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Uzun ME, Kaymaz N, Kara O, Kasap T. Are Mental Health Problems and Mindfulness Awareness Related to Levothyroxine Replacement in Adolescent Patients With Hashimoto's Thyroiditis? Clin Pediatr (Phila) 2024; 63:522-530. [PMID: 37313800 DOI: 10.1177/00099228231180398] [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] [Indexed: 06/15/2023]
Abstract
Considering the possible adverse effects of thyroid autoantibodies on the brain, the present study aimed to investigate whether there was a difference in mental health difficulties and mindfulness awareness levels between subclinical Hashimoto's thyroiditis patients with and without levothyroxine (LT4) use. A case-control study was conducted. The Strengths and Difficulties Questionnaire (SDQ) and the Mindful Attention Awareness Scale (MAAS) were used to screen mental health difficulties and mindfulness awareness. Scale scores were compared by performing correlation analysis between the groups with respect to LT4 use and thyroid autoantibodies. Levothyroxine alone does not affect scale results. Higher thyroid peroxidase antibody (TPOAb) titers were positively correlated with the behavioral problems subscale of the SDQ, while awareness level in patients was inversely correlated with higher thyroglobulin antibody (TgAb) levels.
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Affiliation(s)
- Mehmet Erdem Uzun
- Department of Pediatric and Adolescent Psychiatry, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Nazan Kaymaz
- Department of Pediatrics, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Turkey
| | - Ozlem Kara
- Department of Pediatric Endocrinology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Tolga Kasap
- Department of Pediatrics, Çanakkale Onsekiz Mart University, Faculty of Medicine, Çanakkale, Turkey
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2
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Pathophysiology and Management Possibilities of Thyroid-Associated Depression. ACTA MEDICA BULGARICA 2022. [DOI: 10.2478/amb-2022-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Thyroid hormones and the hypothalamic-pituitary-thyroid (HPA) axis are responsible for multiple metabolic processes and psychological well-being. Hypothyroidism can induce mood changes, depressive symptoms and even major depressive disorder. This review is focused on the pathophysiology and mechanisms through which the low level of thyroid hormones may affect the brain function, causing the characteristic symptoms of depression. Key pathways of hypothyroid-associated depressive states include: morphological changes in some brain areas (mainly in the hippocampus – a reduction in its volume); a significant reduction of the cerebral blood flow (incl. hippocampus), and lowered levels of neurotrophic factors (e. g. BDNF – brain-derived neurotrophic factor), which are regulated by the thyroid hormones. An adequate and timely thyroid hormone replacement and treatment with conventional antidepressants often can reverse the psychological symptoms.
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Khadrawy YA, Khoder NM, Sawie HG, Sharada HM, Hosny EN, Abdulla MS. The Neuroprotective Effect of α-Lipoic Acid and/or Metformin against the Behavioral and Neurochemical Changes Induced by Hypothyroidism in Rat. Neuroendocrinology 2022; 112:1129-1142. [PMID: 35354137 DOI: 10.1159/000524367] [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: 12/22/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The present study evaluates the neuroprotective effect of α-lipoic acid (ALA) and/or metformin (MET) on the behavioral and neurochemical changes induced by hypothyroidism. METHODS Rats were divided into control, rat model of hypothyroidism induced by propylthiouracil, and rat model of hypothyroidism treated with ALA, MET, or their combination. RESULTS Behaviorally, hypothyroid rats revealed impaired memory and reduced motor activity as indicated from the novel object recognition test and open-field test, respectively. Hypothyroidism induced a significant increase in lipid peroxidation (malondialdehyde [MDA]) and a significant decrease in reduced glutathione (GSH) and nitric oxide (NO) in the cortex and hippocampus. These were associated with a significant increase in tumor necrosis factor-α (TNF-α) and a significant decrease in brain-derived neurotrophic factor (BDNF). Hypothyroidism decreased significantly the levels of serotonin (5-HT), norepinephrine (NE), and dopamine (DA) and reduced the activities of acetylcholinesterase (AchE) and Na+, K+-ATPase in the cortex and hippocampus. Treatment of hypothyroid rats with ALA and/or MET showed an improvement in memory function and motor activity. Moreover, ALA and/or MET prevented the increase in MDA and TNF-α, and the decline in GSH, NO, BDNF, 5-HT, NE, and DA. It also restored AchE and Na+, K+-ATPase activities in the studied brain regions. CONCLUSION ALA and/or MET has a potential neuroprotective effect against the adverse behavioral and neurochemical changes induced by hypothyroidism in rats.
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Affiliation(s)
- Yasser A Khadrawy
- Medical Physiology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Noha M Khoder
- Medical Physiology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Hussein G Sawie
- Medical Physiology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Hayat M Sharada
- Chemistry Department, Faculty of Science, Helwan University, Helwan, Egypt
| | - Eman N Hosny
- Medical Physiology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Mohga S Abdulla
- Chemistry Department, Faculty of Science, Helwan University, Helwan, Egypt
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Kalra P, Kumaraswamy DR, Dharmalingam M, Saini J, Yadav R. Neuropsychological Impairments in Young Patients With Subclinical Hypothyroidism: A Case Control Study. Ann Neurosci 2020; 27:169-174. [PMID: 34556956 PMCID: PMC8455001 DOI: 10.1177/0972753121990177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is a lack of clarity about the cognitive dysfunction in young patients with subclinical hypothyroidism (SCH). This study was done to explore the neuropsychological impairments in young patients with SCH and compare them with euthyroid controls. Methods: Patients between 18 and 45 years of age and diagnosed with SCH were recruited. Controls were euthyroid age, gender, and education matched. All the cases and controls underwent a detailed neuropsychological assessment with a battery of tests validated for use in the age groups of 18 to 65 years. Results: Thirty-nine patients with a mean age of 30.3 ± 7.7 years (female:male ratio 12:1) and 23 controls (female:male ratio 21:2) with a mean age of 33.4 ± 7.1 years (P = .24) were included in the study. The mean TSH value was 6.36 ± 1.3 mIU/L and 2.49 ± 1.03 mIU/L in cases and controls, respectively (P < .001). The visual memory delayed recall was impaired, in 48.71% (n = 19) and 21.7% (n = 5) cases and controls, respectively (P = .03). The category fluency test showed impairment in a greater number of cases (35.9%, n = 14) as compared to controls (13%, n = 3; P = .04). Conclusion: This study shows that younger patients with SCH have delayed visual memory recall and category fluency deficits, which are suggestive of dysfunction of the prefrontal cortex and temporal lobe in young SCH patients. These impairments may justify the treatment of young SCH patients with replacement therapy.
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Affiliation(s)
- Pramila Kalra
- Department of Endocrinology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - D R Kumaraswamy
- Department of Neuropsychology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Mala Dharmalingam
- Department of Endocrinology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Gunbey HP, Has AC, Aslan K, Saglam D, Avcı U, Sayıt AT, Incesu L. Microstructural white matter abnormalities in hypothyroidism evaluation with diffusion tensor imaging tract-based spatial statistical analysis. Radiol Med 2020; 126:283-290. [PMID: 32524282 DOI: 10.1007/s11547-020-01234-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Hypothyroidism is presented in a wide range from neuropsychiatric problems including depression, memory and cognitive disorders to poor motor coordination. Against the background of morphologic, functional and molecular changes on the white and grey matter of the brain, we aimed to investigate the effects of hypothyroidism on white matter (WM) integrity using tract-based spatial statistics (TBSS). METHODS Eighteen patients with hyperthyroidism and 14 age-sex-matched healthy control subjects were included in this study. TBSS was used in the diffusion tensor imaging study for whole-brain voxel wise analysis of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) of WM. RESULTS When compared to the control group, the whole brain TBSS revealed extensive reductions of FA in the supratentorial WM including corticospinal tract, posterior limb of the internal capsule (PLIC), uncinate fasciculus, inferior longitudinal fasciculus (p < 0.005). The ROI analyses showed RD increment of superior longitudinal fasciculus, AD decrement of cingulum (CIN), external capsule, PLIC and corpus callosum (CC) in patients with hypothyroidism (p < 0.005). Autoimmune and non-autoimmune hypothyroidism patient subgroups showed a significant difference in terms of hippocampus FA, CIN MD, CC MD, CC AD, CIN RD, SLF RD, CC RD (p < 0.005). CIN FA values showed a negative correlation with the Beck Depression Inventory (p = 0.007, r = - 852). CONCLUSIONS These preliminary results of TBSS analyses represented FA and AD decrement, and RD increment in several WM tracts and indicates the demyelination process underlying pathophysiology of clinical aspects of hypothyroidism.
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Affiliation(s)
- Hediye Pınar Gunbey
- Department of Radiology, University of Health Sciences Kartal Lutfi Kırdar Training and Research Hospital, 34890, Kartal/Istanbul, Turkey.
| | - Arzu Ceylan Has
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerim Aslan
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Dilek Saglam
- Departmant of Radiology, University of Health Sciences Malatya Training and Research Hospital, Malatya, Turkey
| | - Ugur Avcı
- Department of Endocrinology, Recep Tayyip Erdogan University, Rize, Turkey
| | | | - Lutfi Incesu
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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Martínez-Salazar C, Villanueva I, Pacheco-Rosado J, Alva-Sánchez C. Moderate exercise prevents the cell atrophy caused by hypothyroidism in rats. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sinha P, Chakrabarti N, Ghosh N, Mitra S, Dalui S, Bhattacharyya A. Alterations of thyroidal status in brain regions and hypothalamo-pituitary-blood-thyroid-axis associated with dopaminergic depletion in substantia nigra and ROS formation in different brain regions after MPTP treatment in adult male mice. Brain Res Bull 2020; 156:131-140. [PMID: 31891753 DOI: 10.1016/j.brainresbull.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/20/2022]
Abstract
MPTP produces oxidative stress, damages niagrostriatal dopaminergic neurons and develops Parkinsonism in rodents. Due to paucity of information, the thyroidal status in brain regions and peripheral tissues during different post-treatment days in MPTP-induced mice had been executed in the present study. MPTP depleted tyrosine hydroxylase protein expressions that signify the dopaminergic neuronal damage in substantia nigra. MPTP elevated ROS formation differentially in brain regions (cerebral cortex, hippocampus, substantia nigra) with maximal elevation at hippocampus. The changes in thyroid hormone (T4 and T3) levels indicate that brain regions might combat the adverse situation by keeping the levels of thyroid hormones either unchanged or in the elevated conditions in the latter phases (day-3 and day-7), apart from the depletion of thyroid hormones in certain brain regions (T4 in SN and hippocampus, T3 in hippocampus) as the immediate (day-1) effects after MPTP treatment. MPTP caused alterations of cellular morphology, RNA:Protein ratio and TPO protein expression, concomitantly depleted TPO mRNA expression and elevated TSH levels in the thyroid gland. Although T4 levels changed differentially, T3 levels remained unaltered in thyroid gland throughout the post-treatment days. Results have been discussed mentioning the putative role of T4 and TSH in apoptosis and/or proliferation/differentiation of thyrocytes. In blood, T4 levels remained unchanged while the changes in T3 and TSH levels did not signify the clinical feature of hypo/hyperthyroidism of animals. In the pituitary, both T4 and T3 levels remained elevated where TSH differentially altered (elevated followed by depletion) during post-treatment days. Notably, T4, T3 and TSH levels did not alter in hypothalamus except initial (day-1) depletion of the T4 level. Therefore, the feedback control mechanism of hypothalamo-pituitary-blood-thyroid-axis failed to occur after MPTP treatment. Overall, MPTP altered thyroidal status in the brain and peripheral tissues while both events might occur in isolation as well.
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Affiliation(s)
- Priyobrata Sinha
- Immunology Lab, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India; Department of Physiology, University of Calcutta, 92, Acharya Prafulla Chandra Road, Kolkata 700009, India
| | - Nilkanta Chakrabarti
- Department of Physiology, University of Calcutta, 92, Acharya Prafulla Chandra Road, Kolkata 700009, India; Centres with Potential for Excellence in Particular Areas (CPEPA, UGC), Centre for "Electrophysiology & Neuroimaging Studies Including Mathematical Modeling" India.
| | - Nabanita Ghosh
- Immunology Lab, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Soham Mitra
- Immunology Lab, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Shauryabrota Dalui
- Immunology Lab, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India
| | - Arindam Bhattacharyya
- Immunology Lab, Department of Zoology, University of Calcutta, 35, Ballygunge Circular Road, Kolkata 700019, India.
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Cognitive Deficit-Related Interhemispheric Asynchrony within the Medial Hub of the Default Mode Network Aids in Classifying the Hyperthyroid Patients. Neural Plast 2018; 2018:9023604. [PMID: 30532774 PMCID: PMC6250039 DOI: 10.1155/2018/9023604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose Recent studies suggest that abnormal structure and function in the brain network were related to cognitive and emotional impairment in hyperthyroid patients (HPs). The association between altered voxel-mirrored homotopic connectivity (VMHC) and neuropsychological impairment in HPs remains unclear. This study is aimed at investigating the association between the disrupted functional coordination and psychological dysfunction in hyperthyroidism. Method Thirty-three hyperthyroid patients and thirty-three matched healthy controls (HCs) were recruited, and they received resting-state functional magnetic resonance imaging (fMRI) scans and neuropsychological evaluation. The VMHC value was computed to reveal the functional coordination between homotopic regions in both groups. The neurobehavioral relevancy method was employed to explore the relationship between the altered VMHC and emotional, cognition measures. Further receiver operating characteristic (ROC) curve analysis was adopted to examine the power of changed regional VMHC in classifying the patients with hyperthyroidism. Results Compared with the HCs, the HPs exhibited significantly declined VMHC values in the bilateral medial frontal gyrus (MeFG). The interhemispheric asynchrony in the MeFG was positively correlated with Z scores of episodic memory. The ROC analysis further determined that abnormal VMHC in the MeFG could efficiently distinguish the HPs from the HCs (area under the curve (AUC) = 0.808, P < 0.001). Conclusion The altered interhemispheric coordination in the hub of the default mode network may implicated in the modulation of episodic memory in HPs patients and the distinct feature of the interhemispheric asynchrony may be treated as a potential target for the early recognition and intervention for the HPs with cognitive impairments. Clinical Trial Registration This is a study of the neurological basis for dysfunction of mood and cognition in hyperthyroid patients: a resting-state fMRI study (registration number: ChiCTR-OOC-16008607).
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Liu B, Yang H, Gao F, Wang Q, Zhao B, Gong T, Wang Z, Chen W, Wang G, Edden RA. Investigation of brain GABA+ in primary hypothyroidism using edited proton MR spectroscopy. Clin Endocrinol (Oxf) 2017; 86:256-262. [PMID: 27581339 PMCID: PMC5512100 DOI: 10.1111/cen.13177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/17/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Evidence indicates that thyroid hormones have effects on the inhibitory GABAergic system. The aim of this study was to investigate whether brain GABA levels are altered in patients with hypothyroidism compared with healthy controls. DESIGN/METHODS Fifteen patients with primary hypothyroidism and 15 matched healthy controls underwent single-voxel MEGA-PRESS magnetic resonance spectroscopy at 3T, to quantify GABA levels in the median prefrontal cortex (mPFC) and posterior cingulate cortex (PCC). All participants underwent thyroid function test. Neuropsychological performances were evaluated by administration of the Montreal Cognitive Assessment (MoCA) and the 21-item Beck Depression Inventory-II (BDI-II). RESULTS The patients with hypothyroidism had significantly lower GABA+ levels in the mPFC compared with healthy controls (P = 0·016), whereas no significant difference (P = 0·214) was observed in the PCC. Exploratory analyses revealed that mPFC GABA+ levels were negatively correlated with the BDI-II scores in patient group (r = -0·60, P = 0·018). No correlations were found between GABA+ levels and TSH or fT3 or fT4 levels in either region (all P > 0·05). CONCLUSION This study suggests that alteration of GABAergic neurotransmission may play an important role in the pathophysiology of primary hypothyroidism, providing intriguing neurochemical clues to understand thyroid-brain interactions.
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Affiliation(s)
- Bo Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Huan Yang
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Fei Gao
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Tao Gong
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Zhensong Wang
- Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Guangbin Wang
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sánchez-Huerta K, García-Martínez Y, Vergara P, Segovia J, Pacheco-Rosado J. Thyroid hormones are essential to preserve non-proliferative cells of adult neurogenesis of the dentate gyrus. Mol Cell Neurosci 2016; 76:1-10. [DOI: 10.1016/j.mcn.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/09/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022] Open
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Göbel A, Heldmann M, Göttlich M, Dirk AL, Brabant G, Münte TF. Effect of Mild Thyrotoxicosis on Performance and Brain Activations in a Working Memory Task. PLoS One 2016; 11:e0161552. [PMID: 27536945 PMCID: PMC4990413 DOI: 10.1371/journal.pone.0161552] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS Disturbed levels of thyroid hormones are associated with neuropsychiatric disorders, including memory impairments. The aim of this study was to evaluate effects of mild induced thyrotoxicosis on working memory and its neural correlates. METHODS Twenty-nine healthy, male subjects with normal thyroid state participated in the study. Functional MRI was acquired during a working memory task (n-back task) before and after ingesting 250 μg L-thyroxin per day for a period of eight weeks. In addition, neuropsychological tests were performed. RESULTS In the hyperthyroid condition the subjects showed slower reaction times, but a higher accuracy in the 0-back version of the memory tasks. Fewer differences between euthyroid and hyperthyroid state were seen for the more difficult conditions of the n-back task. FMRI revealed effects of difficulty in the parahippocampal gyrus, supplementary motor area, prefrontal cortex, anterior cingulate cortex, posterior cerebellum, rolandic operculum and insula (p<0.05, FWE corrected). When comparing euthyroid and hyperthyroid condition in relation to task-induced activation, differences of activation were found in the right prefrontal cortex as well as in the right parahippocampal area. In the psychological assessment, the alerting effect in the Attention Network Task (ANT) and four out of five parameters of the auditory verbal learning test (AVLT) showed an increase from euthyroid to hyperthyroid state. CONCLUSIONS It can be concluded that even a short-term intake of thyroid hormones leads to an activation of brain areas associated with working memory and to an improvement of accuracy of working memory tasks.
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Affiliation(s)
- Anna Göbel
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Martin Göttlich
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Anna-Luise Dirk
- Department of Internal Medicine I, University of Lübeck, 23538, Lübeck, Germany
| | - Georg Brabant
- Department of Internal Medicine I, University of Lübeck, 23538, Lübeck, Germany
| | - Thomas F. Münte
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
- * E-mail:
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Malt EA, Juhasz K, Malt UF, Naumann T. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Front Behav Neurosci 2016; 10:59. [PMID: 27064909 PMCID: PMC4811959 DOI: 10.3389/fnbeh.2016.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a highly heritable disorder with diverse mental and somatic symptoms. The molecular mechanisms leading from genes to disease pathology in schizophrenia remain largely unknown. Genome-wide association studies (GWASs) have shown that common single-nucleotide polymorphisms associated with specific diseases are enriched in the recognition sequences of transcription factors that regulate physiological processes relevant to the disease. We have used a “bottom-up” approach and tracked a developmental trajectory from embryology to physiological processes and behavior and recognized that the transcription factor NK2 homeobox 1 (NKX2-1) possesses properties of particular interest for schizophrenia. NKX2-1 is selectively expressed from prenatal development to adulthood in the brain, thyroid gland, parathyroid gland, lungs, skin, and enteric ganglia, and has key functions at the interface of the brain, the endocrine-, and the immune system. In the developing brain, NKX2-1-expressing progenitor cells differentiate into distinct subclasses of forebrain GABAergic and cholinergic neurons, astrocytes, and oligodendrocytes. The transcription factor is highly expressed in mature limbic circuits related to context-dependent goal-directed patterns of behavior, social interaction and reproduction, fear responses, responses to light, and other homeostatic processes. It is essential for development and mature function of the thyroid gland and the respiratory system, and is involved in calcium metabolism and immune responses. NKX2-1 interacts with a number of genes identified as susceptibility genes for schizophrenia. We suggest that NKX2-1 may lie at the core of several dose dependent pathways that are dysregulated in schizophrenia. We correlate the symptoms seen in schizophrenia with the temporal and spatial activities of NKX2-1 in order to highlight promising future research areas.
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Affiliation(s)
- Eva A Malt
- Department of Adult Habilitation, Akershus University HospitalLørenskog, Norway; Institute of Clinical Medicine, Ahus Campus University of OsloOslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital Lørenskog, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of OsloOslo, Norway; Department of Research and Education, Institution of Oslo University HospitalOslo, Norway
| | - Thomas Naumann
- Centre of Anatomy, Institute of Cell Biology and Neurobiology, Charite Universitätsmedizin Berlin Berlin, Germany
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Daghighi MH, Poureisa M, Ahmadi P, Reshadatjoo M, Golestani S, Naghavi-Behzad M, Karkon-Shayan F. Serum thyroid-stimulating hormone level and relation with size of hippocampus in patients with mild cognitive disorders. Niger Med J 2016; 57:353-356. [PMID: 27942104 PMCID: PMC5126749 DOI: 10.4103/0300-1652.193862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Cognitive disorders and dementia are common problems, and Alzheimer's disease is one of the major leading causes of death worldwide. Thyroid hormone disorders as a common problem effect on hippocampus size which as a prognostic factor in dementia. The aim of the present study was to investigate the relationship between serum thyroid-stimulating hormone (TSH) level and the size of hippocampus in patients with mild cognitive disorders. Materials and Methods: In a descriptive-analytical study, 41 patients with symptoms of mild cognitive disorders whom referred to take the brain magnetic resonance image (MRI) in a radiology center under the direction of Tabriz University of Medical Sciences (Tabriz, Iran) were evaluated. The right and left hippocampal and brain volume was calculated by MRI at coronal T1-weighted. Serum TSH level was also measured in these patients. Correlation between serum TSH level and hippocampal volume size was evaluated. Results: Male to female ratio was 1.05:1 with mean age of 54.09 ± 3.11 years. Mean serum TSH level of patients was 1.55 ± 1.45 uU/ml. The right and left hippocampal volumes were 1.61 ± 0.42 and 1.62 ± 0.39 ml, respectively. There were slight negative correlations between the right and left hippocampal volumes with TSH level (r = −0.133 and r = −0.092, respectively). Correlations between the right and left hippocampal volumes with TSH level were not statistically significant (P = 0.406, P = 0.566, respectively). Conclusion: Based on findings of the present study, there was a weak negative correlation between serum level of TSH with the right and left hippocampal and brain volume ratio, but the correlation was not statistically significant. It seems that controlling of clinical or subclinical hypothyroidism may have a role in slowing of dementia progression and also have a preventive role.
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Affiliation(s)
| | - Masoud Poureisa
- Department of Radiology and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pegah Ahmadi
- Department of Radiology and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Reshadatjoo
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Golestani
- Department of Radiology and Nuclear Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Karkon-Shayan
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Göttlich M, Heldmann M, Göbel A, Dirk AL, Brabant G, Münte TF. Experimentally induced thyrotoxicosis leads to increased connectivity in temporal lobe structures: a resting state fMRI study. Psychoneuroendocrinology 2015; 56:100-9. [PMID: 25808701 DOI: 10.1016/j.psyneuen.2015.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/20/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
Adult onset hyperthyroidism may impact on different cognitive domains, including attention and concentration, memory, perceptual function, language and executive function. Previous PET studies implicated changed functionality of limbic regions, the temporal and frontal lobes in hyperthyroidism, whereas it is unknown whether cognitive effects of hyperthyroidism may be due to changed brain connectivity. This study aimed to investigate the effect of experimentally induced short-term hyperthyroidism thyrotoxicosis on resting-state functional connectivity using functional magnetic resonance imaging. Twenty-nine healthy male right-handed subjects were examined twice, once prior and once after 8 weeks of oral administration of 250 μg levothyroxine per day. Resting-state fMRI was subjected to graph-theory based analysis methods to investigate whole-brain intrinsic functional connectivity. Despite a lack of subjective changes noticed by the subjects significant thyrotoxicosis was confirmed in all subjects. This induced a significant increase in resting-state functional connectivity specifically in the rostral temporal lobes (0.05 FDR corrected at the cluster level), which is caused by an increased connectivity to the cognitive control network. The increased connectivity between temporal poles and the cognitive control network shown here under experimental conditions supports an important function of thyroid hormones in the regulation of paralimbic structures.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Anna Göbel
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Anna-Luise Dirk
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Georg Brabant
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany.
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15
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Kapoor R, Fanibunda SE, Desouza LA, Guha SK, Vaidya VA. Perspectives on thyroid hormone action in adult neurogenesis. J Neurochem 2015; 133:599-616. [DOI: 10.1111/jnc.13093] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/18/2015] [Accepted: 02/24/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Richa Kapoor
- Department of Biological Sciences; Tata Institute of Fundamental Research; Mumbai India
| | - Sashaina E. Fanibunda
- Department of Biological Sciences; Tata Institute of Fundamental Research; Mumbai India
| | - Lynette A. Desouza
- Department of Biological Sciences; Tata Institute of Fundamental Research; Mumbai India
| | - Suman K. Guha
- Department of Biological Sciences; Tata Institute of Fundamental Research; Mumbai India
| | - Vidita A. Vaidya
- Department of Biological Sciences; Tata Institute of Fundamental Research; Mumbai India
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16
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Sánchez-Huerta K, Pacheco-Rosado J, Gilbert ME. Adult onset-hypothyroidism: alterations in hippocampal field potentials in the dentate gyrus are largely associated with anaesthesia-induced hypothermia. J Neuroendocrinol 2015; 27:8-19. [PMID: 25327136 DOI: 10.1111/jne.12229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/16/2014] [Accepted: 10/03/2014] [Indexed: 01/10/2023]
Abstract
Thyroid hormone (TH) is essential for a number of physiological processes and is particularly critical during nervous system development. The hippocampus is strongly implicated in cognition and is sensitive to developmental hypothyroidism. The impact of TH insufficiency in the foetus and neonate on hippocampal synaptic function has been fairly well characterised. Although adult onset hypothyroidism has also been associated with impairments in cognitive function, studies of hippocampal synaptic function with late onset hypothyroidism have yielded inconsistent results. In the present study, we report hypothyroidism induced by the synthesis inhibitor propylthiouracil (10 p.p.m., 0.001%, minimum of 4 weeks), resulted in marginal alterations in excitatory postsynaptic potential (EPSP) and population spike (PS) amplitude in the dentate gyrus measured in vivo. No effects were seen in tests of short-term plasticity, and a minor enhancement of long-term potentiation of the EPSP slope was observed. The most robust synaptic alteration evident in hypothyroid animals was an increase in synaptic response latency, which was paralleled by a failure to maintain normal body temperature under anaesthesia, despite warming on a heating pad. Latency shifts could be reversed in hypothyroid animals by increasing the external heat source and, conversely, synaptic delays could be induced in control animals by removing the heat source, with a consequent drop in body and brain temperature. Thermoregulation is TH- dependent, and anaesthesia necessary for surgical procedures posed a thermoregulatory challenge that was differentially met in control and hypothyroid animals. Minor increases in field potential EPSP slope, decreases in PS amplitudes and increased latencies are consistent with previous reports of hypothermia in naive control rats. We conclude that failures in thyroid-dependent temperature regulation rather than direct action of TH in synaptic physiology are responsible for the observed effects. These findings stand in contrast to the synaptic impairments observed in adult offspring following developmental TH insufficiency, and emphasise the need to control for the potential unintended consequences of hypothermia in the interpretation of hypothyroid-induced changes in physiological systems, most notably synaptic transmission.
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Affiliation(s)
- K Sánchez-Huerta
- Departamento de Fisiología 'Mauricio Russek', Escuela Nacional de Ciencias Biológicas, IPN, México City, México; Laboratory of Neurochemistry, National Institute of Pediatrics, Mexico City, Mexico
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17
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Cooke GE, Mullally S, Correia N, O'Mara SM, Gibney J. Hippocampal volume is decreased in adults with hypothyroidism. Thyroid 2014; 24:433-40. [PMID: 24205791 DOI: 10.1089/thy.2013.0058] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid hormones are important for the adult brain, particularly regions of the hippocampus including the dentate gyrus and CA1 and CA3 regions. The hippocampus is a thyroid hormone receptor-rich region of the brain involved in learning and memory. Consequently, alterations in thyroid hormone levels have been reported to impair hippocampal-associated learning and memory, synaptic plasticity, and neurogenesis. While these effects have been shown primarily in developing rats, as well as in adult rats, little is known about the effects in adult humans. There are currently no data regarding structural changes in the hippocampus as a result of adult-onset hypothyroidism. We aimed to establish whether hippocampal volume was reduced in patients with untreated adult-onset hypothyroidism compared to age-matched healthy controls. METHODS High-resolution magnetization-prepared rapid acquisition with gradient echo (MPRAGE) scans were performed on 11 untreated hypothyroid adults and 9 age-matched control subjects. Hypothyroidism was diagnosed based on increased levels of thyrotropin (TSH) and reduced levels of free thyroxine (fT4). RESULTS Volumetric analysis of the right and left hippocampal regions, using functional magnetic resonance imaging of the brain (FMRIB) integrated registration and segmentation tool (FIRST), demonstrated significant volume reduction in the right hippocampus in the hypothyroid patients relative to the control group. CONCLUSIONS These findings provide preliminary evidence that hypothyroidism results in structural deficits in the adult human brain. Decreases in volume in the right hippocampus were evident in patients with adult-onset overt hypothyroidism, supporting some of the findings in animal models.
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Affiliation(s)
- Gillian E Cooke
- 1 Institute of Neuroscience , Trinity College Dublin, Dublin, Ireland
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18
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Dias GRM, de Almeida TM, Sudati JH, Dobrachinski F, Pavin S, Soares FAA, Nogueira CW, Barbosa NBV. Diphenyl diselenide supplemented diet reduces depressive-like behavior in hypothyroid female rats. Physiol Behav 2014; 124:116-22. [DOI: 10.1016/j.physbeh.2013.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/22/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022]
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19
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Feldkamp J, Schott M. Somatic causes were omitted. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:11. [PMID: 23450992 DOI: 10.3238/arztebl.2013.0011b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Singh S, Modi S, Bagga D, Kaur P, Shankar LR, Khushu S. Voxel-based morphometric analysis in hypothyroidism using diffeomorphic anatomic registration via an exponentiated lie algebra algorithm approach. J Neuroendocrinol 2013; 25:229-34. [PMID: 23057474 DOI: 10.1111/jne.12001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/04/2012] [Accepted: 10/08/2012] [Indexed: 11/29/2022]
Abstract
The present study aimed to investigate whether brain morphological differences exist between adult hypothyroid subjects and age-matched controls using voxel-based morphometry (VBM) with diffeomorphic anatomic registration via an exponentiated lie algebra algorithm (DARTEL) approach. High-resolution structural magnetic resonance images were taken in ten healthy controls and ten hypothyroid subjects. The analysis was conducted using statistical parametric mapping. The VBM study revealed a reduction in grey matter volume in the left postcentral gyrus and cerebellum of hypothyroid subjects compared to controls. A significant reduction in white matter volume was also found in the cerebellum, right inferior and middle frontal gyrus, right precentral gyrus, right inferior occipital gyrus and right temporal gyrus of hypothyroid patients compared to healthy controls. Moreover, no meaningful cluster for greater grey or white matter volume was obtained in hypothyroid subjects compared to controls. Our study is the first VBM study of hypothyroidism in an adult population and suggests that, compared to controls, this disorder is associated with differences in brain morphology in areas corresponding to known functional deficits in attention, language, motor speed, visuospatial processing and memory in hypothyroidism.
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Affiliation(s)
- S Singh
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Timarpur, Delhi, India
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21
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Hassan WA, Aly MS, Rahman TA, Shahat AS. Impact of experimental hypothyroidism on monoamines level in discrete brain regions and other peripheral tissues of young and adult male rats. Int J Dev Neurosci 2013; 31:225-33. [PMID: 23411049 DOI: 10.1016/j.ijdevneu.2013.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/17/2013] [Accepted: 02/01/2013] [Indexed: 10/27/2022] Open
Abstract
The levels of dopamine (DA), norepinephrine (NE) and serotonin (5-HT) in different brain regions as well as in blood plasma, cardiac muscle and adrenal gland of young and adult male albino rats were measured following experimentally induced hypothyroidism. Hypothyroidism induced by daily oral administration of propylthiouracil (PTU, 5mg/kg body wt) caused a significant reduction in DA levels in most of the tissues examined of both young and adult rats after 21 and 28 days, in NE levels after all the time intervals studied in young rats, and after 21 and 28 days in adult rats. 5-HT exhibited a significant reduction in the selected brain regions and blood plasma after 21 and 28 days and in cardiac muscle after all the time intervals in the two age groups of animals. It may be suggested that the changes in monoamine levels induced by hypothyroidism may be due to disturbance in the synthesis and release of these amines through the neurons impairment or may be due to an alteration pattern of their synthesizing and/or degradative enzymes.
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Affiliation(s)
- Wafaa A Hassan
- National Organization for Drug Control and Research, Hormone Evaluation Department, Cairo 11511, Egypt.
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22
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Leyhe T, Ethofer T, Bretscher J, Künle A, Säuberlich AL, Klein R, Gallwitz B, Häring HU, Fallgatter A, Klingberg S, Saur R, Müssig K. Low performance in attention testing is associated with reduced grey matter density of the left inferior frontal gyrus in euthyroid patients with Hashimoto's thyroiditis. Brain Behav Immun 2013; 27:33-7. [PMID: 23010451 DOI: 10.1016/j.bbi.2012.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/04/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022] Open
Abstract
Hashimoto's thyroiditis (HT) can casually co-occur with an encephalopathy associated with autoimmune thyroid disease. Recently we found an increased occurrence of weaknesses in sustained attention and response inhibition in a subgroup of euthyroid patients with HT as obtained by the d2 attention test. Previous studies in healthy subjects and patients with brain lesions demonstrated a pivotal role for the left inferior frontal gyrus (LIFG) in these skills. Therefore, we studied the association between the performance in the d2 test and grey matter (GM) density of the LIFG in 13 euthyroid patients with HT compared to a control group of 12 euthyroid patients with other thyroid diseases. A significant correlation between GM density and d2 test total score was detected for the opercular part of the LIFG in patients with HT (p<0.001), but not in the control group (p=0.94). Regression in patients with HT was significantly stronger than in the control group (p=0.02). Moreover, GM density was significantly reduced when comparing HT patients with control patients that scored in the lower third during d2 attention testing (p<0.05). It can be concluded that in HT performance in the d2 test correlated with GM density of the LIFG. Particularly low achievement was associated with reduced GM density of this brain region suggesting an influence of autoimmune processes on the frontal cortex in this disease. This could be due to not yet known antibodies affecting brain morphology or an influence of thyroid antibodies themselves.
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Affiliation(s)
- Thomas Leyhe
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Germany.
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de Cock M, Maas YGH, van de Bor M. Does perinatal exposure to endocrine disruptors induce autism spectrum and attention deficit hyperactivity disorders? Review. Acta Paediatr 2012; 101:811-8. [PMID: 22458970 DOI: 10.1111/j.1651-2227.2012.02693.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To provide an overview of studies on perinatal exposure in humans to endocrine disrupting chemicals (EDCs) in relation to autism spectrum (ASD) and attention deficit hyperactivity (ADHD) disorders. METHODS A review of the literature (PubMed) was performed. Exposure-related keywords, including various chemicals, were matched with keywords describing outcome. Animal studies as well as publications not written in English were excluded. In total, 834 titles were retrieved. The final selection included 21 publications. RESULTS Positive associations were found for ASD in relation to exposure to all chemicals investigated, which included hazardous air pollutants, pesticides and bisphenol A (BPA). Increased risks of ADHD or positive associations were found for exposure to polychlorinated biphenyls (PCBs), dialkyl phosphate (DAP) and chlorpyrifos. BPA, polybrominated diphenylethers (PBDEs) and low molecular weight (LMW) phthalates were positively associated with externalizing behaviour. Five of 17 studies did not find any association between exposure and ADHD. CONCLUSION Perinatal exposure to EDCs appears to be associated with the occurrence of ASD as well as ADHD. Disruption of thyroid hormone function and gamma-aminobutyric acid (GABA)ergic mechanisms may offer an explanation for the observed relations; though, conclusive evidence in humans is limited.
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Affiliation(s)
- Marijke de Cock
- Department of Health and Life Sciences, VU University, Amsterdam, The Netherlands
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Biondi B, Wartofsky L. Combination treatment with T4 and T3: toward personalized replacement therapy in hypothyroidism? J Clin Endocrinol Metab 2012; 97:2256-71. [PMID: 22593590 DOI: 10.1210/jc.2011-3399] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Levothyroxine therapy is the traditional lifelong replacement therapy for hypothyroid patients. Over the last several years, new evidence has led clinicians to evaluate the option of combined T(3) and T(4) treatment to improve the quality of life, cognition, and peripheral parameters of thyroid hormone action in hypothyroidism. The aim of this review is to assess the physiological basis and the results of current studies on this topic. EVIDENCE ACQUISITION We searched Medline for reports published with the following search terms: hypothyroidism, levothyroxine, triiodothyronine, thyroid, guidelines, treatment, deiodinases, clinical symptoms, quality of life, cognition, mood, depression, body weight, heart rate, cholesterol, bone markers, SHBG, and patient preference for combined therapy. The search was restricted to reports published in English since 1970, but some reports published before 1970 were also incorporated. We supplemented the search with records from personal files and references of relevant articles and textbooks. Parameters analyzed included the rationale for combination treatment, the type of patients to be selected, the optimal T(4)/T(3) ratio, and the potential benefits of this therapy on symptoms of hypothyroidism, quality of life, mood, cognition, and peripheral parameters of thyroid hormone action. EVIDENCE SYNTHESIS The outcome of our analysis suggests that it may be time to consider a personalized regimen of thyroid hormone replacement therapy in hypothyroid patients. CONCLUSIONS Further prospective randomized controlled studies are needed to clarify this important issue. Innovative formulations of the thyroid hormones will be required to mimic a more perfect thyroid hormone replacement therapy than is currently available.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
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