Hyperthyroidism selectively increases oxidative metabolism of slow-oxidative motor units

Pathogenic SCN5A Mutation and Thyrotoxicosis-Related Neurological Syndrome: Casual or Causal Relationship?

BACKGROUND

Various neurologic complications of hyperthyroidism are reported, and most of these complications are reversible with the amelioration of thyrotoxicosis. We report a previously undescribed concurrence of hyperthyroid-associated exercise-induced myalgia and stiffness, pyramidal tract dysfunction, and myoclonic movements that make an initial clinical diagnosis difficult.

CASE PRESENTATION

A 17-year-old male was hospitalized in the department of neurology, presenting with a 4-year history of severe exercise-induced myalgia and stiffness, weakness of lower limbs, and myoclonic movements. Laboratory investigations unexpectedly revealed hyperthyroidism. MRI of the brain and spine, electrophysiology, and whole exome sequencing were also performed. Antithyroid therapy led to marked improvement of neurologic symptoms, accompanied by a significant improvement of the time-dependent decline in compound muscle action potentials (CMAP) amplitudes after exercise and normalization of the prolonged QTc interval. Genetic analysis identified a rare variant in SCN5A.

CONCLUSION

This case report provides important insights into the relationship between hyperthyroidism and neurologic/cardiac complications, particularly in those with a genetic predisposition. SCN5A mutation possibly plays a role in the complex neurological syndrome associated with hyperthyroidism. Further studies are warranted to better understand the underlying mechanisms and potential therapeutic options for these complex conditions.

Thyroid disease and the nervous system

Thyroid disorders are common in the general population and in hospitalized patients. Thyroid disease may present first with neurological complications or else may occur concurrently in patients suffering other neurological disorders, particularly those with an autoimmune etiology. For this reason neurologists will commonly encounter patients with thyroid disease. This chapter provides an overview of the neurological complications and associations of disorders of the thyroid gland. Particular emphasis is placed on conditions such as thyrotoxic periodic paralysis and myxedema coma in which the underlying thyroid disorder may be occult leading to a first, often emergency, presentation to a neurologist. Information about clinical features, diagnosis, pathogenesis, therapy, and prognosis is provided. Emphasis is placed on those aspects most likely to be relevant to the practicing neurologist and the interested reader is directed to references to good, recent review articles for further information.

Postnatal development of masseteric motoneurons in congenital hypothyroid rats

It has been known that an intact thyroid hormone is obligatory for the attainment of the normal masticatory function at the time of weaning. Following induced maternal thyroid hypo-function, the development of masseter motoneurons was determined at postnatal days 1, 7, 15 and 23 (weaning time), using retrograde transport of horseradish peroxidase (HRP) in the normal and hypothyroid pups. Based on the HRP labeling profile (strong and weak), the soma area of the masseteric labeled motoneurons was measured in each group. No significant morphological differences were observed at the end of the first week of life. On day 15, hypothyroid masseteric labeled motoneurons consisted of 76% small and 24% medium-sized neurons compared to 58% and 42% in normal pups, respectively. At the time of weaning (i.e., day 23) the number of large masseter motoneurons reached to 1/3 of normal value with few, short and disoriented dendrites in the hypothyroid pup. There was no statistically significant difference in the uptake of HRP from the neuromuscular junction. These results suggest that neonatal thyroid hormone deficiency considerably postponed the development of feeding behavior from sucking to chewing and biting.

Comparison of the response of motoneurons innervating perineal and hind limb muscles to spaceflight and recovery

The succinate dehydrogenase (SDH) activities and cell body sizes of motoneurons in the dorsomedial (DM) region of the ventral horn at the lower portion of the L5 and the L6 segmental levels of the rat spinal cord were determined following 14 days of spaceflight and after 9 days of recovery on Earth and compared with those in the retrodorsolateral (RDL) region of the ventral horn at the same segmental levels. No changes in the mean SDH activity of motoneurons in the DM region were observed following spaceflight or after recovery. However, a decrease in the mean SDH activity of motoneurons with cell body sizes between 500 and 900 microm(2) in the RDL region was observed following spaceflight and after recovery. These data indicate that moderate-sized motoneurons in the RDL region, which are most likely associated with the hind limb musculature, were responsive to the microgravity environment. In contrast, the motoneurons in the DM region associated with the perineal muscles (associated with predominantly fast, low-oxidative muscles which are recruited for relatively brief periods at high activation levels and have no load-bearing function at 1G) were not affected by microgravity.

Discharge properties of motoneurones: how are they matched to the properties and use of their muscle units?

A general survey is given of old as well as more recent findings concerning matches between electrophysiological properties of motoneurones and contractile properties of their muscle fibres. Mechanisms for creating and maintaining such matches are discussed. It is pointed out that it is not sufficient to describe the variation of functional motoneurone characteristics simply in terms of 'fast' or 'slow': all properties seem continuously graded and there is cytochemical evidence for several, seemingly independent parameters of functional specialisation.

Hypothyroidism in the rat results in decreased soleus motoneurone soma size

Adult female rats were thyroidectomized. After an average of 17 weeks, horseradish peroxidase (HRP) was injected into the right side soleus muscle. Two days later, left side soleus muscle properties were recorded and muscles and spinal cord were removed for further histological measurements. Soleus muscles from hypothyroid rats no longer contained type IIA fibers. Contraction and half-relaxation times of twitches had increased significantly compared to control rats. The average cross-sectional surface areas of HRP-labeled soleus motoneurones from hypothyroid rats were slightly but significantly smaller than those of control rats. A similar decrease in size was found for other (presumed moto-) neurones lying ventrolaterally to the soleus motor nucleus. It is concluded that changes in the soleus muscle fiber composition, as caused by lowered levels of thyroid hormone, are paralleled by corresponding changes in the size of its motoneurones and also of other spinal (moto)neurones.

Succinate dehydrogenase activity and soma size of motoneurons innervating different portions of the rat tibialis anterior

The spatial distribution, soma size and oxidative enzyme activity of gamma and alpha motoneurons innervating muscle fibres in the deep (away from the surface of the muscle) and superficial (close to the surface of the muscle) portions of the tibialis anterior in normal rats were determined. The deep portion had a higher percentage of high oxidative fibres than the superficial portion of the muscle. Motoneurons were labelled by retrograde neuronal transport of fluorescent tracers: Fast Blue and Nuclear Yellow were injected into the deep portion and Nuclear Yellow into the superficial portion of the muscle. Therefore, motoneurons innervating the deep portion were identified by both a blue fluorescent cytoplasm and a golden-yellow fluorescent nucleus, while motoneurons innervating the superficial portion were identified by only a golden-yellow fluorescent nucleus. After staining for succinate dehydrogenase activity on the same section used for the identification of the motoneurons, soma size and succinate dehydrogenase activity of the motoneurons were measured. The gamma and alpha motoneurons innervating both the deep and superficial portions were located primarily at L4 and were intermingled within the same region of the dorsolateral portion of the ventral horn in the spinal cord. Mean soma size was similar for either gamma or alpha motoneurons in the two portions of the muscle. The alpha motoneurons innervating the superficial portion had a lower mean succinate dehydrogenase activity than those innervating the deep portion of the muscle. An inverse relationship between soma size and succinate dehydrogenase activity of alpha, but not gamma, motoneurons innervating both the deep and superficial portions was observed. Based on three-dimensional reconstructions within the spinal cord, there were no apparent differences in the spatial distribution of the motoneurons, either gamma or alpha, associated with the deep and superficial compartments of the muscle. The data provide evidence for an interdependence in the oxidative capacity between a motoneuron and its target muscle fibres in two subpopulations of motoneurons from the same motor pool, i.e. the same muscle.

Effects of hypophysectomy on soleus muscle fibers and spinal motoneurons in rats

The fiber type distribution of the soleus muscle in male and female rats was investigated 4 weeks after hypophysectomy. Oxidative enzyme activity of the soleus motoneurons in the spinal cord was also examined by enzyme histochemical assay. In male rats, the total number of fibers in the soleus muscle was not changed after hypophysectomy, but the percentage of intermediate (INT) fibers (with intermediate adenosine triphosphatase activity following alkaline preincubation, and high succinate dehydrogenase and alpha-glycerophosphate dehydrogenase activities) was increased. All types of fibers in the soleus muscle of hypophysectomized rats showed high adenosine triphosphatase activity following acid preincubation. Oxidative enzyme activity of the motoneurons innervating the soleus muscle was not changed after hypophysectomy. Similar results were obtained in female rats. It is suggested that the increased percentage of INT fibers in the rat soleus muscle after hypophysectomy is due to a lack or reduced levels of growth hormones, and that the metabolic capacities of the muscle fibers and of the innervating motoneurons are affected independently by hypophysectomy.

Oxidative enzyme activity in the rat soleus muscle and its motoneurons during postnatal maturation

The effect of postnatal maturation on changes in the oxidative enzyme (succinate dehydrogenase) activity in the rat soleus muscle and its motoneurons was examined at 3, 6, and 12 weeks of age. The motoneurons innervating the soleus muscle were identified using the fluorescent retrograde neuronal tracer Nuclear Yellow. An inverse relationship between soma size and oxidative enzyme activity of soleus motoneurons was observed at 3 and 6 weeks of age, whereas there was no correlation between them at 12 weeks. Although the oxidative enzyme activity in the soleus muscle increased during postnatal maturation, it showed a decrease in the soleus motoneurons. These data demonstrate that the inverse relationship between soma size and oxidative enzyme activity of rat soleus motoneurons can only be detected in the early postnatal period and that the oxidative enzyme activity in the rat soleus muscle and its motoneurons can change independently during postnatal maturation.

Retrograde neuronal labeling of motoneurons in the rat by fluorescent tracers, and quantitative analysis of oxidative enzyme activity in labeled neurons

Extensor digitorum longus motoneurons in the rat spinal cord were identified by retrograde labeling with two fluorescent tracers, Fast blue (FB) and Nuclear yellow (NY). Labeled motoneurons had a blue fluorescent cytoplasm at 360 nm excitation wavelength with FB, and a golden-yellow fluorescent nucleus with NY on the cryostat section. Labeled motoneurons were further examined for succinate dehydrogenase activity on the same section used for identification of the motoneurons. This study demonstrates that fluorescent dyes are useful for neuroanatomical studies by the retrograde axonal transport method, and that quantitative analysis of metabolic activity in labeled motoneurons is also possible.