighting the want for dependable, uniform methodologies in thyroid diagnostics. This narrative's primary objective is to guide physicians, researchers, and stakeholders in effectively navigating the intricate nature of contemporary thyroid function tests, with a particular emphasis on resolving the fundamental issue of precision.
Collapse
Affiliation(s)
- Hamd E Yazdaan
- Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Fnu Jaya
- Medicine, Ziauddin University, Karachi, PAK
| | - Fnu Sanjna
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Maha Junaid
- Medicine, Shifa College of Medicine, Islamabad, PAK
| | - Sohaib Rasool
- Medicine, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Ahmadullah Baig
- Internal Medicine, Allama Iqbal Medical College/ Jinnah Hospital, Lahore, PAK
| | | | - Nikhil Maurya
- Medicine, Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, IND
| | - Subhan Iqbal
- Diagnostic Radiology, Dr. Ziauddin Hospital North Nazimabad, Karachi, PAK
| | | | - Alina S Khan
- Medicine and Surgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | | |
Collapse
|
19
|
Xie Y, Wang Z, Chen Z. Analysis of Subclinical Thyroid Dysfunction and Metabolic Abnormality in 28568 Healthy People. Int J Endocrinol 2023; 2023:5216945. [PMID: 37876378 PMCID: PMC10593554 DOI: 10.1155/2023/5216945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/26/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
We analyzed the detection rates of metabolic syndrome (MetS) and subclinical thyroid dysfunction, including subclinical hyperthyroidism (SCHyper) and subclinical hypothyroidism (SCH), in healthy people, as well as their relationship. Clinical data were collected from 28,568 healthy individuals who underwent physical examinations. The detection rates of SCHyper, SCH, and MetS, as well as in different genders and ages, were analyzed. The detection rate of SCHyper and SCH in females was significantly higher than that in males (P < 0.001), but that of MetS in males was significantly higher than that in females (P < 0.001). In each age group, the detection rate of SCH in females was higher than that in males (P < 0.001). The detection rate of SCH was significantly different in different age groups (P < 0.001). The detection rates of hyperlipidemia (P < 0.001), obesity (P = 0.004), hypertension (P = 0.009), and hyperglycemia (P < 0.001) in the female SCH group were significantly higher than those in the normal group. The detection rates of hyperlipidemia (P = 0.006), obesity (P = 0.04), and hypertension (P = 0.04) in the male SCH group were higher than those in the normal group. The males with SCHyper were more prone to hyperlipidemia (P = 0.02) and obesity (P = 0.03). In addition, the female SCHyper group was not significantly different from the normal group (P > 0.05). Conclusively, the detection rate of SCHyper and SCH in females is higher than that in males, which increases with age. Attention should be paid to subclinical thyroid dysfunction in elderly people, especially females. Early individualized screening and early intervention should be carried out for people with abnormal metabolism.
Collapse
Affiliation(s)
- Yan Xie
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Zhixue Wang
- Department of Clinical Laboratory, Bishan Hospital of Chongqing Medical University (Bishan Hospital of Chongqing), Chongqing 402760, China
| | - Zongtao Chen
- Health Management Centre, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| |
Collapse
|
20
|
Yashkin AP, Kolpakov S, Ukraintseva S, Yashin A, Akushevich I. Graves Disease is Associated with Increased Risk of Clinical Alzheimer's Disease: Evidence from the Medicare System. RESEARCH SQUARE 2023:rs.3.rs-2596630. [PMID: 37886578 PMCID: PMC10602068 DOI: 10.21203/rs.3.rs-2596630/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Identification of modifiable risk factors for Alzheimer's Disease (AD) onset is an important aspect of controlling the burden imposed by this disease on an increasing number of older U.S. adults. Graves disease (GD), the most common cause of hyperthyroidism in the U.S., has been hypothesized to be associated with increased AD risk, but there is no consensus. In this study, we explore the link between GD and risk of clinical AD. Methods Cox and Fine-Grey models were applied to a retrospective propensity-score-matched cohort of 15,505 individuals with GD drawn from a nationally representative 5% sample of U.S. Medicare beneficiaries age 65 + over the 1991-2017 period. Results Results showed that the presence of GD was associated with a higher risk of AD (Hazard Ratio [HR]:1.15; 95% Confidence Interval [CI]:1.07-1.23). Magnitude of associated risk varied across subgroups: Males (HR:1.19; CI:1.01-1.41), Females (HR:1.09; CI:1.02-1.18), Whites (HR:1.13; CI:1.04-1.20), Blacks (HR:1.33; CI:1.04-1.20). Competing risk estimates were consistent with these findings. Conclusions A potential mechanism connecting GD and AD may involve shared etiological factors between the two diseases. Although replication of our findings is needed, they suggest that GD prevention and treatment may contribute to reducing the burden of AD in U.S. older adults.
Collapse
|
21
|
Ma F, Zhang Q, Shi J, Li S, Wu L, Zhang H. Risk factors for cognitive dysfunction and glycemic management in older adults with type 2 diabetes mellitus: a retrospective study. BMC Endocr Disord 2023; 23:220. [PMID: 37821909 PMCID: PMC10565992 DOI: 10.1186/s12902-023-01476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Epidemiological evidence shows a robust relationship between cognitive dysfunction and type 2 diabetes mellitus (T2DM). This study identified major risk factors that might prevent or ameliorate T2DM-associated cognitive dysfunction in the realm of clinical practice. METHODS Using Mini-mental State Examination (MMSE) in the light of education level, we identified older adults with T2DM on admission aged 50 and above. We conducted this case-control study when eligible participants were divided into Cognitively Normal (CN) group and Cognitively Impaired (CI) group. Analytical data referred to demographic characteristics, clinical features, fluid biomarkers, and scale tests. RESULTS Of 596 records screened, 504 cases were included in the final analysis. Modified multivariate logistic regression analysis verified that homocysteine (OR = 2.048, 95%CI = 1.129-3.713), brain infarction (OR = 1.963, 95%CI = 1.197-3.218), dementia (OR = 9.430, 95%CI = 2.113-42.093), education level (OR = 0.605, 95%CI = 0.367-0.997), severity of dependence (OR = 1.996, 95%CI = 1.397-2.851), creatine kinase (OR = 0.514, 95%CI = 0.271-0.974) were significant risk factors of incident T2DM-related cognitive dysfunction in patients of advanced age. CONCLUSION Our study supported a robust relationship between T2DM and cognitive dysfunction. Our results provide clinicians with major risk factors for T2DM-related cognitive dysfunction, in particular the protective role of creatine kinase.
Collapse
Affiliation(s)
- Fanyuan Ma
- Department of Geriatrics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Qian Zhang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Juan Shi
- Department of Anatomy, Histology and Embryology, Air Force Medical University, Xi'an, 710032, China
| | - Shuaifeng Li
- Department of Spine Surgery, General Hospital of PLA Tibet Military Area Command, Lhasa, 850007, China
| | - Liping Wu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Hua Zhang
- Department of Geriatrics, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, China.
| |
Collapse
|
22
|
Lou K, Liu S, Zhang F, Sun W, Su X, Bi W, Yin Q, Qiu Y, Zhang Z, Jing M, Ma S. The effect of hyperthyroidism on cognitive function, neuroinflammation, and necroptosis in APP/PS1 mice. J Transl Med 2023; 21:657. [PMID: 37740205 PMCID: PMC10517505 DOI: 10.1186/s12967-023-04511-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Increasing evidence has linked the thyroid dysfunction to the pathogenesis of dementia. Evidence from clinical studies has demonstrated that hypothyroidism is related to an increased risk of dementia. But the association of hyperthyroidism with dementia is largely unknown. METHODS We used the adenovirus containing thyrotropin receptor (TSHR) amino acid residues 1-289 (Ad-TSHR289)-induced Graves' disease (GD) phenotype in Alzheimer's disease (AD) model mice (APP/PS1 mice) to evaluate the effect of hyperthyroidism on the cognitive function and β-amyloid (Aβ) accumulation. RESULTS GD mice exhibited a stable long-term hyperthyroidism and cognitive deficits. Single Cell RNA-sequencing analysis indicated that microglia function played a critical role in the pathophysiological processes in GD mice. Neuroinflammation and polarization of microglia (M1/M2 phenotype) and activated receptor-interacting serine/threonine protein kinase 3 (RIPK3)/mixed lineage kinase domain-like pseudo-kinase (MLKL)-mediated necroptosis contributed to the pathological process, including Aβ deposition and neuronal loss. RIPK3 inhibitor could inhibit GD-mediated Aβ accumulation and neuronal loss. CONCLUSIONS Our findings reveal that GD hyperthyroidism aggravates cognitive deficits in AD mice and induces Aβ deposition and neuronal loss by inducing neuroinflammation and RIPK3/MLKL-mediated necroptosis.
Collapse
Affiliation(s)
- Kai Lou
- Department of Endocrinology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, China
| | - Shudong Liu
- Department of Endocrinology, Shandong Rongjun General Hospital, Jinan, 250013, China
| | - Fengxia Zhang
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China
| | - Wenxiu Sun
- Department of Nursing, Taishan Vocational College of Nursing, Taian, 271000, Shandong, China
| | - Xinhuan Su
- Department of Geriatrics Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Wenkai Bi
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, 250021, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Qingqing Yin
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yaxin Qiu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, 250021, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Zhenyuan Zhang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, 250021, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Mengzhe Jing
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, 250021, Shandong, China
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Shizhan Ma
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China.
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, 250021, Shandong, China.
- Shandong Prevention and Control Engineering Laboratory of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China.
| |
Collapse
|
23
|
Rajabi F, Rahimi S, Maracy MR, Barekatain M. Association between cognitive capacity and metabolic indices in patients with neuropsychiatric disorders. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:292. [PMID: 37849862 PMCID: PMC10578545 DOI: 10.4103/jehp.jehp_82_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/11/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Although previous studies suggested the relationship between metabolic indices and cognitive capacity, results have been conflicting. The prevalence of metabolic and cognitive disorders is high in patients with neuropsychiatric disorders. We aimed to assess the relationship between laboratory metabolic indices and specific areas of cognitive capacity. MATERIALS AND METHODS This was a retrospective review of the medical records of 423 from 452 patients with neuropsychiatric disorders who were admitted to the neuropsychiatry unit, Ayatollah Kashani Hospital, Isfahan, Iran, from September 1, 2018, to September 30, 2022. We extracted demographic factors, laboratory metabolic indices, and scores of the Neuropsychiatry Unit Cognitive Assessment tool (NUCOG). We utilized a generalized linear model (GLM) to demonstrate the effect of metabolic indices on the risk of reduction in cognitive domains. Due to the presence of missing data in the metabolic indices, we used the multiple imputation method. RESULTS The regression coefficient of NUCOG total score and subscale scores for metabolic indices using GLM after multiple imputation method demonstrated that among the metabolic indicators, fasting blood sugar (FBS) had the reverse relationship with the total score of NUCOG (β = -.05). Among the NUCOG subscales, executive functioning had the strongest relationship with FBS (β = -.01). Also, there was a negative relationship between patients' age and the total score of NUCOG (β = -.38). Educational level had a positive relationship with the total NUCOG score (β =10.2). CONCLUSIONS The main metabolic factors that might reduce cognitive capacity were higher FBS.
Collapse
Affiliation(s)
- Fatemeh Rajabi
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayyeh Rahimi
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad R. Maracy
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
24
|
Yu ZW, Pu SD, Sun XT, Wang XC, Gao XY, Shan ZY. Impaired Sensitivity to Thyroid Hormones is Associated with Mild Cognitive Impairment in Euthyroid Patients with Type 2 Diabetes. Clin Interv Aging 2023; 18:1263-1274. [PMID: 37554512 PMCID: PMC10406107 DOI: 10.2147/cia.s413584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
Purpose The prevalence of mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D) is rapidly increasing. Thyroid hormones are key regulators of cognitive function in adults. The purpose of this study was to investigate the relationship between thyroid hormone sensitivity and MCI in euthyroid T2D patients. Patients and Methods A total of 400 euthyroid T2D patients were enrolled in this cross-sectional study, including 218 patients with normal cognition and 182 MCI patients. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function. The free triiodothyronine to free thyroxine (FT3/FT4) ratio was calculated as a measure of peripheral sensitivity to thyroid hormones; the thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI) and thyroid feedback quantile-based index (TFQI) were calculated as measures of central sensitivity to thyroid hormones. Linear regression analysis and logistic regression analysis were performed to explore the relationships between these indices of thyroid hormone sensitivity and the MoCA score and MCI, respectively. Results Compared with the normal cognitive function group, patients in the MCI group had higher TSHI, TT4RI and TFQI but a lower FT3/FT4 ratio (P<0.05). The MoCA score was positively correlated with the FT3/FT4 ratio but negatively correlated with TSHI, TT4RI and TFQI (P< 0.05). Multivariate logistic regression analysis showed that a low FT3/FT4 ratio and high TSHI, TT4RI and TFQI were independently associated with MCI (P<0.05). After adjustment for confounding factors, the odds ratio (OR) for the association between MCI and the highest tertile of the FT3/FT4 was 0.455 (95% CI: 0.264-0.785), for the highest tertile of TSHI, the OR was 2.380 (95% CI: 1.376-4.119), for the highest tertile of TT4RI, the OR was 2.342 (95% CI:1.353-4.054), and for the highest tertile of TFQI, the OR was 2.536 (95% CI: 1.466-4.387) (P< 0.05). Conclusion Impaired sensitivity to thyroid hormones is associated with MCI in euthyroid T2D patients.
Collapse
Affiliation(s)
- Zi-Wei Yu
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Sheng-Dan Pu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xiao-Tong Sun
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xi-Chang Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Xin-Yuan Gao
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Zhong-Yan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| |
Collapse
|
25
|
Cappola AR, Auchus RJ, El-Hajj Fuleihan G, Handelsman DJ, Kalyani RR, McClung M, Stuenkel CA, Thorner MO, Verbalis JG. Hormones and Aging: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1835-1874. [PMID: 37326526 DOI: 10.1210/clinem/dgad225] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Multiple changes occur across various endocrine systems as an individual ages. The understanding of the factors that cause age-related changes and how they should be managed clinically is evolving. This statement reviews the current state of research in the growth hormone, adrenal, ovarian, testicular, and thyroid axes, as well as in osteoporosis, vitamin D deficiency, type 2 diabetes, and water metabolism, with a specific focus on older individuals. Each section describes the natural history and observational data in older individuals, available therapies, clinical trial data on efficacy and safety in older individuals, key points, and scientific gaps. The goal of this statement is to inform future research that refines prevention and treatment strategies in age-associated endocrine conditions, with the goal of improving the health of older individuals.
Collapse
Affiliation(s)
- Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Richard J Auchus
- Departments of Pharmacology and Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
- Endocrinology and Metabolism Section, Medical Service, LTC Charles S. Kettles Veteran Affairs Medical Center, Ann Arbor, MI 48015, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology, Department of Internal Medicine, American University of Beirut, Beirut 1107-2020, Lebanon
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Andrology Department, Concord Repatriation General Hospital, Sydney 2139, Australia
| | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Michael McClung
- Oregon Osteoporosis Center, Portland, OR 97213, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Cynthia A Stuenkel
- Department of Medicine, University of California, San Diego, School of Medicine, La Jolla, CA 92093, USA
| | - Michael O Thorner
- Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20057, USA
| |
Collapse
|
26
|
Hennessey JV. Levothyroxine Monotherapy: What Works Better for the Individual With Hypothyroidism? Endocr Pract 2023; 29:572-580. [PMID: 37419564 DOI: 10.1016/j.eprac.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 07/09/2023]
Abstract
OBJECTIVE I explore objective data not supporting the addition of liothyronine (medication) (LT3) to levothyroxine (medication) (LT4) in patients with hypothyroidism. Accurate identification of patients with symptomatic (almost exclusively overt) hypothyroidism is important in evaluating clinical outcomes of therapies. Recent studies have documented that nearly a third of individuals who are offered thyroid hormone are euthyroid at the time of initiation. Additionally, others are clinically diagnosed without biochemical confirmation, so a sizable proportion of those started on LT4 are not hypothyroid. The assumption that nonhypothyroid symptoms will resolve with LT4 is problematic. The true underlying cause of these symptoms remains unidentified and untreated. METHODS In a narrative fashion I will review the positive predictive value of and correlation of symptoms consistent with hypothyroidism and confirmed hypothyroidism likely to favorably respond to thyroid hormone replacement. RESULTS Following a review of the reliability of thyroid-stimulating hormone (TSH) in predicting a euthyroid state, the correlation of circulating triiodothyronine (serum measurement) (T3) levels with symptoms and predictive value of T3 to forecast the outcome of adding LT3 to LT4 will be reviewed. The utility of striving for high, middle, or low TSH set points within the expected range to predict changes in clinical quality of life and the ability of blinded patients to sense subtle differences along this spectrum will be documented. In addition, the clinical impact of single nucleotide polymorphisms in the type 2 deiodinase gene will be reviewed. Finally, the overall satisfaction of selected patients with their thyroid hormone treatments will be outlined and preferences for T3-containing treatments from blinded studies will be summarized. CONCLUSION Basing thyroid hormone treatment decisions on patient symptoms likely results in missed diagnoses We should encourage primary care physicians to assess a differential diagnosis, exclude other diagnoses, and not assume a thyroid etiology when TSH is normal. Modifying treatment to a particular TSH target or adjusting based on a low T3 level does not seem to enhance patient outcomes. Finally, pending further trials of "symptomatic" participants, using sustained release LT3 to mimic normal physiology, and including monocarboxylate 10 transporter and Type 2 deiodinase polymorphisms and objective outcomes, I will continue to depend on therapy with LT4 monotherapy and seek alternative explanations for my patients' nonspecific symptoms.
Collapse
Affiliation(s)
- James V Hennessey
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
27
|
Wu J, Wang Z, Xu H, Yang L, Liu J, Zheng Y, Kang C, Wang X, Shi J, Zhao N, Zhang XY. Thyroid dysfunction in young, first-episode and drug-naïve patients with major depressive disorder: prevalence and associated clinical factors. Front Psychiatry 2023; 14:1156481. [PMID: 37457778 PMCID: PMC10348838 DOI: 10.3389/fpsyt.2023.1156481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
Objective The incidence of thyroid dysfunction (TD) and major depressive disorder (MDD) is increasing year by year in the general population. However, the prevalence and correlates of TD in first-episode drug-naive (FEDN) MDD patients have not been explored. This study sought to fill this gap and examine the association between TD and MDD. Methods We recruited 1,289 FEDN MDD patients aged 18 ~ 45 years. A total of 1,289 FEDN MDD outpatients were recruited. Demographical and suicide data were collected for each patient, and lipid profiles, thyroid function, and fasting blood glucose (FBG) levels were measured. The Hamilton Depression Scale 17 (HAMD-17) was assessed for depression. Results The prevalence of TD in young FEDN MDD patients was 64.86%. Compared with those without TD, patients with TD had longer duration of illness, greater HAMD score, higher BMI, TG, TC, and LDL-C levels, and higher suicide attempt rates, but lower HDL-C and FBG levels. Further logistic regression indicated that duration of illness, HAMD score, TC, HDL-C, BMI, and FBG levels were significantly associated with TD. Limitations No causal relationship can be drawn due to the cross-sectional design. Conclusion TD is common in young FEDN MDD patients. So clinicians should monitor thyroid function in patients with MDD.
Collapse
Affiliation(s)
- Jinbo Wu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | | | - Hongjiao Xu
- Qingdao Mental Health Center, Qingdao, China
| | - Liying Yang
- Dalian No.7 People's Hospital, Dalian, Liaoning Province, China
| | - Jiacheng Liu
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yue Zheng
- Peking University Sixth Hospital, Beijing, China
| | - Chuanyi Kang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaohong Wang
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jingjing Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Na Zhao
- First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
28
|
Cho S, Ok Kim C, Cha BS, Kim E, Mo Nam C, Kim MG, Soo Park M. The effects of long-term cumulative HbA1c exposure on the development and onset time of dementia in the patients with type 2 diabetes mellitus: hospital based retrospective study (2005-2021). Diabetes Res Clin Pract 2023:110721. [PMID: 37196708 DOI: 10.1016/j.diabres.2023.110721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
AIMS We examine cumulative effect of long-term glycemic exposure in patients with type 2 diabetes mellitus (T2DM) on the development of dementia. METHODS The study involved 20,487 records of patients with T2DM identified in the electronic medical record at Severance Hospital, Korea. Cumulative HbA1c (AUCHbA1c) and mean HbA1c over time (HbA1cavg) as measures of long-term glycemic exposure were compared for the development of dementia and the time to dementia. RESULTS AUCHbA1c and HbA1cavg were significantly higher in patients who later developed dementia than in those who did not dementia (AUCHbA1c: 56.2 ± 26.4 vs. 52.1 ± 26.1 %*Year; HbA1cavg: 7.0 ± 1.0 vs. 7.3 ± 1.0 %). Odds ratio of dementia increased when HbA1cavg was 7.2% (55 mmol/mol) or above, and when AUCHbA1c was 42 %*Year (e.g., HbA1c 7.0% maintained for 6 years) or above. Among those who developed dementia, as HbA1cavg increased, the time to dementia onset decreased (β = -380.6 days, 95% confidence interval [CI]: -416.2 to -345.0). CONCLUSIONS Our results indicate poorly controlled T2DM was associated with an increased risk of developing dementia, as measured by AUCHbA1c and HbA1cavg. Higher cumulative glycemic exposure may lead to developing dementia in a shorter time.
Collapse
Affiliation(s)
- Sunyoung Cho
- Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul, Korea.
| | - Choon Ok Kim
- Department of Clinical Pharmacology and Clinical Trials Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.
| | - Bong-Soo Cha
- Division of Endocrinology, Department of Internal Medicine, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, College of Medicine, Yonsei University, Yonsei University, Seoul, Korea.
| | - Chung Mo Nam
- Department of Preventive Medicine, College of Medicine , Yonsei University, Seoul, Korea.
| | - Min-Gul Kim
- Department of Pharmacology, College of Medicine, Jeonbuk National University, Jeonju, Korea.
| | - Min Soo Park
- Department of Pediatrics, Department of Clinical Pharmacology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Korea.
| |
Collapse
|
29
|
Wang L, Yu H, Hao L, Ju M, Feng W, Xiao R. The Interaction Effect of 27-Hydroxycholesterol Metabolism Disorder and CYP27A1 Single Nucleotide Polymorphisms in Mild Cognitive Impairment: Evidence from a Case-Control Study. Mol Nutr Food Res 2023; 67:e2200576. [PMID: 36811281 DOI: 10.1002/mnfr.202200576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/02/2023] [Indexed: 02/24/2023]
Abstract
SCOPE The aim of the study is to investigate the relationship between 27-hydroxycholesterol (27-OHC), 27-hydroxylase (CYP27A1) polymorphisms, and Alzheimer's disease (AD). METHODS AND RESULTS A case-control study based on EMCOA study includes 220 healthy cognition and mild cognitive impairment (MCI) subjects respectively, matched by sex, age, and education. The level of 27-OHC and its related metabolites are examined by high performance liquid chromatography-mass spectrometry (HPLC-MS). The results show that 27-OHC level is positively associated with risk of MCI (p < 0.001), negatively associated with specific domain of cognitive function. Serum 27-OHC is positively associated with 7a-hydroxy-3-oxo-4-cholestenoic acid (7-HOCA) in cognitive healthy subjects, while positively associated with 3β-hydroxy-5-cholestenoic acid (27-CA) in MCI subjects (p < 0.001). CYP27A1 and Apolipoprotein E (ApoE) single nucleotide polymorphisms (SNPs) genotyping are determined. The global cognitive function is significant higher in Del-carrier of rs10713583, compared with AA genotype (p = 0.007). Stroop Color-Word Test Interference Trial (SCWT-IT) is significant higher in G-carrier genotype (p = 0.042), compared with TT genotype in rs12614206. CONCLUSIONS The results show that 27-OHC metabolic disorder is associated with MCI and multi-domain cognitive function. CYP27A1 SNPs is correlated to cognitive function, while the interaction between 27-OHC and CYP27A1 SNPs need further study.
Collapse
Affiliation(s)
- Lijing Wang
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Huiyan Yu
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Ling Hao
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Mengwei Ju
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Wenjing Feng
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Rong Xiao
- School of Public Health, Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| |
Collapse
|
30
|
Cognitive Dysfunction, an Increasingly Valued Long-Term Impairment in Acromegaly. J Clin Med 2023; 12:jcm12062283. [PMID: 36983284 PMCID: PMC10058029 DOI: 10.3390/jcm12062283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
Acromegaly is a chronic disease caused by the overproduction of growth hormone (GH) and accompanying insulin-like growth factor-1 (IGF-1), which is often caused by GH-secreting pituitary adenomas. In addition to its somatic burden, a growing number of studies have found that patients suffering from acromegaly exhibit psychosocial and personality changes. Over the past 70 years, there has been increasing interest in the cognitive impairment and neuropsychological issues of patients with acromegaly, and a variety of neuropsychological and neurophysiological tests have been used to measure cognitive changes in patients. The impact of disease progression status, treatment modalities, and various comorbidities on cognitive function and the mechanisms of cognitive impairment in patients with acromegaly are therefore outlined in this review. Multidisciplinary assessment has important implications for the management of acromegaly, particularly in relation to cognitive function. Here, we summarize the relevant literature concerning cognitive-behavioral research on acromegaly to demonstrate the impact of long-term impairment caused by GH and IGF-1 on the cognitive behavior of patients.
Collapse
|
31
|
High Thyrotropin Levels and Risk of Mortality in the Elderly With Subclinical Hypothyroidism: A Systematic Review and Meta-analysis. Endocr Pract 2023; 29:206-213. [PMID: 36464133 DOI: 10.1016/j.eprac.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE This study aims to determine whether elevated endogenous thyrotropin levels contribute to an increased risk of adverse outcomes, such as all-cause mortality in older adults with subclinical hypothyroidism. METHODS Eight electronic databases were searched for relevant articles from inception until March 23, 2022. Cohort studies assessing the association between thyrotropin levels and the risk of mortality among older adults aged ≥60 years with subclinical hypothyroidism were eligible. The outcomes of interest were either all-cause or cardiovascular-related mortality. Two independent researchers assessed the eligibility of the studies and collected data through a previously defined data extraction form. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence, and multivariate-adjusted hazard ratios (HRs) (95% Cl) were collected as the necessary risk estimate for synthesis. Random-effects models were applied for meta-analysis. RESULTS Overall, 13 studies involving 44 514 participants were included in this meta-analysis. There were no significant differences in the risk of all-cause mortality (pooled HR: 1.18 [95% Cl: 0.95, 1.45], I2 = 94%) and cardiovascular-related mortality (pooled HR: 1.08 [95% Cl: 0.94, 1.23], I2 = 0%) between euthyroid older adults and older adults with subclinical hypothyroidism. The results remained the same when only older adults with thyrotropin ≥10 mIU/L were assessed (pooled HR for all-cause mortality and cardiovascular-related mortality, respectively: 1.53 [95% Cl: 0.81, 2.88], I2 = 22%, 1.35 [95% Cl: 0.63, 2.86], I2 = 43%). CONCLUSION High thyrotropin levels are not associated with increased risk for all-cause mortality as well as cardiovascular-related mortality in older adults aged ≥60 years with subclinical hypothyroidism, suggesting an unnecessity in initialing treatment.
Collapse
|
32
|
Chen Y, Han T. Cross‐sectional associations between healthy eating index and thyroid function in U.S. male Adults,
NHANES
2007–2012. Food Sci Nutr 2023. [DOI: 10.1002/fsn3.3270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- Yiqiu Chen
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, School of Medicine Tongji University Shanghai China
| | - Ting Han
- Department of Clinical Nutrition, Shanghai Tenth People's Hospital, School of Medicine Tongji University Shanghai China
| |
Collapse
|
33
|
Dolatshahi M, Salehipour A, Saghazadeh A, Sanjeari Moghaddam H, Aghamollaii V, Fotouhi A, Tafakhori A. Thyroid hormone levels in Alzheimer disease: a systematic review and meta-analysis. Endocrine 2023; 79:252-272. [PMID: 36166162 DOI: 10.1007/s12020-022-03190-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Thyroid hormone (TH) disturbances are perceived to contribute to cognitive impairment and dementia. However, there is no consensus on the association between TH levels and Alzheimer Disease (AD). In this study, we aimed to compare serum and cerebrospinal fluid (CSF) TH levels in AD patients to controls by performing a meta-analysis. METHODS We systematically searched online databases for papers comparing CSF or serum TH levels in AD patients to controls, and performed a meta-analysis on the extracted data. RESULTS Out of 1604 records identified, 32 studies were included. No significant difference in serum TSH (standardized mean difference (SMD): -0.03; 95% confidence interval (CI): -0.22-0.16), total T4 (SMD: 0.10; 95% CI: -0.29-0.49), and free T4 (SMD: 0.25; 95% CI: -0.16-0.69) levels were observed. However, there was significantly lower serum total T3 (SMD: -0.56; 95%CI: -0.97 to -0.15) and free T3 (SMD: -0.47; 95%CI: -0.89 to -0.05) levels in AD group compared to controls. Subgroup analyses on studies including only euthyroid patients did not show any significant difference in either of the thyroid hormone levels. Also, no significant difference in CSF total T4 and total T3/total T4 ratios but significantly lower CSF total T3 (SMD: -2.45; 95% CI: -4.89 to -0.02) in AD group were detected. CONCLUSION Serum total and free T3 and CSF total T3 levels are significantly lower in AD patients compared to controls. The temporality of changes in thyroid hormone levels and AD development should be illustrated by further longitudinal studies.
Collapse
Affiliation(s)
- Mahsa Dolatshahi
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, 510 South Kingshighway Boulevard, Campus Box 8131, St. Louis, MO, 63110, USA
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Arash Salehipour
- NeuroImaging Network (NIN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta Analysis Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vajiheh Aghamollaii
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
34
|
Praw SS, Brent GA. Approach to the Patient With a Suppressed TSH. J Clin Endocrinol Metab 2023; 108:472-482. [PMID: 36329632 DOI: 10.1210/clinem/dgac635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Subclinical hyperthyroidism (SCH) is a laboratory diagnosis defined by a serum thyrotropin (TSH) concentration below the reference range (< 0.4 mU/L in most assays), and a free thyroxine (FT4) and 3,5,3'-triiodothyronine levels (FT3) in the reference range. Many patients diagnosed with SCH will be clinically euthyroid while others may present with manifestations characteristic of thyroid hormone excess, such as tachycardia, tremor, intolerance to heat, bone density loss, or weight loss. In addition to the laboratory abnormalities, patient factors such as age, symptoms, and underlying heart and bone disease are used to stratify patients for the risk of adverse outcomes and determine the appropriate treatment. Evaluation should include repeat thyroid function tests to document persistent TSH suppression, investigation of the underlying cause, as well as evaluation of the patient's risk of adverse outcomes in the setting of a subnormal TSH. Persistent SCH has been associated with an increased risk of a range of adverse events, including cardiovascular events such as atrial fibrillation and heart failure, bone loss and fracture, and in some studies, cognitive decline. Despite the consistent association of these adverse events with SCH, prospective studies showing improved outcomes with treatment remain limited. Management options include observation without active therapy, radioactive iodine ablation of the thyroid, antithyroid medication, thyroid surgery, or radiofrequency ablation, as appropriate for the patient and clinical setting. The choice of therapy should be guided by the underlying etiology of disease, patient factors, and the risks and benefits of each treatment option.
Collapse
Affiliation(s)
- Stephanie Smooke Praw
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
| | - Gregory A Brent
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA
| |
Collapse
|
35
|
Zhou L, Song K, Luo W. Association between circulating resistin levels and thyroid dysfunction: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 13:1071922. [PMID: 36686437 PMCID: PMC9845899 DOI: 10.3389/fendo.2022.1071922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background As a product of adipose tissue, resistin exceeds other adipokines in its role in regulating appetite, energy expenditure, insulin sensitivity, inflammation, and immunity, similar to thyroid hormones. This study aimed to evaluate the association between resistin levels and thyroid dysfunction and to explore variations in circulating resistin levels before and after treatment for thyroid dysfunction. Methods This study was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. A comprehensive search of PubMed, Embase, and Cochrane databases was conducted until June 15, 2022, with no start date restriction, according to the preregistered protocol (PROSPERO-CRD42022336617). RevMan version 5.4 and R software package version 4.2.0 were used for statistical analyses. Results Fourteen studies with 1716 participants were included in this study. The findings of the meta-analysis confirmed that the resistin levels of patients with thyroid dysfunction were significantly higher than those of the euthyroid function control group (mean difference [MD] = 2.11, 95% confidence interval [CI] = 1.11-3.11, P < 0.00001). Furthermore, the resistin levels of patients with hyperthyroidism (MD = 3.23, 95% CI = 0.68-5.79, P = 0.01) and subclinical hypoidism (MD = 1.37, 95% CI = 0.31-2.42, P = 0.01) were significantly higher than those of euthyroid controls. The resistin levels of patients with thyroid dysfunction after treatment were significantly lower than those before treatment (MD = 1.00, 95% CI = 0.34-1.65, P = 0.003), especially in patients with hyperthyroidism (MD = 2.16, 95% CI = 1.00-3.32, P = 0.0003). Correlation analysis confirmed a positive correlation between resistin levels and free triiodothyronine (FT3) levels in patients with thyroid dysfunction (r = 0.27578, P = 0.001). Conclusions Our meta-analysis demonstrates that resistin levels are significantly higher in patients with thyroid dysfunction, and the resistin levels after treatment in patients with thyroid dysfunction are significantly lower than those before treatment. Correlation analysis shows a positive correlation between resistin levels and FT3 levels in patients with thyroid dysfunction. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022336617.
Collapse
Affiliation(s)
- Lin Zhou
- Department of Postgraduate, Qinghai University, Xining, China
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining, China
| | - Kang Song
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining, China
| | - Wei Luo
- Department of Endocrinology, Qinghai Provincial People’s Hospital, Xining, China
| |
Collapse
|
36
|
Teng Z, Feng J, Lv P. Subclinical Hypothyroidism is Associated with Cognitive Impairment in Patients with Cerebral Small Vessel Disease. Neuropsychiatr Dis Treat 2023; 19:303-310. [PMID: 36761397 PMCID: PMC9904226 DOI: 10.2147/ndt.s401020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the association between subclinical hypothyroidism (SCH) and cognitive function in patients with cerebral small vessel disease (CSVD). METHODS We evaluated 528 patients with CSVD in this retrospective study. SCH was defined as elevated levels of thyroid stimulating hormone with normal concentrations of free thyroxine. Magnetic resonance imaging was performed to assess the total CSVD burden score and the Montreal Cognitive Assessment was used to measure the cognitive function. Participants were grouped based on cognitive function or total CSVD burden score. Multivariate logistic regression and mediation analysis models were used to estimate the association of SCH with cognitive function and CSVD burden. RESULTS SCH was an independent risk factor for cognitive impairment in patients with CSVD after adjustment for potential confounding factors (OR: 1.939; 95% CI: 1.170 to 3.213; P=0.010). Additionally, SCH was independently associated with severe CSVD burden after adjustment for potential confounding factors (OR: 1.668; 95% CI: 1.085 to 2.564; P=0.020). Mediation analysis found a significant moderating effect (P=0.021) of the severe CSVD burden on the relation between SCH and cognitive impairment after adjustment for potential confounding factors. A 30.1% of the total effect between this relation was attributable to the presence of severe CSVD burden. CONCLUSION SCH was associated with an increased risk of cognitive impairment in patients with CSVD. The mediating role of severe CSVD burden suggests that SCH may lead to cognitive impairment through the presence of severe CSVD burden. These findings may suggest strategies for screening for SCH in the context of cognitive impairment in patients with severe CSVD.
Collapse
Affiliation(s)
- Zhenjie Teng
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
| | - Jing Feng
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People's Republic of China
| | - Peiyuan Lv
- Department of Neurology, Hebei Medical University, Shijiazhuang, People's Republic of China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, People's Republic of China.,Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, People's Republic of China
| |
Collapse
|
37
|
Ye Y, Wang Y, Li S, Guo J, Ding L, Liu M. Association of Hypothyroidism and the Risk of Cognitive Dysfunction: A Meta-Analysis. J Clin Med 2022; 11:jcm11226726. [PMID: 36431204 PMCID: PMC9694203 DOI: 10.3390/jcm11226726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The purpose of this meta-analysis was to assess whether there is an association between hypothyroidism and the risk of cognitive dysfunction. Methods: PubMed, Cochrane Library, and Embase were searched for relevant studies published from database inception to 4 May 2022, using medical subject headings (MeSHs) and keywords. Results: Eight studies involving 1,092,025 individuals were included, published between 2010 and 2021. The pooled analysis showed that there was no association between hypothyroidism and cognitive dysfunction (OR = 1.13, 95% CI = 0.84−1.51, p = 0.426), including both all-cause dementia (OR = 1.04, 95% CI = 0.76−1.43, p = 0.809) and cognitive impairment (OR = 1.50, 95% CI = 0.68−3.35, p = 0.318). Neither overt hypothyroidism (OR = 1.19, 95% CI = 0.70−2.02, p = 0.525) nor subclinical hypothyroidism (OR = 1.04, 95% CI = 0.73−1.48, p = 0.833) was associated with cognitive dysfunction. Neither prospective cohort (OR = 1.08, 95% CI = 0.77−1.51, p = 0.673) nor cross-sectional studies (OR = 1.23, 95% CI = 0.63−2.42, p = 0.545) had any effect on the association. Interestingly, the risk of cognitive dysfunction was significantly increased in the group not adjusted for vascular comorbidity (OR = 1.47, 95% CI = 1.07−2.01, p = 0.017), while it was reduced in the adjusted group (OR =0.82, 95% CI = 0.79−0.85, p < 0.001). Conclusions: This meta-analysis shows that hypothyroidism was associated with a reduced risk of cognitive dysfunction after adjustment for vascular-disease comorbidities. More prospective observational studies are needed in the future to investigate the relationship between hypothyroidism and cognitive dysfunction.
Collapse
Affiliation(s)
| | | | | | | | - Li Ding
- Correspondence: (L.D.); (M.L.)
| | | |
Collapse
|
38
|
Abbey EJ, McGready J, Oh E, Simonsick EM, Mammen JSR. Thyroid hormone use and overuse in dementia: Results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2022; 70:3308-3311. [PMID: 35866295 PMCID: PMC9669113 DOI: 10.1111/jgs.17961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Enoch J Abbey
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Esther Oh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Jennifer S R Mammen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
39
|
Zhu W, Wu F, Li J, Meng L, Zhang W, Zhang H, Cha S, Zhang J, Guo G. Impaired learning and memory generated by hyperthyroidism is rescued by restoration of AMPA and NMDA receptors function. Neurobiol Dis 2022; 171:105807. [PMID: 35777536 DOI: 10.1016/j.nbd.2022.105807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022] Open
Abstract
Hyperthyroidism has been identified as a risk factor for cognitive disorders. The hippocampus is a key brain region associated with cognitive function, among which excitatory synapse transmission plays an important role in the process of learning and memory. However, the mechanism by which hyperthyroidism leads to cognitive dysfunction through a synaptic mechanism remains unknown. We investigated the synaptic mechanisms in the effects of hyperthyroidism in an animal model that involved repeated injection of triiodothyronine (T3). These mice displayed impaired learning and memory in the Novel object recognition test, Y-maze test, and Morris Water Maze test, as well as elevated anxiety in the elevated plus maze. Mature dendritic spines in the hippocampal CA1 region of hyperthyroid mice were significantly decreased, accompanied by decreased level of AMPA- and NMDA-type glutamate receptors in the hippocampus. In primary cultured hippocampal neurons, levels of AMPA- and NMDA-type glutamate receptors also decreased and whole-cell patch-clamp recording revealed that excitatory synaptic function was obviously attenuated after T3 treatment. Notably, pharmacological activation of AMPAR or NMDAR by intraperitoneal injection of CX546, an AMPAR agonist, or NMDA, an NMDAR agonist can restore excitatory synaptic function and corrected impaired learning and memory deficit in hyperthyroid mice. Together, our findings uncovered a previously unrecognized AMPAR and NMDAR-dependent mechanism involved in regulating hippocampal excitatory synaptic transmission and learning and memory disorders in hyperthyroidism.
Collapse
Affiliation(s)
- Wei Zhu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Fengming Wu
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Jiong Li
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Lianghui Meng
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Wenjun Zhang
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Huijie Zhang
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Shuhan Cha
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China
| | - Jifeng Zhang
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China.
| | - Guoqing Guo
- Department of Anatomy, Neuroscience Laboratory for Cognitive and Developmental Disorders, Medical College of Jinan University, Guangzhou 510630, China.
| |
Collapse
|
40
|
Abstract
Subclinical thyroid dysfunction is defined by serum thyroid-stimulating hormone (TSH) levels either greater or less than the reference range with normal thyroxine (T4) concentrations, and consists of subclinical hypothyroidism (SCH) and subclinical hyperthyroidism (SCHyper). For the proper diagnosis of SCH, it is most important to be able to correctly evaluate the serum TSH levels, which have numerous unique characteristics. We also need to be versed in TSH harmonization, which was recently launched world-wide. In this review, we will attempt to determine the best clinical approaches to the treatment of subclinical thyroid dysfunction based on recent guidelines published from several countries and novel findings of several recent large-scale clinical studies.
Collapse
Affiliation(s)
- Koshi Hashimoto
- Department of Diabetes, Endocrinology, and Hematology, Dokkyo Medical University Saitama Medical Center, Saitama 343-8555, Japan
| |
Collapse
|
41
|
Abstract
Background: Some levothyroxine (LT4)-treated hypothyroid patients report a constellation of persistent and distressing cognitive symptoms that has been termed brain fog. This narrative review focuses on attempts to define and measure hypothyroid-associated brain fog, summarize possible etiologies and contributing factors, present treatment options, and propose avenues for future research. Methods: Published literature was reviewed to summarize available information on patient-reported symptoms associated with brain fog in hypothyroidism, as well as objective evidence of impairment based on neurocognitive testing and functional imaging studies. Given the limited information specific for hypothyroid-associated brain fog, relevant data from other medical conditions associated with brain fog were also reviewed and incorporated into recommendations for clinical care and future research areas. Results: Hypothyroid-associated brain fog has not been well defined or quantitated, and the underlying pathophysiology is unclear. Symptoms vary among patients but commonly include fatigue, depressed mood, and cognitive difficulties in the areas of memory and executive function. Symptoms often predate the diagnosis of hypothyroidism, and the magnitude of cognitive impairment can range from mild to severe. Regardless of severity, these symptoms are associated with impaired quality of life and cause dissatisfaction with treatment, so often lead to requests for alternate therapies. Disease-specific and psychological factors impact the experience of brain fog in complex ways, including potential limitations in LT4 monotherapy, self-knowledge of a disease state, and expectations for therapeutic effects. Conclusions: Brain fog is a variable symptom complex in people with hypothyroidism, causing significant distress and diminished quality of life. In the absence of proven therapies, individualized treatment plans are recommended, which incorporate thyroid-specific, general medical, and psychosocial approaches. In particular, cognitive rehabilitation is an underutilized technique that is beneficial in other medical conditions associated with brain fog and could improve symptoms in hypothyroid people. The limitations in our current knowledge and questions presented throughout this review highlight a major need for clinical research in this understudied area. Future research should include attention to standardization of survey instruments to quantitate brain fog in hypothyroid people, as well as rigorously designed intervention studies.
Collapse
Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
- Address correspondence to: Mary H. Samuels, MD, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 Sam Jackson Park Road, CR107, Portland, OR 97221, USA
| | - Lori J. Bernstein
- Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Santhanam P, Nath T, Lindquist MA, Cooper DS. Relationship Between TSH Levels and Cognition in the Young Adult: An Analysis of the Human Connectome Project Data. J Clin Endocrinol Metab 2022; 107:1897-1905. [PMID: 35389477 DOI: 10.1210/clinem/dgac189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The nature of the relationship between serum thyrotropin (TSH) levels and higher cognitive abilities is unclear, especially within the normal reference range and in the younger population. OBJECTIVE To assess the relationship between serum TSH levels and mental health and sleep quality parameters (fluid intelligence [Gf], MMSE (Mini-Mental State Examination), depression scores, and, finally, Pittsburgh Sleep Quality Index (PSQI) scores (working memory, processing speed, and executive function) in young adults. METHODS This was a retrospective analysis of the data from the Human Connectome Project (HCP). The HCP consortium is seeking to map human brain circuits systematically and identify their relationship to behavior in healthy adults. Included were 391 female and 412 male healthy participants aged 22-35 years at the time of the screening interview. We excluded persons with serum TSH levels outside the reference range (0.4-4.5 mU/L). TSH was transformed logarithmically (log TSH). All the key variables were normalized and then linear regression analysis was performed to assess the relationship between log TSH as a cofactor and Gf as the dependent variable. Finally, a machine learning method, random forest regression, predicted Gf from the dependent variables (including alcohol and tobacco use). The main outcome was normalized Gf (nGf) and Gf scores. RESULTS Log TSH was a significant co-predictor of nGF in females (β = 0.31(±0.1), P < .01) but not in males. Random forest analysis showed that the model(s) had a better predictive value for females (r = 0.39, mean absolute error [MAE] = 0.81) than males (r = 0.24, MAE = 0.77). CONCLUSION Higher serum TSH levels might be associated with higher Gf scores in young women.
Collapse
Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tanmay Nath
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David S Cooper
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
43
|
Fitzgerald SP, Falhammar H. Redefinition of Successful Treatment of Patients With Hypothyroidism. Is TSH the Best Biomarker of Euthyroidism? Front Endocrinol (Lausanne) 2022; 13:920854. [PMID: 35784560 PMCID: PMC9243528 DOI: 10.3389/fendo.2022.920854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/10/2022] [Indexed: 12/14/2022] Open
Abstract
In recent years evidence has accumulated supporting a revised view of the nature of euthyroidism and the biomarkers of thyroid function. Within the normal range, variations in thyroid hormone levels are associated with variations in clinical parameters and outcomes. There are therefore no readily identified individually specific optimum levels of thyroid hormones for any individual. Levels around the middle of the normal population range may best reflect euthyroidism. These levels may have evolutionary advantages on the basis that adverse outcomes often increase with divergence from such levels, and physiological processes tend to minimise such inter-individual and intra-individual divergence. In populations of predominantly untreated individuals, levels of thyroid hormones and in particular levels of free thyroxine (FT4) correlate more often with clinical parameters than do levels of thyrotropin (TSH). Levels of thyroid hormones may therefore be regarded as the best available biomarkers of euthyroidism and dysthyroidism. It follows that 'subclinical hypothyroidism' (normal FT4/raised TSH levels), rather than being an accurate marker of peripheral tissue hypothyroidism is more a marker of decreased thyroid reserve and prognosis. The recent evidence suggests that treatment of hypothyroxinemia, regardless of the TSH level, and monitoring therapy using FT4 and/or triiodothyronine levels, depending on the replacement regime, may result in more successful treatment of hypothyroidism than relying on thyrotropin levels for patient selection and subsequent treatment monitoring. The equivalents of mid-range levels of thyroid hormones (especially FT4), adjusted by individual comorbidity concerns, may be rational general replacement targets. These implications of the new evidence may create opportunities for novel trials of thyroid replacement therapy.
Collapse
Affiliation(s)
- Stephen P. Fitzgerald
- The Departments of General Medicine and Endocrinology, The Royal Adelaide Hospital, Adelaide, SA, Australia
- School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Menzies School of Health Research and Royal Darwin Hospital, Tiwi, NT, Australia
| |
Collapse
|
44
|
Abstract
BACKGROUND Although thyroid dysfunction has been considered as a cause of reversible cognitive impairment, association between subclinical hypothyroidism and cognitive impairment is controversial. OBJECTIVE We compared cognitive profiles of patients in an euthyroid or subclinical hypothyroid (sHypo) state, as well as their disease progression from mild cognitive impairment (MCI) to dementia within 3 years. METHODS We included 2,181 patients in a euthyroid and 284 in a sHypo state over 60 years of age who underwent an extensive cognitive assessment at Seoul National University Bundang Hospital but were not prescribed levothyroxine, methimazole, carbimazole, or propylthiouracil. After propensity score matching for age, sex, and education level, 1,118 patients in a euthyroid and 283 patients in a sHypo state were included. Attention, language, memory, visuocontructive, and executive functions were compared between the groups using Student's t-test or the Mann-Whitney U test. To investigate the association between disease progression and subclinical hypothyroidism, a Cox regression analyses was performed in 1,265 patients with MCI. Patients with thyroid-stimulating hormone levels over 10 mlU/L was classified as the "sHypo10", and hazard ratios for sHypo or sHypo10 were assessed. RESULTS There was no difference in attention, language, memory, visuoconstructive, and executive functions between the patient groups. Progression from MCI to dementia was not associated with sHypo or sHypo10. CONCLUSION There was no difference in cognitive profile between euthyroid and sHypo patients, and no association between subclinical hypothyroidism and disease progression. This might suggest a clue of strategies regarding hormone therapy in subclinical hypothyroidism with cognitive impairment.
Collapse
Affiliation(s)
- Jung-Min Pyun
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Park
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
45
|
Higher thyroid function is associated with accelerated hippocampal volume loss in Alzheimer's disease. Psychoneuroendocrinology 2022; 139:105710. [PMID: 35278981 DOI: 10.1016/j.psyneuen.2022.105710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In epidemiological studies, higher thyroid hormone (TH) levels have been associated with lower brain volume and increased risk of Alzheimer's disease (AD) in elderly individuals. However, the relationships between serum THs and hippocampal atrophy rates have previously not been investigated. METHODS A prospective study of patients with AD (n = 55), stable mild cognitive impairment (sMCI; n = 84) and healthy controls (n = 29) recruited at a single memory clinic. We investigated whether serum THs were associated with magnetic resonance imaging (MRI)-estimated hippocampal volumes at baseline and with longitudinal alterations, defined as annualized percent changes. RESULTS Serum levels of free triiodothyronine (FT3) and FT3/free thyroxine (FT4) ratio were reduced in AD and sMCI patients compared with the controls (p < 0.05). Hierarchical linear regression analyses showed that higher serum FT3/FT4 ratio was associated with greater baseline hippocampal volume in all study groups. Only in AD patients, higher serum FT4 was associated with lower baseline volume of the left hippocampus. Finally, exclusively in the AD group, higher serum levels of FT3 and FT3/FT4 ratio, and lower serum TSH levels, were associated with greater annual hippocampal volume loss. CONCLUSIONS In all study groups, FT3/FT4 ratio was related to baseline hippocampal volume. However, only in AD patients, higher levels of THs were associated with greater annual loss of hippocampal volume, suggesting that excessive TH levels exert a deleterious effect on the hippocampus in the presence of existing AD neuropathology.
Collapse
|
46
|
Kim HK, Song J. Hypothyroidism and Diabetes-Related Dementia: Focused on Neuronal Dysfunction, Insulin Resistance, and Dyslipidemia. Int J Mol Sci 2022; 23:ijms23062982. [PMID: 35328405 PMCID: PMC8952212 DOI: 10.3390/ijms23062982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
The incidence of dementia is steadily increasing worldwide. The risk factors for dementia are diverse, and include genetic background, environmental factors, sex differences, and vascular abnormalities. Among the subtypes of dementia, diabetes-related dementia is emerging as a complex type of dementia related to metabolic imbalance, due to the increase in the number of patients with metabolic syndrome and dementia worldwide. Thyroid hormones are considered metabolic regulatory hormones and affect various diseases, such as liver failure, obesity, and dementia. Thyroid dysregulation affects various cellular mechanisms and is linked to multiple disease pathologies. In particular, hypothyroidism is considered a critical cause for various neurological problems-such as metabolic disease, depressive symptoms, and dementia-in the central nervous system. Recent studies have demonstrated the relationship between hypothyroidism and brain insulin resistance and dyslipidemia, leading to diabetes-related dementia. Therefore, we reviewed the relationship between hypothyroidism and diabetes-related dementia, with a focus on major features of diabetes-related dementia such as insulin resistance, neuronal dysfunction, and dyslipidemia.
Collapse
Affiliation(s)
- Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, 264 Seoyangro, Hwasun 58128, Korea;
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, 264 Seoyangro, Hwasun 58128, Korea
- Correspondence: ; Tel.: +82-61-379-2706; Fax: +82-61-375-5834
| |
Collapse
|