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Bazika-Gerasch B, Kumowski N, Enax-Krumova E, Kaisler M, Eitner LB, Maier C, Dietrich JW. Impaired autonomic function and somatosensory disturbance in patients with treated autoimmune thyroiditis. Sci Rep 2024; 14:12358. [PMID: 38811750 PMCID: PMC11137073 DOI: 10.1038/s41598-024-63158-w] [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: 09/08/2023] [Accepted: 05/26/2024] [Indexed: 05/31/2024] Open
Abstract
Despite treatment with levothyroxine, hypothyroidism and autoimmune thyroiditis (AIT) may be associated with reduced quality of life (QoL), an enigmatic condition referred to as "syndrome T". Peripheral neuropathy, described in untreated thyroid disease, could be a contributing mechanism. We analysed autonomic and somatosensory function in 29 patients with AIT and treated hypothyroidism and 27 healthy volunteers. They underwent heart rate variability (HRV) analysis and quantitative sensory testing (n = 28), comprising 13 parameters of small and large nerve fibre function and pain thresholds. Autonomic cardiovascular function was assessed in rest, deep respiration and orthostasis. Additionally, biomarkers for autoimmunity and thyroid function were measured. Anxiety, depression and QoL were assessed using validated questionnaires. 36% of the patients showed at least one sign of somatosensory small or large fibre dysfunction. 57% presented with mild hyperalgesia to at least one stimulus. Several markers of autonomic function and some detection thresholds were related to the antibody titres. Anxiety, depression scores and QoL correlated to antibody titres and HRV measures. Autonomic and somatosensory dysfunction indicate that in treated hypothyroidism and AIT a subgroup of patients suffers from neuropathic symptoms leading to impaired QoL. Additionally, mild hyperalgesia as a possible sensitisation phenomenon should be considered a target for symptomatic treatment.
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Affiliation(s)
- Bojana Bazika-Gerasch
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, NRW, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527, Hattingen, NRW, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791, Bochum, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791, Bochum, NRW, Germany
- Centre for Thyroid Medicine KKB, Catholic Hospitals Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, NRW, Germany
| | - Nina Kumowski
- Department of Internal Medicine 1, University Hospital Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, Pauwelsstraße 30, 52074, Aachen, NRW, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, NRW, Germany
| | - Miriam Kaisler
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, NRW, Germany
| | - Lynn Bernadette Eitner
- Pediatrics Department, Catholic Hospitals Bochum, Ruhr University Bochum, Alexandrinenstraße 5, 44791, Bochum, NRW, Germany
- Centre for Thyroid Medicine KKB, Catholic Hospitals Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, NRW, Germany
| | - Christoph Maier
- Pediatrics Department, Catholic Hospitals Bochum, Ruhr University Bochum, Alexandrinenstraße 5, 44791, Bochum, NRW, Germany
| | - Johannes W Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, NRW, Germany.
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527, Hattingen, NRW, Germany.
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791, Bochum, Germany.
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791, Bochum, NRW, Germany.
- Centre for Thyroid Medicine KKB, Catholic Hospitals Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, NRW, Germany.
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Guasti L, Marino F, Cosentino M, Cimpanelli M, Piantanida E, Mainardi LT, Vanoli P, De Palma D, Bombelli R, Ferrari M, Crespi C, Simoni C, Klersy C, Gaudio G, Maroni L, Grandi AM, Tanda M, Bartalena L, Cerutti S, Lecchini S, Venco A. Changes in autonomic modulation to the heart and intracellular catecholamines. A longitudinal study in differentiated thyroid carcinoma during short-term hypothyroidism and thyroid hormone replacement. HORMONE RESEARCH 2006; 67:171-8. [PMID: 17106203 DOI: 10.1159/000097013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2006] [Accepted: 09/21/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effects of thyroid deprivation on the autonomic modulation to the heart remain controversial. METHODS In this study in patients followed for thyroid carcinoma, we investigated (1) heart rate variability parameters and the baroreflex gain and (2) intracellular catecholamine levels in circulating lymphocytes during short-term hypothyroidism (phase 1) and after reinstitution of TSH-suppressive thyroid hormone replacement (phase 2). RESULTS The RR interval value (p < 0.01) and systolic blood pressure (p < 0.05) were higher in phase 1 than in phase 2. The low-frequency/high-frequency (LF/HF) ratio was significantly lower in the hypothyroid state (p < 0.05), with a higher HF component (p < 0.05). After adjusting for mean RR interval in the regression model, the difference between the power of RR interval oscillations calculated in the two states was greater for the LF band (p = 0.005) and it was borderline significant for the HF band (p = 0.052). The baroreflex gain alpha(LF) index was similar in the two phases. The stimulus-induced cellular production of norepinephrine and epinephrine in peripheral blood mononuclear cells was significantly higher in phase 2. CONCLUSION The neurally-mediated influences on the sinus node and the study of intracellular catecholamine production suggest a reduced sympathoexcitation in hypothyroidism compared with the treatment phase. The early increase in blood pressure observed after thyroid hormone withdrawal is not due to impaired sensitivity of the baroreflex arc.
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Affiliation(s)
- L Guasti
- Department of Clinical Medicine, University of Insubria, Varese, Italy.
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Chen JL, Chiu HW, Tseng YJ, Chu WC. Hyperthyroidism is characterized by both increased sympathetic and decreased vagal modulation of heart rate: evidence from spectral analysis of heart rate variability. Clin Endocrinol (Oxf) 2006; 64:611-6. [PMID: 16712661 DOI: 10.1111/j.1365-2265.2006.02514.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The clinical manifestations of hyperthyroidism resemble those of the hyperadrenergic state. This study was designed to evaluate the impact of hyperthyroidism on the autonomic nervous system (ANS) and to investigate the relationship between serum thyroid hormone concentrations and parameters of spectral heart rate variability (HRV) analysis in hyperthyroidism. DESIGN AND PATIENTS Thirty-two hyperthyroid Graves' disease patients (mean age 31 years) and 32 sex-, age-, and body mass index (BMI)-matched normal control subjects were recruited to receive one-channel electrocardiogram (ECG) recording. MEASUREMENTS The cardiac autonomic nervous function was evaluated by the spectral analysis of HRV, which indicates the autonomic modulation of the sinus node. The correlation coefficients between serum thyroid hormone concentrations and parameters of the spectral HRV analysis were also computed. RESULTS The hyperthyroid patients revealed significant differences (P < 0.001) compared with the controls in the following HRV parameters: a decrease in total power (TP), very low frequency power (VLF), low frequency power (LF), high frequency power (HF), and HF in normalized units (HF%); and an increase in LF in normalized units (LF%) and in the ratio of LF to HF (LF/HF). After correction of hyperthyroidism in 28 patients, all of the above parameters were restored to levels comparable to those of the controls. In addition, serum thyroid hormone concentrations showed significant correlations with spectral HRV parameters. CONCLUSIONS Hyperthyroidism is in a sympathovagal imbalanced state, characterized by both increased sympathetic and decreased vagal modulation of the heart rate. These autonomic dysfunctions can be detected simultaneously by spectral analysis of HRV, and the spectral HRV parameters could reflect the disease severity in hyperthyroid patients.
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Affiliation(s)
- Jin-Long Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
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Osman F, Franklyn JA, Daykin J, Chowdhary S, Holder RL, Sheppard MC, Gammage MD. Heart rate variability and turbulence in hyperthyroidism before, during, and after treatment. Am J Cardiol 2004; 94:465-9. [PMID: 15325930 DOI: 10.1016/j.amjcard.2004.04.061] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2004] [Revised: 04/27/2004] [Accepted: 04/27/2004] [Indexed: 11/19/2022]
Abstract
Patients with subclinical and treated overt hyperthyroidism have an excess vascular mortality rate. Several symptoms and signs in overt hyperthyroidism suggest abnormality of cardiac autonomic function that may account in part for this excess mortality rate, but few studies have examined cardiac autonomic function in untreated and treated hyperthyroidism. We assessed heart rate turbulence (HRT) and time-domain parameters of heart rate variability in a large, unselected cohort of patients with overt hyperthyroidism referred to our thyroid clinic (n = 259) and compared findings with a group of normal subjects with euthyroidism (n = 440). These measures were also evaluated during antithyroid therapy (when serum-free thyroxine and triiodothyronine concentrations returned to normal but thyrotropin remained suppressed (i.e., subclinical hyperthyroidism, n = 110) and when subjects were rendered clinically and biochemically euthyroid (normal serum thyrotropin, free thyroxine and triiodothyronine concentrations, n = 219). We found that overall measures of heart rate variability and those specific for cardiac vagal modulation were attenuated in patients with overt hyperthyroidism compared with normal subjects; measurements of overall heart rate variability remained low in those with low levels of serum thyrotropin but returned to normal in patients with biochemical euthyroidism. Measurements of HRT (onset and slope) were also decreased in patients with overt hyperthyroidism, but HRT slope returned to normal values with antithyroid treatment. This study is the first to evaluate HRT in overt and treated hyperthyroidism.
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Affiliation(s)
- Faizel Osman
- Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom
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Yönem O, Dökmetaş HS, Aslan SM, Erselcan T. Is antithyroid treatment really relevant for young patients with subclinical hyperthyroidism? Endocr J 2002; 49:307-14. [PMID: 12201213 DOI: 10.1507/endocrj.49.307] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study investigated whether symptoms and findings of hyperthyroidism exist in patients with subclinical hyperthyroidism (SCH) and sought to determine whether hyperthyroidism treatment improves them. Twenty patients (mean age: 36.10 +/- 1.41 years) and 20 healthy controls [mean age: 36.35 +/- 1.50 years) were included in the study. The SCH duration of patients was at least 6 months. Bone mineral density (BMD) was measured in both patients and controls. The patients were randomly divided into 2 groups of 10 patients each. Symptoms and findings of hyperthyroidism were evaluated and BMD, 24 hour ambulatory blood pressure, holter measurements and serum lipids were determined initially in both groups and 6 months after the attainment of euthyroidism in the treatment group (Group 1) and after a 6 months follow-up in the observation group (Group 2). In the patient group, BMD showed a decrease of 1.3% and 3.9% in femur neck and L1-4 vertebra compared with controls, respectively. But there was no difference in BMD between patients and controls. Fatigue, nervousness, over sweating, tachycardia and tremor improved with treatment. The number of patients with fatigue, nervousness, over sweating and tachycardia increased in Group 2 after the observation. There was no difference between initial values and after a 6 month period from observation or on attainment of euthyroidism in the values of BMD, lipids, minimal and maximal heart rate, total number of ventricular and supraventricular beats and heart rate variability. As a result symptoms of hyperthyroidism were found to be increased in SCH but they partly decreased after antithyroid treatment. But no favourable effects of antithyroid treatment on BMD, heart rate and arrhythmia incidence were found in young, premenopausal patients with SCH during the 6 month period.
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Affiliation(s)
- Ozlem Yönem
- Department of Internal Medicine, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Barczyński M, Thor P. Reversible autonomic dysfunction in hyperthyroid patients affects gastric myoelectrical activity and emptying. Clin Auton Res 2001; 11:243-9. [PMID: 11710797 DOI: 10.1007/bf02298956] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The autonomic nervous system (ANS) function in hyperthyroidism has been so far investigated mainly from the cardiovascular point of view. The aim of this study is to show that the ANS dysfunction in hyperthyroidism is also expressed in gastric myoelectrical activity disturbances and gastric emptying disorders and to search for a correlation between the severity of clinical manifestation and free thyroid hormone levels and the degree of the ANS dysfunction. The analyzed group included 50 recently diagnosed patients with hyperthyroidism who were examined twice: before and after 3 months of thyrostatic treatment. Results were compared with those of a sex-, age- and BMI-matched control group of 50 healthy volunteers. The study included: heart rate variability analysis in time and frequency domain, at rest and during a deep-breathing test, surface electrogastrography in preprandial and postprandial periods measured simultaneously with the ultrasound assessment of gastric emptying time by Bolondi method. In patients with hyperthyroidism in comparison with the control group, the following significant differences were observed: a sharp reduction of the high-frequency component and a decrease of heart rate variability, a high incidence of dysrhythmia with dominant bradyarrhythmia, and a delay of gastric emptying. The degree of disorders related to the degree of clinical manifestation of hyperthyroidism's symptoms and free triiodothyronine serum concentration both. All the disorders were functional and disappeared in a stable euthyroidism. To conclude, the ANS dysfunction in hyperthyroidism results not only in withdrawal of vagal inhibitory effect on sinoatrial node, but in impaired mutual neuro-hormonal regulation (decrease of vagal influence) of gastric myoelectrical activity followed by delay of gastric emptying.
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Affiliation(s)
- M Barczyński
- Department of Endocrine Surgery, Jagiellonian University College of Medicine, Krakow, Poland.
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Agelink MW, Malessa R, Baumann B, Majewski T, Akila F, Zeit T, Ziegler D. Standardized tests of heart rate variability: normal ranges obtained from 309 healthy humans, and effects of age, gender, and heart rate. Clin Auton Res 2001; 11:99-108. [PMID: 11570610 DOI: 10.1007/bf02322053] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors undertook this study to determine the effects of age, gender, and heart rate (HR) on the results of cardiac autonomic function tests for measuring heart rate variability (HRV) in a large sample of healthy subjects (n = 309). Conventional tests (deep breathing, maximum/minimum 30:15 ratio), and a standardized 5-minute resting study, including spectral analysis of HR, were used. The main findings included (1) the indices of all tests, except for the ratio of the low- (LF) to high-frequency (HF) spectral power (LF/HF ratio) and HR itself, are inversely related to age in both sexes; (2) the 5-minute spectral bands (except for the LF/HF ratio), the variation coefficient, expiratory-inspiratory ratio during deep breathing, and the maximum/minimum 30:15 ratio are independent of HR; (3) women up to the age of 55 years have a higher resting HR compared with men; (4) young and middle-aged women show a significantly lower LF power and LF/HF ratio compared with age-matched men, whereas no significant gender differences are observed in the absolute HF power. The authors computed age- and gender-dependent normal values for each of the HRV indices studied here and discuss the clinical consequences arising from gender differences in HRV.
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Affiliation(s)
- M W Agelink
- Institute of Biological Psychiatry and Neuroscience at the Evangelical Clinics Gelsenkirchen, Ruhr-University of Bochum, Germany
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Safa-Tisseront V, Ponchon P, Laude D, Elghozi JL. Autonomic contribution to the blood pressure and heart rate variability changes in early experimental hyperthyroidism. J Hypertens 1998; 16:1989-92. [PMID: 9886887 DOI: 10.1097/00004872-199816121-00020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the interaction between autonomic nervous activity and thyroid hormones in the control of heart rate (HR) and blood pressure (BP). DESIGN AND METHODS Thyrotoxicosis was produced by injections of L-thyroxine (0.5 mg/kg/day for five days). Blockers were atropine (0.5 mg/kg), atenolol (1 mg/kg) or prazosin (1 mg/kg). Eight animals were studied in each group. Spectral analyses was performed using continuous BP time series obtained in conscious rats. RESULTS Thyroxine treatment was sufficient to induce a significant degree of tachycardia (423+/-6 vs 353+/-4 bpm, P < 0.001, unpaired Student's t test), systolic BP elevation (142+/-3 vs 127+/-2 mmHg, P < 0.001) and cardiac hypertrophy (1.165+/-0.017 vs 1.006+/-0.012 g, P < 0.001). The intrinsic HR was markedly increased after treatment with thyroxine (497+/-16 vs 373+/-10 bpm, P < 0.05). Vagal tone was positively linearly related to intrinsic HR (r = 0.84, P< 0.01). Atenolol neither modified HR nor BP variability in rats with hyperthyroidism. The thyrotoxicosis was associated with a reduction of the 0.4 Hz component of BP variability (modulus 1.10+/-0.07 vs 1.41+/-0.06 mmHg, P < 0.01). Prazosin was without effect on this 0.4 Hz component in hyperthyroid animals. CONCLUSIONS These data show a functional diminution of the vascular and cardiac sympathetic tone in early experimental hyperthyroidism. The marked rise in the intrinsic HR could be the main determinant of tachycardia. The BP elevation may reflexly induce vagal activation and sympathetic (vascular and cardiac) inhibition.
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Affiliation(s)
- V Safa-Tisseront
- Laboratoire de Pharmacologie, CNRS URA 1482, Faculté de Médecine Necker, Paris, France
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