1
|
Capalbo D, Alfano S, Polizzi M, Di Mase R, Improda N, Esposito A, Bravaccio C, Salerno M. Cognitive Function in Children With Idiopathic Subclinical Hypothyroidism: Effects of 2 Years of Levothyroxine Therapy. J Clin Endocrinol Metab 2020; 105:5718305. [PMID: 32002552 DOI: 10.1210/clinem/dgaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term consequences of mild subclinical hypothyroidism (SH) in children are still unclear, and the need for levothyroxine (L-T4) supplementation remains controversial. We designed a 2-year, case-control, prospective study of a cohort of children with SH to evaluate the effects of L-T4 therapy on neurocognitive outcome. METHODS Thirty-four children, age 9.1 ± 2.6 years, with long-lasting, idiopathic, and mild SH, and 34 healthy matched controls, were enrolled. Twenty SH children underwent a 2-year L-T4 treatment (group A), whereas 14 refused treatment and were reevaluated after a 2-year-follow-up (group B). IQ and specific cognitive domains were evaluated in all children at study entry and after 2 years of therapy (group A) or observation (group B) in SH individuals. RESULTS In SH children baseline IQ scores were normal and comparable to controls (full-scale IQ [FSIQ] 100.4 ± 11.3 vs 101.8 ± 14.2, verbal IQ [VIQ] 99.7 ± 13.7 vs 98.3 ± 14.9 and performance IQ [PIQ] 101.2 ± 10.4 vs 105 ± 10.4).In group A, L-T4 treatment was associated with normalization of thyrotropin (6.3 ± 1.0 mIU/L at baseline vs 2.8 ± 1.4 mIU/L at 2 years, P < .001). However, 2-year L-T4 therapy was not associated with a change in IQ scores (FSIQ 104.4 ± 13.8 vs 102.7 ± 11.0; VIQ 101.8 ± 14.9 vs 102.3 ± 11.9; and PIQ 106.5 ± 13.9 vs 102.7 ± 10.7) or in verbal or performance subtest scores. No significant differences were found in IQ scores after 2 years of treatment in group A compared to group B after a 2-year follow-up. CONCLUSIONS Our data suggest neurocognitive function in children is not impaired by persistent, mild, untreated SH and is not significantly modified by 2-year L-T4 supplementation.
Collapse
Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Sara Alfano
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Miriam Polizzi
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Nicola Improda
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carmela Bravaccio
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| |
Collapse
|
2
|
Churilov LP, Sobolevskaia PA, Stroev YI. Thyroid gland and brain: Enigma of Hashimoto's encephalopathy. Best Pract Res Clin Endocrinol Metab 2019; 33:101364. [PMID: 31801687 DOI: 10.1016/j.beem.2019.101364] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The versatile clinical manifestations of the Hashimoto's chronic autoimmune thyroiditis often include psycho-neurological disorders. Although hypothyroidism disturbs significantly the ontogenesis and functions of central nervous system, causing in severe cases of myxedema profound impairment of cognitive abilities and even psychosis, the behavioral, motor and other psychoneurological disorders accompany euthyroid and slightly hypothyroid cases and periods of Hashimoto's disease as well, thus constituting the picture of so called "Hashimoto's encephalopathy". The entity, although discussed and explored for more than 50 years since its initial descriptions, remains an enigma of thyroidology and psychiatry, because its etiology and pathogenesis are obscure. The paper describes the development of current views on the role of thyroid in ontogeny and functions of brain, as well as classical and newest ideas on the etiology and pathogenesis of Hashimot's encephalopathy. The synopsis of the world case reports and research literature on this disorder is added with authors' own results obtained by study of 17 cases of Hashimoto's thyroiditis with schizophrenia-like clinical manifestations. The relation of the disease to adjuvant-like etiological factors is discussed. Three major mechanistic concepts of Hashimoto's encephalopathy are detailed, namely cerebral vasculitis theory, hormone dysregulation theory and concept, explaining the disease via direct action of the autoantibodies against various thyroid (thyroperoxidase, thyroglobulin, and TSH-receptor) and several extrathyroid antigens (alpha-enolase and other enzymes, gangliosides and MOG-protein, onconeuronal antigens) - all of them expressed in the brain. The article demonstrates that all above mentioned concepts intermingle and prone to unification, suggesting the unified scheme of pathogenesis for the Hashimoto's encephalopathy. The clinical manifestations, criteria, forms, course, treatment and prognosis of Hashimoto's encephalopathy and its comorbidity to other diseases - are also discussed in brief. The relation between Hashimoto's encephalopathy and non-vasculitis autoimmune encephalomyelitides of paraneoplastic and non-paraneoplastic origin is emphasized [1 figure, bibliography - 200 references].
Collapse
Affiliation(s)
- Leonid P Churilov
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
| | - Polina A Sobolevskaia
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
| | - Yuri I Stroev
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
| |
Collapse
|
3
|
Kocaaslan Atli S, Olgaç Dündar N, Bayazit O, Evirgen Esin N, Erdoğan U, Çatli G, Kahya MC, Dündar BN. Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism. J Pediatr Endocrinol Metab 2019; 32:689-697. [PMID: 31194683 DOI: 10.1515/jpem-2018-0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to examine the cognitive functions of children with subclinical hypothyroidism (SH) and healthy children with the use of auditory event-related potentials (AERPs) and neuropsychological tests. Methods Twenty children aged between 8 and 17 years, diagnosed with SH, and 20 age-matched healthy controls were included in this study. A classical auditory oddball paradigm was applied during the electroencephalography (EEG) recordings, and event-related potentials (ERPs) were evaluated between the 0.5- and 20-Hz frequency intervals. P1, N1, P2, N2 and P3 amplitudes and latencies were measured in Fz, FCz, Cz, CPz, Pz and Oz electrodes. Additionally, a number of neuropsychological tests evaluating the reaction time and various cognitive functions were carried out. Results In children with SH, P3 amplitudes in FCz, Cz and CPz electrodes were significantly lower than those in controls (p < 0.05). In addition to this, the P1N1 and N1P2 peak-to-peak amplitude values were also found to be smaller for children with SH than controls (p < 0.05). With regard to the neuropsychological tests, no significant difference was observed between the SH and control groups on any of the cognitive test parameters, reaction time or correct response rates. Conclusions In the present study, while children with SH did not differ from controls with respect to their cognitive functions evaluated via neuropsychological tests, cognitive differences were detected via electrophysiological investigations. This result implies that implicit changes in cognition which are not yet overtly reflected on neuropsychological tests may be detected at an early stage in children with SH.
Collapse
Affiliation(s)
- Sibel Kocaaslan Atli
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Nihal Olgaç Dündar
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Onur Bayazit
- Aydın University, Faculty of Medicine, Biophysics Department, Istanbul, Turkey
| | | | - Uğraş Erdoğan
- Izmir Institute of Technology, Faculty of Engineering, Department of Electrical - Electronics, Izmir, Turkey
| | - Gönül Çatli
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Mehmet Cemal Kahya
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Bumin Nuri Dündar
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| |
Collapse
|
4
|
Djurovic M, Pereira AM, Smit JWA, Vasovic O, Damjanovic S, Jemuovic Z, Pavlovic D, Miljic D, Pekic S, Stojanovic M, Asanin M, Krljanac G, Petakov M. Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement. Endocrine 2018; 62:136-143. [PMID: 29959689 DOI: 10.1007/s12020-018-1649-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status. DESIGN Retrospective cross-sectional study. PATIENTS AND MEASUREMENTS One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20-49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations. RESULTS FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20-49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score). CONCLUSION Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.
Collapse
Affiliation(s)
- Marina Djurovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia.
| | - Alberto M Pereira
- Department of Endocrinology and Metabolic Diseases, and Centre for Endocrine Tumors Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johannes W A Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Vasovic
- Institute for Gerontology and Palliative Care, Belgrade, Belgrade, Serbia
| | - Svetozar Damjanovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Zvezdana Jemuovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragan Pavlovic
- Institute of Neurology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragana Miljic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Sandra Pekic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Marko Stojanovic
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milika Asanin
- Clinic for Cardiology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Krljanac
- Clinic for Cardiology, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milan Petakov
- Clinic for Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
5
|
Kumar M, Modi S, Rana P, Kumar P, Kanwar R, Sekhri T, D'souza M, Khushu S. Alteration in intrinsic and extrinsic functional connectivity of resting state networks associated with subclinical hypothyroid. J Neuroendocrinol 2018; 30. [PMID: 29504670 DOI: 10.1111/jne.12587] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/27/2018] [Indexed: 11/28/2022]
Abstract
Subclinical hypothyroidism (SCH) is characterized by mild elevation of thyroid stimulating hormone (TSH) (range 5-10 μIU/ml) and normal free triiodothyronine (FT3) and free thyroxine (FT4). The cognitive function impairment is well known in thyroid disorders such as hypothyroidism and hyperthyroidism, but little is known about deficits in brain functions in SCH subjects. Also, whether hormone-replacement treatment is necessary or not in SCH subjects is still debatable. In order to have an insight into the cognition of SCH subjects, intrinsic and extrinsic functional connectivity (FC) of the resting state networks (RSNs) was studied. For resting state data analysis we used an unbiased, data-driven approach based on Independent Component Analysis (ICA) and dual-regression that can emphasize widespread changes in FC without restricting to a set of predefined seeds. 28 SCH subjects and 28 matched healthy controls (HC) participated in the study. RSN analysis showed significantly decreased intrinsic FC in somato-motor network (SMN) and right fronto-parietal attention network (RAN) and increased intrinsic FC in default mode network (DMN) in SCH subjects as compared to control subjects. The reduced intrinsic FC in the SMN and RAN suggests neuro-cognitive alterations in SCH subjects in the corresponding functions which were also evident from the deficit in the neuropsychological performance of the SCH subjects on behavioural tests such as digit span, delayed recall, visual retention, recognition, Bender Gestalt and Mini-Mental State Examination (MMSE). We also found a significant reduction in extrinsic network FC between DMN and RAN; SMN and posterior default mode network (PDMN); and increased extrinsic FC between SMN and anterior default mode network (ADMN) in SCH subjects as compared to controls. An altered extrinsic FC in SCH suggests functional reorganization in response to neurological disruption. The partial correlation analysis between intrinsic and extrinsic RSNs FC and neuropsychological performances as well as clinical indices give interesting insights into brain-behavior relationship in SCH subjects. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Mukesh Kumar
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| | - Shilpi Modi
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| | - Poonam Rana
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| | - Pawan Kumar
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| | - Ratnesh Kanwar
- Thyroid Research Centre, (INMAS), Brig. SK Mazumdar Marg, Timarpur, Delhi, India, 110054
| | - Tarun Sekhri
- Thyroid Research Centre, (INMAS), Brig. SK Mazumdar Marg, Timarpur, Delhi, India, 110054
| | - Maria D'souza
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| | - Subash Khushu
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS)
| |
Collapse
|
6
|
Cojić M, Cvejanov-Kezunović L. Subclinical Hypothyroidism - Whether and When To Start Treatment? Open Access Maced J Med Sci 2017; 5:1042-1046. [PMID: 29362642 PMCID: PMC5771276 DOI: 10.3889/oamjms.2017.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 12/15/2022] Open
Abstract
Subclinical hypothyroidism represents a state with increased values of thyroid stimulating hormone (TSH) and normal values of thyroxine (T4) and triiodothyronine (T3). The disorder is asymptomatic, and the diagnosis is made based on the results of laboratory findings when the level of TSH reaches values above 4.0 mU/l. It is still subject to debate whether patients with subclinical hypothyroidism are at increased risk of cardiovascular disease, neuropsychiatric and neuromuscular disorders. Studies have shown that the appearance of general symptoms and complications are more common in patients whose values of TSH are above 10 mU/l. Therefore, the initiation of therapy with levothyroxine, which is the foundation of substitution therapy, is advised in patients whose TSH is >10 mU/l. As for patients whose values of TSH are from 4.0 to 10.0 mU/l and who make up 90% of the patients with subclinical hypothyroidism, further research is needed to determine the effects of the disorder and levothyroxine therapy on the health. Until then, the introduction of the substitution therapy in patients with TSH which is <10 mU/l should be considered in the case of the presence of general symptoms, anti-thyroid antibodies, increased lipids and other risk factors, goitre, pregnancy, ovarian dysfunction and infertility.
Collapse
Affiliation(s)
- Milena Cojić
- Primary Health Center Podgorica, Trg Nikole Kovačevića 6 , Podgorica 81000, Montenegro.,Medical Faculty Podgorica, Univercity of Montenegro - Family Medicine, Kruševac bb, Podgorica, Montenegro
| | - Ljiljana Cvejanov-Kezunović
- JZU Dom Zdravlja Podgorica - ZS Nova Varos, Podgorica 20000, Montenegro.,Medical Faculty - Podgorica - Occupational Medicine, Krusevac bb, Podgorica 20000, Montenegro
| |
Collapse
|
7
|
Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S, Sánchez-Rodríguez Martha A, Retana-Ugalde R, Juárez-Cedillo E, Gonzalez-Melendez Roberto C, Escobedo-de-la-Peña J. Prevalence of thyroid dysfunction and its impact on cognition in older mexican adults: (SADEM study). J Endocrinol Invest 2017; 40:945-952. [PMID: 28343318 DOI: 10.1007/s40618-017-0654-6] [Citation(s) in RCA: 28] [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: 09/28/2016] [Accepted: 03/07/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. METHODS We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0 IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3 IU/l and FT4 >23 pmol/l; (3) Overt hypothyroidism: TSH >4.8 IU/l, FT4 <13 pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3 IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8 IU/l, FT4: 13-23 pmol/l. RESULTS The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). CONCLUSIONS The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.
Collapse
Affiliation(s)
- T Juárez-Cedillo
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico.
- High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico.
| | - L Basurto-Acevedo
- Endocrine Research Unit, National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - S Vega-García
- Endocrine Research Unit, National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - A Sánchez-Rodríguez Martha
- Gerontology Research Unit. Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - R Retana-Ugalde
- Gerontology Research Unit. Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - E Juárez-Cedillo
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico
| | | | - J Escobedo-de-la-Peña
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico
| |
Collapse
|
8
|
Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
| |
Collapse
|
9
|
Moon JH. Endocrine Risk Factors for Cognitive Impairment. Endocrinol Metab (Seoul) 2016; 31:185-92. [PMID: 27118278 PMCID: PMC4923401 DOI: 10.3803/enm.2016.31.2.185] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 12/28/2022] Open
Abstract
Cognitive impairment, including Alzheimer's disease and other kinds of dementia, is a major health problem in older adults worldwide. Although numerous investigators have attempted to develop effective treatment modalities or drugs, there is no reasonably efficacious strategy for preventing or recovering from cognitive impairment. Therefore, modifiable risk factors for cognitive impairment have received attention, and the growing literature of metabolic risk factors for cognitive impairment has expanded from epidemiology to molecular pathogenesis and therapeutic management. This review focuses on the epidemiological evidence for the association between cognitive impairment and several endocrine risk factors, including insulin resistance, dyslipidemia, thyroid dysfunction, vitamin D deficiency, and subclinical atherosclerosis. Researches suggesting possible mechanisms for this association are reviewed. The research investigating modifiable endocrine risk factors for cognitive impairment provides clues for understanding the pathogenesis of cognitive impairment and developing novel treatment modalities. However, so far, interventional studies investigating the beneficial effect of the "modification" of these "modifiable risk factors" on cognitive impairment have reported variable results. Therefore, well-designed, randomized prospective interventional studies are needed.
Collapse
Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| |
Collapse
|
10
|
Abstract
IMPORTANCE Subclinical hypothyroidism (SCH) is a common clinical entity with a putative role in a wide range of disorders. The impact of SCH on mortality and markers of morbidity has been demonstrated, but studies have shown inconsistent results. Evidence regarding the effect of levothyroxine treatment on reversing morbidity markers is emerging, but the value of treatment is still unclear. OBJECTIVE The objectives of this review were to assess recent, high-quality studies evaluating the role of SCH in cardiovascular health, cognition, mood, pregnancy, anemia, and renal disease; to examine the effects of levothyroxine on reducing mortality or reversing markers of morbidity in these conditions; and to consider how new research insights may help guide clinical practice. EVIDENCE REVIEW A PubMed search was conducted (using 'subclinical hypothyroidism' [Title/Abstract] AND morbidity [MeSH Subheading] as search criteria) and was restricted to human studies published in the English language between 1990 and 2013. Subsequent searches of retrieved articles yielded further studies, which were included based on quality. Emphasis was given to large observational studies, well-conducted meta-analyses, and randomized controlled trials. FINDINGS The difficulty of diagnosing SCH, particularly in the elderly, may underlie many of the conflicting results seen in the literature. Increased understanding of the at-risk patient population will result in better selection of study subjects and, likely, unequivocal results. Regardless of the current confusion, emerging evidence suggests that certain markers of morbidity are reversed by levothyroxine therapy across the disorders examined here. CONCLUSION AND RELEVANCE Future large, well-controlled studies will not only clarify the role of SCH but also help identify patients for whom levothyroxine treatment will provide the most benefit.
Collapse
Affiliation(s)
- James V Hennessey
- Department of Medicine, Division of Endocrinology, Beth Israel Deaconess Medical Center , Boston, MA , USA
| | | |
Collapse
|
11
|
E Silva SO, Chan IT, Lobo Santos MA, Cohen M, de La Roque P Araujo M, da Silva Almeida J, Simões A, Givigi HRB, Vaisman M, Paixão CM, de Fatima Dos S Teixeira P. Impact of thyroid status and age on comprehensive geriatric assessment. Endocrine 2014; 47:255-65. [PMID: 24178891 PMCID: PMC4145217 DOI: 10.1007/s12020-013-0077-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 10/04/2013] [Indexed: 12/18/2022]
Abstract
This study aimed to evaluate the prevalence of thyroid dysfunction in elderly subjects attending an outpatient clinic at a tertiary hospital and to assess whether subclinical hypothyroidism (SCH) or aging affected activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive status, or depressive symptoms. This crosssectional study included 411 patients recruited in the outpatient geriatric setting. 48 subjects reported levothyroxine use and were evaluated separately. After excluding subjects with diseases or drugs which could influence thyroid status, the 284 subjects remaining were classified as having euthyroidism (n = 235, 82.8 %), subclinical hypothyroidism (n = 43, 15.1 %), subclinical hyperthyroidism (n = 4, 1.4 %), or overt hyperthyroidism (n = 2, 0.7 %). ADLs and IADLs were assessed using the Katz Index (ranging from 0 [independence] to 6 [dependence in all activities]) and Health Assessment Questionnaire (ranging from 0 to 3 [severely disabled]), respectively. Cognition was assessed using the mini mental state depressive symptoms that were assessed using the Geriatric depression scale or cornell scale for depression in dementia. SCH did not reduce performance in ADLs or IADLs in elderly subjects as a whole, but was an independent protective factor against dependence in ADLs (OR = 0.196 [0.045-0.853]; p = 0.003) and IADLs (OR = 0.060 [0.010-0.361]; p = 0.002) in subjects aged ≥85 years. Very old subjects with SCH showed better performance in ADLs than did those with euthyroidism (Katz Index: 0.9 ± 1.6 [median: 0.5] vs. 1.7 ± 1.7 [1.0], p = 0.024; HAQ: 1.2 ± 0.8 [0.9] vs. 1.8 ± 1.0 [1.9], p = 0.015). This putative protective effect of SCH was not found in subjects aged <85 years. The number of falls, number of medications used, depressive symptoms, and cognitive impairment did not differ among thyroid status groups, regardless of age. In conclusion, SCH does not have impact functional performance in the elderly population as a whole, but was associated with better functional status in subjects aged ≥85 years.
Collapse
Affiliation(s)
- Silvana Oliveira E Silva
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício do Centro de Ciências da Saúde, Bloco K, Cidade Universitária, Rio de Janeiro, RJ, 21.941-902, Brazil,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
Overt hypothyroidism and thyrotoxicosis are associated with significant decrements in mood and cognitive function, and therapy usually leads to improvement in these symptoms. In contrast, major affective or cognitive dysfunction is not typical of subclinical thyroid disease. Subtle deficits in specific cognitive domains (primarily working memory and executive function) likely exist in subclinical hypothyroidism and thyrotoxicosis, but these are unlikely to cause major problems in most patients. Patients with mild thyroid disease and significant distress related to mood or cognition most likely have independent diagnoses that should be evaluated and treated separately.
Collapse
Affiliation(s)
- Mary H Samuels
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| |
Collapse
|
13
|
Moon JH, Park YJ, Kim TH, Han JW, Choi SH, Lim S, Park DJ, Kim KW, Jang HC. Lower-but-normal serum TSH level is associated with the development or progression of cognitive impairment in elderly: Korean Longitudinal Study on Health and Aging (KLoSHA). J Clin Endocrinol Metab 2014; 99:424-32. [PMID: 24285689 DOI: 10.1210/jc.2013-3385] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT The association between subclinical hyperthyroidism and the risk of dementia has been validated in several studies. However, the effect of thyroid function within reference range on the risk of cognitive dysfunction including mild cognitive impairment (MCI) and dementia is still unclear. OBJECTIVE Our aim was to investigate the association between thyroid function and the risk of MCI and dementia in euthyroid elderly subjects. DESIGN, SETTING, AND PARTICIPANTS We conducted a population-based prospective study as a part of the Korean Longitudinal Study on Health and Aging. A total of 313 participants who were euthyroid and nondemented at baseline and completed cognitive function tests at a 5-year follow-up evaluation (mean age 72.5 ± 6.9 y) were analyzed in the present study. MAIN OUTCOME MEASURE Baseline thyroid function was compared according to the development of MCI or dementia during the study period. Binary logistic regression analysis was performed to investigate the independent association between thyroid function and cognitive impairment. RESULTS At baseline evaluation, 237 subjects were cognitively normal, and 76 subjects had MCI. Diagnoses of cognitive function in 259 subjects remained unchanged or improved during the study period (nonprogression group), whereas 54 subjects showed progression of cognitive impairment to MCI or dementia (progression group). In the progression group, baseline serum TSH levels were lower than those in nonprogression group. Baseline serum free T₄ levels were not significantly different between these two groups. The association between lower baseline serum TSH levels and the development of MCI or dementia was maintained after adjustment for conventional baseline risk factors. CONCLUSIONS Lower serum TSH level within the reference range was independently associated with the risk of cognitive impairment including MCI and dementia in elderly subjects.
Collapse
Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine (J.H.M., S.H.C., S.L., H.C.J.) and Neuropsychiatry (T.H.K., J.W.H., K.W.K.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea; and Department of Internal Medicine (Y.J.P., D.J.P.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul 110-799, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Booth T, Deary IJ, Starr JM. Thyroid stimulating hormone, free thyroxine and cognitive ability in old age: the Lothian Birth Cohort Study 1936. Psychoneuroendocrinology 2013; 38:597-601. [PMID: 22959930 DOI: 10.1016/j.psyneuen.2012.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/30/2012] [Accepted: 07/31/2012] [Indexed: 11/15/2022]
Abstract
The current study investigated the associations between thyroid stimulating hormone (TSH), free thyroxine (T(4)) and cognitive ability (general ability, memory and processing speed), in a large age homogenous sample (n=659) of generally healthy euthyroid older adults. Associations were considered both at baseline (mean age wave 1=69.5 years; SD=0.8 years) and approximately 3 years later (mean age wave 2=72.5 years; SD=0.7 years). Results indicated mean level decreases across waves in both TSH (t=10.99, p<0.001) and T(4) (t=34.55, p<0.001). There were no significant associations between TSH and T(4) with any of the cognitive variables at either wave. There was no suggestion of non-linear associations. The lack of associations supports suggestions that the effects of thyroid hormones on cognition may be restricted to older individuals above a given threshold, and/or those with levels of thyroid hormones within the range defining clinical thyroid disorder.
Collapse
Affiliation(s)
- Tom Booth
- Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, EH8 9JZ Edinburgh, UK.
| | | | | |
Collapse
|
15
|
Joffe RT, Pearce EN, Hennessey JV, Ryan JJ, Stern RA. Subclinical hypothyroidism, mood, and cognition in older adults: a review. Int J Geriatr Psychiatry 2013; 28:111-8. [PMID: 22410877 PMCID: PMC3488161 DOI: 10.1002/gps.3796] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 02/06/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To perform a critical review of the literature on the mood and cognitive changes associated with subclinical hypothyroidism (SCH), with an emphasis on older adults. To evaluate these data against the Consensus Statement on the management of SCH from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. METHOD A comprehensive literature review. RESULTS Subclinical hypothyroidism may be associated with an increased risk of mood and cognitive dysfunction, although the strength of this association and the efficacy of replacement hormone therapy require further investigation. CONCLUSION It remains unclear whether SCH leads to significant mood and cognitive impairments in most older patients. More research is required to determine the nature and extent of this association and whether thyroid hormone replacement therapy is appropriate and effective in treating SCH-associated neurobehavioral impairments.
Collapse
Affiliation(s)
- Russell T Joffe
- Department of Psychiatry, Staten Island University Hospital, Staten Island, NY 10305, USA.
| | | | | | | | | |
Collapse
|
16
|
Ge JF, Peng L, Hu CM, Wu TN. Impaired learning and memory performance in a subclinical hypothyroidism rat model induced by hemi-thyroid electrocauterisation. J Neuroendocrinol 2012; 24:953-61. [PMID: 22324892 DOI: 10.1111/j.1365-2826.2012.02297.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
It is well known that clinical hypothyroidism (CH) can induce cognitive deficits, and the decision to start treatment for CH with thyroxine is usually straightforward. However, the relationship of cognition dysfunction with subclinical hypothyroidism (SCH) is inconsistent, and the decision concerning the need to treat SCH is controversial. In the present study, we induced a SCH rat model by hemi-thyroid electrocauterisation; then employed a serial of behavioural tests, including a beam balance, open field task and Morris water maze (MWM), to investigate the behaviour performance of SCH rats; and finally explored the protein expression of phosphorylated extracellular signal-regulated kinase (ERK)1/2 in the hippocampus by western blotting. The results demonstrated that hemi-thyroid electrocauterised rats had an elevated plasma thyrotrophin-stimulating hormone (TSH) level, with normal free thyroxine (fT4) and triiodothyronine (T3) concentrations, which defines SCH in humans. If rat SCH is diagnosed according to measurements of both plasma TSH higher than 97.5 percentile for the sham group and fT4 in the range 2.5-97.5 percentile for the sham group, the success rate of SCH modelling was 66.6%. SCH decreased exploratory behaviour but did not affect motor function in rats, showing a negative correlation of exploratory behaviour with plasma TSH concentration. Moreover, SCH rats displayed an impairment of learning and memory ability in the MWM task, with a longer escape latency in the acquisition phase and a shorter duration in the target quadrant in the test phase compared to that of sham rats. The mechanism for this might be related to the increased plasma TSH concentration, the decreased hippocampal T3 level and the enhanced expression of phosphorylated ERK1/2 in the hippocampus. The results of the present study, together with the results obtained in other studies, suggest that treatment is necessary for SCH.
Collapse
Affiliation(s)
- J-F Ge
- School of Pharmacy, Anhui Medical University, Hefei, China.
| | | | | | | |
Collapse
|