1
|
Li Z, Liu J. Thyroid dysfunction and Alzheimer's disease, a vicious circle. Front Endocrinol (Lausanne) 2024; 15:1354372. [PMID: 38419953 PMCID: PMC10899337 DOI: 10.3389/fendo.2024.1354372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Recently, research into the link between thyroid dysfunction and Alzheimer's disease (AD) remains a current topic of interest. Previous research has primarily concentrated on examining the impact of thyroid dysfunction on the risk of developing AD, or solely explored the mechanisms of interaction between hypothyroidism and AD, a comprehensive analysis of the mechanisms linking thyroid dysfunction, including hyperthyroidism and hypothyroidism, to Alzheimer's disease (AD) still require further elucidation. Therefore, the aim of this review is to offer a thorough and comprehensive explanation of the potential mechanisms underlying the causal relationship between thyroid dysfunction and AD, highlighting the existence of a vicious circle. The effect of thyroid dysfunction on AD includes neuron death, impaired synaptic plasticity and memory, misfolded protein deposition, oxidative stress, and diffuse and global neurochemical disturbances. Conversely, AD can also contribute to thyroid dysfunction by affecting the stress repair response and disrupting pathways involved in thyroid hormone (TH) production, transport, and activation. Furthermore, this review briefly discusses the role and significance of utilizing the thyroid as a therapeutic target for cognitive recovery in AD. By exploring potential mechanisms and therapeutic avenues, this research contributes to our understanding and management of this devastating neurodegenerative disease.
Collapse
Affiliation(s)
| | - Jia Liu
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
2
|
Casula S, Ettleson MD, Bianco AC. Are We Restoring Thyroid Hormone Signaling in Levothyroxine-Treated Patients With Residual Symptoms of Hypothyroidism? Endocr Pract 2023; 29:581-588. [PMID: 37419565 DOI: 10.1016/j.eprac.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION Levothyroxine (LT4) at doses that maintain the serum thyroid-stimulating hormone levels within the normal range constitutes the standard of care for the treatment of hypothyroidism. After a few months, this eliminates the signs and symptoms of overt hypothyroidism in the majority of patients, owing to the endogenous activation of thyroxine to triiodothyronine, the biologically active thyroid hormone. Still, a small percentage of the patients (10%-20%) exhibit residual symptoms, despite having normal serum thyroid-stimulating hormone levels. These symptoms include cognitive, mood, and metabolic deficits, with a significant impairment in psychological well-being and quality of life. OBJECTIVE To provide a summary of progress in the approach of patients with hypothyroidism that exhibit residual symptoms despite treatment. METHODS We reviewed the current literature and here we focused on the mechanisms leading to a deficiency of T3 in some LT4-treated patients, the role of residual thyroid tissue and the rationale for combination therapy with LT4 + liothyronine (LT3). RESULTS A score of clinical trials comparing therapy with LT4 versus LT4 + LT3 concluded that both are safe and equally effective (neither is superior); however, these trials failed to recruit a sufficiently large number of patients with residual symptoms. New clinical trials that considered LT4-treated symptomatic patients revealed that such patients benefit from and prefer therapy containing LT4 + LT3; desiccated thyroid extract has also been used with similar results. A practical approach to patients with residual symptoms and on initiation of combination therapy with LT4 + LT3 is provided. CONCLUSION A recent joint statement of the American, British, and European Thyroid Associations recommends that a trial with combination therapy be offered to patients with hypothyroidism that do not fully benefit from therapy with LT4.
Collapse
Affiliation(s)
- Sabina Casula
- Department of Endocrinology, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Matthew D Ettleson
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois
| | - Antonio C Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois.
| |
Collapse
|
3
|
Stern M, Finch A, Haskard-Zolnierek KB, Howard K, Deason RG. Cognitive decline in mid-life: Changes in memory and cognition related to hypothyroidism. J Health Psychol 2023; 28:388-401. [PMID: 35811484 DOI: 10.1177/13591053221107745] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study assessed specific cognitive impairments within a primarily female, hypothyroid population, while controlling for factors that commonly contribute to cognitive decline. Participants (N = 739) included 461 individuals with hypothyroidism. This study involved an online survey assessing several aspects of memory and cognition. Those with hypothyroidism generally scored worse on self-assessments of memory, higher perceived stress, high rates of depression and anxiety, greater fatigue, poorer concentration, and less motivation. A Receiver Operating Characteristic curve indicated that the cognitive questionnaires are successful at classifying hypothyroidism and a mediation analysis showed fatigue is a mediating symptom of these cognitive outcomes.
Collapse
Affiliation(s)
- Mark Stern
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Alyse Finch
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | - Krista Howard
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Rebecca G Deason
- Department of Psychology, Texas State University, San Marcos, TX, USA
| |
Collapse
|
4
|
Khaleghzadeh-Ahangar H, Talebi A, Mohseni-Moghaddam P. Thyroid Disorders and Development of Cognitive Impairment: A Review Study. Neuroendocrinology 2022; 112:835-844. [PMID: 34963121 DOI: 10.1159/000521650] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
Dementia is a neurological disorder that is spreading with increasing human lifespan. In this neurological disorder, memory and cognition are declined and eventually impaired. Various factors can be considered as the background of this disorder, one of which is endocrine disorders. Thyroid hormones are involved in various physiological processes in the body; one of the most important of them is neuromodulation. Thyroid disorders, including hyperthyroidism or hypothyroidism, can affect the nervous system and play a role in the development of dementia. Despite decades of investigation, the nature of the association between thyroid disorders and cognition remains a mystery. Given the enhancing global burden of dementia, the principal purpose of this study was to elucidate the association between thyroid disturbances as a potentially modifiable risk factor of cognitive dysfunction. In this review study, we have tried to collect almost all of the reported mechanisms demonstrating the role of hypothyroidism and hyperthyroidism in the pathogenesis of dementia.
Collapse
Affiliation(s)
- Hossein Khaleghzadeh-Ahangar
- Department of Physiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
- Immunoregulation Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Anis Talebi
- Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Parvaneh Mohseni-Moghaddam
- Department of Physiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| |
Collapse
|
5
|
Du Puy RS, Poortvliet RKE, Mooijaart SP, den Elzen WPJ, Jagger C, Pearce SHS, Arai Y, Hirose N, Teh R, Menzies O, Rolleston A, Kerse N, Gussekloo J. Outcomes of Thyroid Dysfunction in People Aged Eighty Years and Older: An Individual Patient Data Meta-Analysis of Four Prospective Studies (Towards Understanding Longitudinal International Older People Studies Consortium). Thyroid 2021; 31:552-562. [PMID: 33012278 DOI: 10.1089/thy.2020.0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Subclinical and overt thyroid dysfunction is easily detectable, often modifiable, and, in younger age groups, has been associated with clinically relevant outcomes. Robust associations in very old persons, however, are currently lacking. This study aimed to investigate the associations between (sub-)clinical thyroid dysfunction and disability in daily living, cognitive function, depressive symptoms, physical function, and mortality in people aged 80 years and older. Methods: Four prospective cohorts participating in the Towards Understanding Longitudinal International older People Studies (TULIPS) consortium were included. We performed a two-step individual participant data meta-analysis on source data from community-dwelling participants aged 80 years and older from the Netherlands, New Zealand, United Kingdom, and Japan. Outcome measures included disability in daily living (disability in activities of daily living [ADL] questionnaires), cognitive function (Mini-Mental State Examination [MMSE]), depressive symptoms (Geriatric Depression Scale [GDS]), physical function (grip strength) at baseline and after 5 years of follow-up, and all-cause five-year mortality. Results: Of the total 2116 participants at baseline (mean age 87 years, range 80-109 years), 105 participants (5.0%) were overtly hypothyroid, 136 (6.4%) subclinically hypothyroid, 1811 (85.6%) euthyroid, 60 (2.8%) subclinically hyperthyroid, and 4 (0.2%) overtly hyperthyroid. Participants with thyroid dysfunction at baseline had nonsignificantly different ADL scores compared with euthyroid participants at baseline and had similar MMSE scores, GDS scores, and grip strength. There was no difference in the change of any of these functional measures in participants with thyroid dysfunction during five years of follow-up. Compared with the euthyroid participants, no 5-year survival differences were identified in participants with overt hypothyroidism (hazard ratio [HR] 1.0, 95% confidence interval [CI 0.6-1.6]), subclinical hypothyroidism (HR 0.9 [CI 0.7-1.2]), subclinical hyperthyroidism (HR 1.1 [CI 0.8-1.7]), and overt hyperthyroidism (HR 1.5 [CI 0.4-5.9]). Results did not differ after excluding participants using thyroid-influencing medication. Conclusions: In community-dwelling people aged 80 years and older, (sub-)clinical thyroid dysfunction was not associated with functional outcomes or mortality and may therefore be of limited clinical significance.
Collapse
Affiliation(s)
- Robert S Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Gerontology and Geriatrics, and Leiden University Medical Center, Leiden, The Netherlands
| | - Wendy P J den Elzen
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Carol Jagger
- Campus for Ageing and Vitality, Newcastle University Institute for Ageing, Newcastle upon Tyne, United Kingdom
| | - Simon H S Pearce
- Institute of Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyoshi Hirose
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Oliver Menzies
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, and Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
6
|
Abstract
Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.
Collapse
Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Section, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Mitchell AL, Hegedüs L, Žarković M, Hickey JL, Perros P. Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation. Clin Endocrinol (Oxf) 2021; 94:513-520. [PMID: 32978985 DOI: 10.1111/cen.14340] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. DESIGN AND PATIENTS We conducted an online survey of individuals with self-reported hypothyroidism. RESULTS Nine hundred sixty-nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L-T4) and liothyronine (L-T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L-T4 or L-T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L-T4 + L-T3 or L-T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L-T4 (P < .001) and expectations for more support from the GP (P < .001), for L-T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L-T3 independently (P = .014), negative experiences with L-T4 (P = .013), having expectations for L-T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006). CONCLUSIONS Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.
Collapse
Affiliation(s)
- Anna L Mitchell
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- British Thyroid Foundation, Harrogate, UK
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Miloš Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- British Thyroid Foundation, Harrogate, UK
| |
Collapse
|
8
|
Wildisen L, Feller M, Del Giovane C, Moutzouri E, Du Puy RS, Mooijaart SP, Collet TH, Poortvliet RKE, Kearney P, Quinn TJ, Klöppel S, Bauer DC, Peeters RP, Westendorp R, Aujesky D, Gussekloo J, Rodondi N. Effect of Levothyroxine Therapy on the Development of Depressive Symptoms in Older Adults With Subclinical Hypothyroidism: An Ancillary Study of a Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2036645. [PMID: 33566107 PMCID: PMC7876592 DOI: 10.1001/jamanetworkopen.2020.36645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Previous trials on the effect of levothyroxine on depressive symptom scores in patients with subclinical hypothyroidism were limited by small sample sizes (N = 57 to 94) and potential biases. OBJECTIVE To assess the effect of levothyroxine on the development of depressive symptoms in older adults with subclinical hypothyroidism in the largest trial on this subject and to update a previous meta-analysis including the results from this study. DESIGN, SETTING, AND PARTICIPANTS This predefined ancillary study analyzed data from participants in the Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism (TRUST) trial, a double-blind, randomized, placebo-controlled, parallel-group clinical trial conducted from April 2013 to October 31, 2016. The TRUST trial included adults aged 65 years or older diagnosed with subclinical hypothyroidism, defined as the presence of persistently elevated thyroid-stimulating hormone (TSH) levels (4.6-19.9 mIU/L) with free thyroxine (T4) within the reference range. Participants were identified from clinical and general practitioner laboratory databases and recruited from the community in Switzerland, the Netherlands, Ireland, and the UK. This ancillary study included a subgroup of 472 participants from the Netherlands and Switzerland; after exclusions, a total of 427 participants (211 randomized to levothyroxine and 216 to placebo) were analyzed. This analysis was conducted from December 1, 2019, to September 1, 2020. INTERVENTIONS Randomization to either levothyroxine or placebo. MAIN OUTCOMES AND MEASURES Depressive symptom scores after 12 months measured with the Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (minimal clinically important difference = 2). RESULTS A total of 427 participants with subclinical hypothyroidism (mean [SD] age, 74.52 [6.29] years; 239 women [56%]) were included in this analysis. The mean (SD) TSH level was 6.57 (2.22) mIU/L at baseline and decreased after 12 months to 3.83 (2.29) mIU/L in the levothyroxine group; in the placebo group, it decreased from 6.55 (2.04) mIU/L to 5.91 (2.66) mIU/L. At baseline, the mean (SD) GDS-15 score was 1.26 (1.85) in the levothyroxine group and 0.96 (1.58) in the placebo group. The mean (SD) GDS-15 score at 12 months was 1.39 (2.13) in the levothyroxine and 1.07 (1.67) in the placebo group with an adjusted between-group difference of 0.15 for levothyroxine vs placebo (95% CI, -0.15 to 0.46; P = .33). In a subgroup analysis including participants with a GDS-15 of at least 2, the adjusted between-group difference was 0.61 (95% CI, -0.32 to 1.53; P = .20). Results did not differ according to age, sex, or TSH levels. A previous meta-analysis (N = 278) on the association of levothyroxine with depressive symptoms was updated to include these findings, resulting in an overall standardized mean difference of 0.09 (95% CI, -0.05 to 0.22). CONCLUSIONS AND RELEVANCE This ancillary study of a randomized clinical trial found that depressive symptoms did not differ after levothyroxine therapy compared with placebo after 12 months; thus, these results do not provide evidence in favor of levothyroxine therapy in older persons with subclinical hypothyroidism to reduce the risk of developing depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01853579.
Collapse
Affiliation(s)
- Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Martin Feller
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Elisavet Moutzouri
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robert S. Du Puy
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetology, Nutrition, and Therapeutic Education, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Terence J. Quinn
- Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Douglas C. Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Robin P. Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, the Netherland
| | - Rudi Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
9
|
Tsou M, Chen J. Burnout and metabolic syndrome among healthcare workers: Is subclinical hypothyroidism a mediator? J Occup Health 2021; 63:e12252. [PMID: 34286911 PMCID: PMC8291686 DOI: 10.1002/1348-9585.12252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Evidence suggests that subclinical hypothyroidism (SCH) is associated with burnout and metabolic syndrome (MetS). We examined the relationship between burnout and MetS among healthcare workers (HCWs) and investigated the potential mediation of SCH. METHODS This cross-sectional study included HCWs from a tertiary medical center; demographic data were obtained using a questionnaire. Burnout was evaluated according to the Chinese version of the Maslach Burnout Inventory-Health Services Survey (MBI-HSS). MetS and thyroid function data were obtained from a physical check-up. Logistic regression models were used to evaluate the adjusted odds ratio (aOR), and mediation analysis was employed to examine the mediation effect. RESULTS Among 945 non-doctor/nurse and 1868 doctor/nurse staff, MetS was 30% and 14%, respectively, and the prevalence of burnout was nearly 6.5%. The results showed that burnout induced higher aOR of MetS in the doctor/nurse group (1.27, 95% confidence interval [CI]: 1.05-3.62). Thyroid-stimulating hormone (TSH) showed a positive association factor of MetS in doctor/nurse group-adjusted burnout (aOR = 1.15, 95% CI: 1.01-4.19). A higher TSH level was associated with an increased odds of MetS in younger doctor/nurse staff with burnout syndrome (aOR = 1.74; 95% CI: 1.04-3.22). There was a borderline significant mediation effect of SCH in the association between burnout and MetS in doctor/nurse staff. CONCLUSIONS The results showed that higher TSH levels were positively associated with burnout and MetS in doctor/nurse professionals, especially in the young cohort. Burnout may rely on the borderline mediation effect of SCH, which is likely to affect MetS.
Collapse
Affiliation(s)
- Meng‐Ting Tsou
- Department of Family MedicineMacKay Memorial HospitalTaipei CityTaiwan
- Department of Occupation MedicineMacKay Memorial HospitalTaipei CityTaiwan
- Department of MacKay Junior College of Medicine, Nursing, and ManagementNew Taipei CityTaiwan
| | - Jau‐Yuan Chen
- Department of Family MedicineChang‐Gung Memorial HospitalLinkou BranchTaiwan
- Chang Gung University College of MedicineTaoyuanTaiwan
| |
Collapse
|
10
|
Zhang Y, Yang Y, Tao B, Lv Q, Lui S, He L. Gray Matter and Regional Brain Activity Abnormalities in Subclinical Hypothyroidism. Front Endocrinol (Lausanne) 2021; 12:582519. [PMID: 33716959 PMCID: PMC7943870 DOI: 10.3389/fendo.2021.582519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 01/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) brain structure and resting state of functional activity have remained unexplored. PURPOSE To investigate gray matter volume (GMV) and regional brain activity with the fractional amplitude of low-frequency fluctuations (fALFF) in subclinical hypothyroidism (SCH) patients before and after treatment. MATERIAL AND METHODS We enrolled 54 SCH and 41 age-, sex-, and education-matched controls. GMV and fALFF of SCH were compared with controls and between pre- and post-treatment within SCH group. Correlations of GMV and fALFF in SCH with thyroid function status and mood scales were assessed by multiple linear regression analysis. RESULTS Compared to controls, GMV in SCH was significantly decreased in Orbital part of inferior frontal, superior frontal, pre-/postcentral, inferior occipital, and temporal pole gyrus. FALFF values in SCH were significantly increased in right angular, left middle frontal, and left superior frontal gyrus. After treatment, there were no significant changes in GMV and the local brain function compared to pre-treatment, however the GMV and fALFF of the defective brain areas were improved. Additionally, decreased values of fALFF in left middle frontal gyrus were correlated with increased mood scales. CONCLUSION In this study we found that patients with SCH, the gray matter volume in some brain areas were significantly reduced, and regional brain activity was significantly increased. After treatment, the corresponding structural and functional deficiencies had a tendency for improvement. These changes may reveal the neurological mechanisms of mood disorder in SCH patients.
Collapse
Affiliation(s)
- Yang Zhang
- Neurology Department, West China Hospital of Sichuan University, Chengdu, China
| | - Yaqiong Yang
- Neurology Department, West China Hospital of Sichuan University, Chengdu, China
| | - Bo Tao
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qingguo Lv
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, China
| | - Su Lui
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Li He, ; Su Lui,
| | - Li He
- Neurology Department, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Li He, ; Su Lui,
| |
Collapse
|
11
|
Rehman MU, Ali SS, Khan N, Ahmad I, Ullah I. Using Thypro 39 Scale For Predicting The Quality Of Life In Hypothyroid Patients At Lady Reading Hospital. J Ayub Med Coll Abbottabad 2020; 32:395-399. [PMID: 32829558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Thyroid disorders are the second most common of the endocrine diseases. With regards to Hypothyroidism, it has a slow indolent course over the years, before its diagnosis. Most of the patient, on adequate treatment with biochemical euthyroid status, have generalised symptoms that affect their quality of life. Several tools to assess quality of life in thyroid disorders have been validated and recommended for use for those patients in clinical follow ups. ThyPRO 39 is one of a recently developed thyroid-specific quality of life (QoL) questionnaires applicable to patients with benign thyroid disorders (BTD). The purpose of this study was to predict the thyroid-related quality of life (QoL) instrument ThyPRO 39 in patients with Hypothyroidism, who were rendered euthyroid with thyroid replacement therapy prior to the administration of study tool and to assess the internal reliability of this scale in our population. METHODS A sample of 52 patients undergoing maintenance treatment for Hypothyroidism who visited the outpatient Endocrinology clinics at Lady Reading Hospital was studied. They were interviewed for their baseline demographic details and details on ThyPRO 39 questionnaire were recorded after a written informed consent. The data was entered and analysed using SPSS 25. The Internal reliability of the ThyPRO 39 scale was assessed for multi-item scales using Cronbach's alpha coefficient. RESULTS The ThyPRO 39 scale demonstrated good response across the whole range of QoL aspects in patients with hypothyroidism. Internal reliability for ThyPRO 39 scale was satisfactory. Cronbach's Alpha in our study was 0.928, which was comparable to the results of other studies. CONCLUSIONS We suggest implementing this measurement tool as a patient-reported outcome in clinical studies in our indigenous population and further more to utilise it as a screening tool for QoL in clinical management of Hypothyroidism in our routine medical consultations.
Collapse
Affiliation(s)
- Mujeeb Ur Rehman
- Diabetes and Endocrinology Division, MTI Lady Reading Hospital, Peshawar, Pakistan
| | - Sobia Sabir Ali
- Diabetes and Endocrinology Division, MTI Lady Reading Hospital, Peshawar, Pakistan
| | - Nawaz Khan
- Diabetes and Endocrinology Division, MTI Lady Reading Hospital, Peshawar, Pakistan
| | - Ibrar Ahmad
- Diabetes and Endocrinology Division, MTI Lady Reading Hospital, Peshawar, Pakistan
| | - Irfan Ullah
- Diabetes and Endocrinology Division, MTI Lady Reading Hospital, Peshawar, Pakistan
| |
Collapse
|
12
|
Yuan L, Luan D, Xu X, Yang Q, Huang X, Zhao S, Zhang Y, Zhou Z. Altered attention networks in patients with thyroid dysfunction: A neuropsychological study. Horm Behav 2020; 121:104714. [PMID: 32057820 DOI: 10.1016/j.yhbeh.2020.104714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
Patients with thyroid dysfunction (31 hypothyroid, 32 subclinical hypothyroidism, 34 hyperthyroid, and 30 subclinical hyperthyroidism) and 37 euthyroid control subjects were recruited and performed the attention network test (ANT), which can simultaneously examine the alertness, orientation and execution control of the participants. Patients with hypothyroidism had abnormalities in the alerting network, and those with hyperthyroidism had impairments of the alerting and executive control networks. No attention networks deficit existed in patients with subclinical hyperthyroidism and subclinical hypothyroidism. The anxiety and depression scores of patients with thyroid dysfunction were significantly higher than those of the healthy control group. Covariance analysis demonstrated that interactions between group and Hamilton Anxiety Scale scores, group and HAMD score were not significant, but there was a significant main effect for group when analyzing the difference in values of the alerting network between groups. Further, the efficiency of the executive control network was negatively correlated with the T4 level in the hypothyroidism group, and positively correlated with the T4 level in the hyperthyroidism group. T4 or T3 level and efficiencies of the executive control network had a significant quadratic U-shaped relationship in all participants. In summary, the patients with four kinds of thyroid dysfunction exhibited different characteristics of ANT performance. Patients with thyroid dysfunction had various degrees of anxiety and depression disorders, but anxiety and depression disorders had no effect on the differences in the executive control network between the groups.
Collapse
Affiliation(s)
- Lili Yuan
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China.
| | - Di Luan
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Xiangjun Xu
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Qian Yang
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Xianjun Huang
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Shoucai Zhao
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Yuanxiang Zhang
- Department of Clinical Pharmacy, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| | - Zhiming Zhou
- Department of Neurology, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, PR China
| |
Collapse
|
13
|
Costantine MM, Smith K, Thom EA, Casey BM, Peaceman AM, Varner MW, Sorokin Y, Reddy UM, Wapner RJ, Boggess K, Tita ATN, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa JE, Caritis SN, VanDorsten JP. Effect of Thyroxine Therapy on Depressive Symptoms Among Women With Subclinical Hypothyroidism. Obstet Gynecol 2020; 135:812-820. [PMID: 32168208 PMCID: PMC7103482 DOI: 10.1097/aog.0000000000003724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate the effect of antenatal treatment of subclinical hypothyroidism on maternal depressive symptoms. METHODS We conducted an ancillary study to a multicenter trial in women with singleton pregnancies diagnosed with subclinical hypothyroidism randomized to antenatal thyroxine therapy or placebo. Treatment was discontinued at the end of pregnancy. Women with overt thyroid disease, diabetes, autoimmune disease, and those diagnosed with depression were excluded. Participants were assessed for depressive symptoms using the Center for Epidemiological Studies-Depression scale (CES-D) before starting the study drug (between 11 and 20 weeks of gestation), between 32 and 38 weeks of gestation, and at 1 year postpartum. The primary outcome was maternal depressive symptoms score as assessed using the CES-D. Secondary outcome was the percentage of women who scored 16 or higher on the CES-D, as such a score is considered screen-positive for depression. RESULTS Two hundred forty-five (36.2% of parent trial) women with subclinical hypothyroidism were allocated to thyroxine (n=124) or placebo (n=121). Median CES-D scores and the proportion of participants with positive scores were similar at baseline between the two groups. Treatment with thyroxine was not associated with differences in CES-D scores (10 [5-15] vs 10 [5-17]; P=.46) or in odds of screening positive in the third trimester compared with placebo, even after adjusting for baseline scores (24.3% vs 30.1%, adjusted odds ratio 0.63, 95% CI 0.31-1.28, P=.20). At 1 year postpartum, CES-D scores were not different (6 [3-11] vs 6 [3-12]; P=.79), nor was the frequency of screen-positive CES-D scores in the treated compared with the placebo group (9.7% vs 15.8%; P=.19). Treatment with thyroxine during pregnancy was also not associated with differences in odds of screening positive at the postpartum visit compared with placebo even after adjusting for baseline scores. Sensitivity analysis including women who were diagnosed with depression by the postpartum visit did not change the results. CONCLUSIONS This study did not achieve its planned sample size, thus our conclusions may be limited, but in this cohort of pregnant women with subclinical hypothyroidism, antenatal thyroxine replacement did not improve maternal depressive symptoms.
Collapse
Affiliation(s)
- Maged M Costantine
- Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, University of Texas - Southwestern, Dallas, Texas, Northwestern University, Chicago, Illinois, University of Utah Health Sciences Center, Salt Lake City, Utah, Wayne State University, Detroit, Michigan, Columbia University, New York, New York, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Alabama at Birmingham, Birmingham, Alabama; Brown University, Providence, Rhode Island, University of Texas - Houston, Houston, Texas, The Ohio State University, Columbus, Ohio, Case Western Reserve University, Cleveland, Ohio, Oregon Health Sciences University, Portland, Oregon, University of Pittsburgh, Pittsburgh, Pennsylvania, Medical University of South Carolina, Charleston, South Carolina; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Kerp H, Engels K, Kramer F, Doycheva D, Sebastian Hönes G, Zwanziger D, Christian Moeller L, Heuer H, Führer D. Age effect on thyroid hormone brain response in male mice. Endocrine 2019; 66:596-606. [PMID: 31494803 DOI: 10.1007/s12020-019-02078-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Thyroid hormones (TH) are important for brain development and central nervous system (CNS) function. Disturbances of thyroid function occur with higher prevalence in the ageing population and may negatively impact brain function. METHODS We investigated the age impact on behavior in young adult and old male mice (5 vs. 20 months) with chronic hypo- or hyper-thyroidism as well as in sham-treated controls. Expression of TH transporters and TH responsive genes was studied in CNS and pituitary by in situ hybridization and qRT-PCR, whereas TH serum concentrations were determined by immunoassay. RESULTS Serum TH levels were lower in old compared with young hyperthyroid mice, suggesting a milder hyperthyroid phenotype in the aged group. Likewise, elevated plus maze activity was reduced in old hyperthyroid animals. Under hypothyroid conditions, thyroxine serum concentrations did not differ in young and old mice. Both groups showed a comparable decline in activity and elevated anxiety levels. However, an attenuated increase in hypothalamic thyrotropin releasing hormone and pituitary thyroid stimulating hormone transcript expression was found in old hypothyroid mice. Brain expression of monocarboxylate transporter 8 and organic anion transporting polypeptide 1c1 was not affected by age or TH status. CONCLUSIONS In summary, ageing attenuates neurological phenotypes in hyperthyroid but not hypothyroid mice, which fits with age effects on TH serum levels in the animals. In contrast no changes in TH transporter expression were found in aged mouse brains with hyper- or hypo-thyroid state.
Collapse
Affiliation(s)
- Helena Kerp
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
| | - Kathrin Engels
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
| | - Frederike Kramer
- Leibniz Institute on Aging/Fritz Lipmann Institute (FLI), 07745, Jena, Germany
| | - Denica Doycheva
- Leibniz Institute on Aging/Fritz Lipmann Institute (FLI), 07745, Jena, Germany
| | - Georg Sebastian Hönes
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
| | - Lars Christian Moeller
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
| | - Heike Heuer
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany
- Leibniz Institute on Aging/Fritz Lipmann Institute (FLI), 07745, Jena, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, 45122, Essen, Germany.
| |
Collapse
|
15
|
Choi KW, Kim Y, Fava M, Mischoulon D, Na EJ, Kim SW, Shin MH, Chung MK, Jeon HJ. Increased Morbidity of Major Depressive Disorder After Thyroidectomy: A Nationwide Population-Based Study in South Korea. Thyroid 2019; 29:1713-1722. [PMID: 31422760 DOI: 10.1089/thy.2019.0091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: The number of thyroidectomies in South Korea has been increasing rapidly due to extensive checkups for thyroid cancer. However, few studies have examined the association between thyroidectomy and major depressive disorder (MDD). We investigated the association between thyroidectomy and the risk of MDD. Methods: A population-based electronic medical records database from South Korea was used to identify 187,176 individuals who underwent partial or total thyroidectomy between 2009 and 2016. A self-controlled case series design and Cox regression analyses were used to identify risk factors for MDD. Results: Among the 187,176 individuals who underwent thyroidectomy, 16,744 (8.9%) were diagnosed with MDD during the observation period. Of those, 3837 (22.9%) underwent partial thyroidectomy and 12,907 (77.1%) underwent total thyroidectomy. An elevated MDD risk was found during the one-year period before thyroidectomy, with incidence rate ratios (IRRs) of 1.29 ([95% confidence interval [CI] 1.18-1.41], p < 0.0001) for subjects with partial thyroidectomy and 1.27 ([95% CI 1.21-1.33], p < 0.0001) for subjects with total thyroidectomy. After total thyroidectomy, the IRR increased for 31-60 days (IRR 1.81; [95% CI 1.59-2.06], p < 0.0001) and remained elevated for up to 540 days, whereas after partial thyroidectomy, the IRR increased for 31-60 days (IRR 1.68; [95% CI 1.32-2.13], p < 0.0001) but returned to baseline levels after 270 days. Total thyroidectomy was associated with a prolonged risk of MDD compared with partial thyroidectomy in patients with cancer, which was different from the results in patients without cancer. Conclusion: The incidence of MDD increased in the period immediately after thyroidectomy and remained high for one to two years. This study highlights the importance of relatively long-term regular psychiatric assessments in patients who undergo partial or total thyroidectomy.
Collapse
Affiliation(s)
- Kwan Woo Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yuwon Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eun Jin Na
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Korean Psychological Autopsy Center (KPAC), Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine Seoul, South Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Korean Psychological Autopsy Center (KPAC), Seoul, Korea
- Department of Health Sciences & Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Medical Device Management & Research, and Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
16
|
Romero-Gómez B, Guerrero-Alonso P, Carmona-Torres JM, Notario-Pacheco B, Cobo-Cuenca AI. Mood Disorders in Levothyroxine-Treated Hypothyroid Women. Int J Environ Res Public Health 2019; 16:ijerph16234776. [PMID: 31795239 PMCID: PMC6926863 DOI: 10.3390/ijerph16234776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023]
Abstract
Background: Hypothyroidism has several symptoms (weight gain, arrhythmias, mood changes, etc.). The aims of this study were (1) to assess the prevalence of anxiety and depression in levothyroxine-treated hypothyroid women and in women without hypothyroidism; (2) to identify variables associated with anxiety and depression. Methods: A case-control study was performed with 393 women. Case-group: 153 levothyroxine-treated hypothyroid women. Control-group: 240 women without hypothyroidism. Convenience sampling. Instrument: The Hamilton Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire. Results: The prevalence of anxiety in levothyroxine-treated hypothyroid women was higher than in women without hypothyroidism (29.4% vs. 16.7%, χ2 p < 0.001). The prevalence of depression in the case group was higher than in the control group (13.1% vs. 4.6%, χ2 p < 0.001). Levothyroxine-treated hypothyroid women were more likely to have anxiety (OR = 2.08, CI: 1.28-3.38) and depression (OR = 3.13, IC = 1.45-6.45). Conclusion: In spite of receiving treatment with levothyroxine, women with hypothyroidism are more likely to have depression and anxiety. Health professionals need to assess the mood of women with hypothyroidism. Although levothyroxine is a good treatment for the symptoms of hypothyroidism, it may not be enough to prevent development or persistence of depression and anxiety by itself.
Collapse
Affiliation(s)
- Benjamín Romero-Gómez
- Hospital El Tomillar de Sevilla, Servicio Andaluz de Salud (SAS), 41500 Alcalá de Guadaira, Spain;
| | | | - Juan Manuel Carmona-Torres
- Facultad de Fisioterapia y Enfermería y Fisioterapia de Toledo, Universidad de Castilla la Mancha, 45005 Toledo, Spain;
- Grupo de Investigación Multidisciplinar en Cuidados, Universidad de Castilla la Mancha, 45005 Toledo, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
- Correspondence: ; Tel./Fax: +34-925-268800 (ext. 5819)
| | - Blanca Notario-Pacheco
- Facultad de Enfermería de Cuenca, Universidad de Castilla la Mancha, 16071 Cuenca Toledo, Spain;
- Grupo de Investigación CESS, Universidad de Castilla la Mancha, 16071 Cuenca, Spain
| | - Ana Isabel Cobo-Cuenca
- Facultad de Fisioterapia y Enfermería y Fisioterapia de Toledo, Universidad de Castilla la Mancha, 45005 Toledo, Spain;
- Grupo de Investigación Multidisciplinar en Cuidados, Universidad de Castilla la Mancha, 45005 Toledo, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| |
Collapse
|
17
|
Gluvic ZM, Sudar-Milovanovic EM, Samardzic VS, Obradovic MM, Jevremovic DP, Radenkovic SP, Isenovic ER. Serum nitric oxide levels correlate with quality of life questionnaires scores of hypothyroid females. Med Hypotheses 2019; 131:109299. [PMID: 31443778 DOI: 10.1016/j.mehy.2019.109299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/01/2019] [Indexed: 02/05/2023]
Abstract
Primary hypothyroidism can affect lipid metabolism, cardiovascular (CV) function, and overall patients' quality of life (QoL). Decrease in serum nitric oxide (NO) levels could promote the atherosclerosis acceleration in hypothyroid patients. Our hypothesis is that serum NO level is altered in hypothyroidism; more specifically, we hypothesize that the early vascular changes that can be observed in hypothyroidism could be due to these alterations and that serum NO levels are associated with lipid levels in female patients diagnosed with subclinical hypothyroidism (SCH) or clinical hypothyroidism (CH). Furthermore, since serum NO level is an early marker of atherosclerosis and related CV disorders, which are commonly present and follow hypothyreosis and greatly contribute to overall QoL, we further hypothesized that NO level would correlate with Thyroid Symptom Questionnaire (TSQ) and General Health Questionnaire 12 (GHQ12) scores in hypothyroid patients. A collaterally of our hypothesis was that levothyroxine (LT4) treatment would affect serum NO levels as well as TSQ and GHQ12 scores. Therefore, we have analyzed lipid profile, the level of NO and QoL scores in female patients diagnosed with SCH and CH in order to determine the correlation between NO and generic and thyroid disease symptoms in treatment naïve SCH and CH patients and after LT4 treatment and laboratory euthyroidism achievement. As a consequence of our hypothesis is that measurement of serum NO level in SCH and CH patients may be an innovative way to improve LT4 treatment efficacy. This assumption could have a practical significance for future investigations regarding the management of hypothyroidism treatment protocols in current guidelines.
Collapse
Affiliation(s)
- Zoran M Gluvic
- Clinic for Internal Medicine, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emina M Sudar-Milovanovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia.
| | - Vladimir S Samardzic
- Clinic for Internal Medicine, Zemun Clinical Hospital, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan M Obradovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia
| | - Danimir P Jevremovic
- Faculty of Stomatology in Pancevo, University Business Academy in Novi Sad, Pancevo, Serbia
| | - Sasa P Radenkovic
- Clinic for Endocrinology, Diabetes and Metabolism Disorders, School of Medicine, University of Nis, Serbia
| | - Esma R Isenovic
- Institute of Nuclear Sciences Vinca, University of Belgrade, Laboratory of Radiobiology and Molecular Genetics, Belgrade, Serbia; Faculty of Stomatology in Pancevo, University Business Academy in Novi Sad, Pancevo, Serbia
| |
Collapse
|
18
|
Recker S, Voigtländer R, Viehmann A, Dunschen K, Kerp H, Frank-Raue K, Leidig-Bruckner G, Graf D, Lederbogen S, Dietrich JW, Görges R, Brabant G, Völker U, Watt T, Zwanziger D, Moeller LC, Führer D. Thyroid Related Quality of Life in Elderly with Subclinical Hypothyroidism and Improvement on Levothyroxine is Distinct from that in Young Patients (TSAGE). Horm Metab Res 2019; 51:568-574. [PMID: 31505703 DOI: 10.1055/a-0897-8785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate in a longitudinal approach whether levothyroxine (LT4) substitution has a different impact on quality of life (QoL) and thyroid related QoL in younger (<40 years) and older subjects (>60 years) with elevated thyroid-stimulating hormone (TSH) concentrations. The study included male and female patients with newly diagnosed, untreated subclinical hypothyroidism defined by TSH>8 mU/l. Patients were recruited throughout Germany from 2013-2016 and evaluated by clinical assessment, blood sampling and questionnaires for health related QoL and thyroid-disease thyroid-related QoL (ThyPRO) at time of diagnosis and six months after initiation of LT4 treatment. We found significantly lower QoL in both young and old patients with subclinical hypothyroidism compared to age-matched healthy individuals. Higher scores on follow-up were found in all patients irrespective of age, indicating better QoL on LT4 therapy. Analysis of the ThyPRO questionnaire showed that old patients experienced less Emotional Susceptibility, Tiredness, and Impaired Day Life on LT4, while young patients reported less Cognitive Complaints, Emotional Susceptibility, and Impaired Day Life compared to baseline assessment. Hypothyroidism with TSH concentrations>8 mU/l is associated with impairment in general and ThyPRO QoL in young and old age. Older patients benefited from LT4 therapy and remarkably show similar degree of improvement as younger patients, albeit with some thematic variation in ThyPRO QoL. Our data confirm current recommendations on initiation of LT4 substitution and suggest that this should not be withheld in elderly with TSH concentration above 8-10 mU/l.
Collapse
Affiliation(s)
- Stefanie Recker
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Richard Voigtländer
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Anja Viehmann
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karin Dunschen
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Helena Kerp
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | - Dieter Graf
- Endocrine and Nuclear Medicine Center Lüneburg, Lüneburg, Germany
| | | | - Johannes W Dietrich
- Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University Bochum, Bochum, Germany
| | - Rainer Görges
- Department of Nuclear Medicine, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology, Medical Clinic I, University of Luebeck, Luebeck, Germany
| | - Uwe Völker
- Institute for Genetics and Functional Genome Research, University of Greifswald, Greifswald, Germany
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Denise Zwanziger
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Lars Christian Moeller
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, Clinical Chemistry - Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
19
|
Labad J, Soria V, Armario A, Nadal R, Monreal JA, Palao D. Levothyroxine treatment for persistent cognitive symptoms in major depression. Rev Psiquiatr Salud Ment (Engl Ed) 2019; 12:199-200. [PMID: 30898441 DOI: 10.1016/j.rpsm.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Javier Labad
- Departamento de Salud Mental, Hospital Universitari Parc Taulí, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell (Barcelona), España; Universitat Autònoma de Barcelona, Cerdanyola del Vallès (Barcelona), España; Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Centro de Investigación Biomédica en Red-Salud Mental (CIBERSAM).
| | - Virginia Soria
- Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Servicio de Psiquiatría, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), España
| | - Antonio Armario
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès (Barcelona), España; Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Centro de Investigación Biomédica en Red-Salud Mental (CIBERSAM); Institut de Neurociències, Cerdanyola del Vallès (Barcelona), España
| | - Roser Nadal
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès (Barcelona), España; Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Centro de Investigación Biomédica en Red-Salud Mental (CIBERSAM); Institut de Neurociències, Cerdanyola del Vallès (Barcelona), España
| | - José Antonio Monreal
- Departamento de Salud Mental, Hospital Universitari Parc Taulí, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell (Barcelona), España; Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Centro de Investigación Biomédica en Red-Salud Mental (CIBERSAM)
| | - Diego Palao
- Departamento de Salud Mental, Hospital Universitari Parc Taulí, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell (Barcelona), España; Universitat Autònoma de Barcelona, Cerdanyola del Vallès (Barcelona), España; Unidad de Neurociencia Translacional, Universitat Autònoma de Barcelona-Parc Taulí, Barcelona, España; Centro de Investigación Biomédica en Red-Salud Mental (CIBERSAM)
| |
Collapse
|
20
|
Walter KM, Miller GW, Chen X, Harvey DJ, Puschner B, Lein PJ. Changes in thyroid hormone activity disrupt photomotor behavior of larval zebrafish. Neurotoxicology 2019; 74:47-57. [PMID: 31121238 DOI: 10.1016/j.neuro.2019.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/12/2019] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
High throughput in vitro, in silico, and computational approaches have identified numerous environmental chemicals that interfere with thyroid hormone (TH) activity, and it is posited that human exposures to such chemicals are a contributing factor to neurodevelopmental disorders. However, whether hits in screens of TH activity are predictive of developmental neurotoxicity (DNT) has yet to be systematically addressed. The zebrafish has been proposed as a second tier model for assessing the in vivo DNT potential of TH active chemicals. As an initial evaluation of the feasibility of this proposal, we determined whether an endpoint often used to assess DNT in larval zebrafish, specifically photomotor behavior, is altered by experimentally induced hyper- and hypothyroidism. Developmental hyperthyroidism was simulated by static waterborne exposure of zebrafish to varying concentrations (3-300 nM) of thyroxine (T4) or triiodothyronine (T3) beginning at 6 h post-fertilization (hpf) and continuing through 5 days post-fertilization (dpf). Teratogenic effects and lethality were observed at 4 and 5 dpf in fish exposed to T4 or T3 at concentrations >30 nM. However, as early as 3 dpf, T4 (> 3 nM) and T3 (> 10 nM) significantly increased swimming activity triggered by sudden changes from light to dark, particularly during the second dark period (Dark 2). Conversely, developmental hypothyroidism, which was induced by treatment with 6-propyl-2-thiouracil (PTU), morpholino knockdown of the TH transporter mct8, or ablation of thyroid follicles in adult females prior to spawning, generally decreased swimming activity during dark periods, although effects did vary across test days. All effects of developmental hypothyroidism on photomotor behavior occurred independent of teratogenic effects and were most robust during Dark 2. Treatment with the T4 analog, Tetrac, restored photomotor response in mct8 morphants to control levels. Collectively, these findings suggest that while the sensitivity of photomotor behavior in larval zebrafish to detect TH disruption is influenced by test parameters, this test can distinguish between TH promoting and TH blocking activity and may be useful for assessing the DNT potential of TH-active chemicals.
Collapse
Affiliation(s)
- Kyla M Walter
- Department of Molecular Biosciences, University of California-Davis School of Veterinary Medicine, Davis, CA, 95616, United States.
| | - Galen W Miller
- Department of Molecular Biosciences, University of California-Davis School of Veterinary Medicine, Davis, CA, 95616, United States.
| | - Xiaopeng Chen
- Department of Molecular Biosciences, University of California-Davis School of Veterinary Medicine, Davis, CA, 95616, United States.
| | - Danielle J Harvey
- Department of Public Health Sciences University of California, Davis, School of Medicine, Davis, California 95616, United States.
| | - Birgit Puschner
- Department of Molecular Biosciences, University of California-Davis School of Veterinary Medicine, Davis, CA, 95616, United States.
| | - Pamela J Lein
- Department of Molecular Biosciences, University of California-Davis School of Veterinary Medicine, Davis, CA, 95616, United States.
| |
Collapse
|
21
|
Affiliation(s)
- A Garrahy
- Department of Endocrinology, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
| | - A Agha
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland.
| |
Collapse
|
22
|
Abstract
OBJECTIVE The objective of this analysis was to compare adherence at 6 months and 12 months across levothyroxine formulations for patients with hypothyroidism. METHODS This retrospective analysis utilized insurance claims data from a commercially insured population from January 1, 2000 through March 31, 2016. Patients were included if they were diagnosed with hypothyroidism and initiated treatment with generic levothyroxine, Levoxyl, Synthroid, Unithroid, or Tirosint. Patients were excluded if they were younger than age 18, were diagnosed with thyroid cancer, received a prescription for liothyronine, or did not have continuous insurance coverage over the study period. Adherence, defined by the proportion of days covered (PDC) ≥ 80%, was examined using multivariable analyses for both 6 and 12 months post-initiation on therapy Results: The study identified 580,331 patients who fit the study criteria. At 6 months, 40.3% of patients were found to be non-adherent, while 51.9% were non-adherent at 12 months. Synthroid was associated with significantly higher adherence compared to all other levothyroxine formulations at both 6 and 12 months. Compared to generic levothyroxine, the likelihood of being adherent at 12 months was highest for Synthroid (OR = 1.44; 95% CI = 1.43-1.46), followed by Levoxyl (OR = 1.20 95% CI = 1.17-1.23). Tirosint and Unithroid were associated with significantly lower adherence at 12 months compared to generic levothyroxine (OR = 0.65; 95% CI = 0.57-0.75 and OR = 0.79; 95% CI = 0.71-0.89, respectively). CONCLUSIONS This large, retrospective real-world study demonstrated that adherence to levothyroxine remains a concern among patients with hypothyroidism, and that differences in adherence may exist across levothyroxine formulations.
Collapse
Affiliation(s)
- Zsolt Hepp
- a Formerly Global Health Economics and Outcomes Research Analytics , AbbVie, Inc. , North Chicago , IL , USA
| | - Kathleen Wyne
- b Division of Endocrinology, Diabetes & Metabolism , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Shivaji R Manthena
- c Health Economics and Outcomes Research Analytics , AbbVie, Inc. , North Chicago , IL , USA
| | - Siting Wang
- c Health Economics and Outcomes Research Analytics , AbbVie, Inc. , North Chicago , IL , USA
| | - Ved Gossain
- d Division of Endocrinology , Michigan State University , East Lansing , MI , USA
| |
Collapse
|
23
|
Abstract
INTRODUCTION Biological activity of thyroid hormones (TH) is regulated by enzymes known as deiodinases. The most important is represented by the type 2 deiodinase (D2), which is the main T4-activating enzyme, ubiquitous in human tissues and therefore essential in many metabolic processes. A single nucleotide polymorphism (SPN) of D2, known as Thr92Ala (rs225014), has been reported in the general population while other polymorphisms are less frequently described. AREAS COVERED Several authors investigated the potential metabolic effect of these polymorphisms in the general population and in specific groups of patients. Thr92Ala polymorphism was mainly studied in patients with autoimmune or surgical hypothyroidism and in patients with physical/psychological disorders that could be related to an overt hypothyroidism. Susceptibility to develop more severe type 2 diabetes or insulin resistance has also been evaluated. EXPERT COMMENTARY There is an increasing evidence that the presence of D2 polymorphisms may play a pivotal role in a better definition and customized therapeutic approach of patients with hypothyroidism and/or type 2 diabetes, suggesting that these patients should be screened for D2 polymorphisms. Nevertheless, further research should be performed in order to clarify the association between D2 polymorphisms, metabolic alterations and clinical conditions of the carrier patients.
Collapse
Affiliation(s)
- Fabio Maino
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Silvia Cantara
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Raffaella Forleo
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Tania Pilli
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Maria Grazia Castagna
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| |
Collapse
|
24
|
Hong JW, Noh JH, Kim DJ. Association between subclinical thyroid dysfunction and depressive symptoms in the Korean adult population: The 2014 Korea National Health and Nutrition Examination Survey. PLoS One 2018; 13:e0202258. [PMID: 30106989 PMCID: PMC6091963 DOI: 10.1371/journal.pone.0202258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical hyper and hypothyroidism are associated with a risk for depression. OBJECTIVES This study was performed to investigate the association between depressive symptoms and subclinical thyroid dysfunction. METHODS Among the 7,550 subjects who participated in the 2014 Korea National Health and Nutrition Examination Survey, 1,763 participants without overt thyroid disease were included in this study. Serum thyroid stimulating hormone (TSH), serum free thyroxine (fT4), and depressive symptoms were analyzed based on the Patient Health Questionnaire (PHQ9). RESULTS The percentages of subjects with subclinical hypothyroidism and subclinical hyperthyroidism were 3.3% and 2.6%, respectively. The percentages of subjects with moderate (10-14 points), moderately severe (15-19 points), and severe (≥20 points) depression according to the distribution of PHQ-9 scores were 4.7%, 1.1%, and 0.3%, respectively. TSH, fT4, and the percentage of patients with subclinical hypothyroidism were not significantly associated with PHQ-9 score. However, the percentage of patients with subclinical hyperthyroidism increased significantly with PHQ9 score (P = 0.002). Subjects with subclinical hyperthyroidism had higher PHQ-9 scores than those with normal thyroid function (mean ± standard error [SE], 4.2 ± 0.5 vs. 2.7 ± 0.1 points, P = 0.010). More subjects with subclinical hyperthyroidism had a PHQ9 score ≥ 10 than did those with normal thyroid function (mean ± SE, 17.1 ± 3.5 vs. 5.8 ± 0.6%, P = 0.005). We performed logistic regression analyses for the presence of depressive symptoms, using age, sex, education, household income, alcohol drinking, smoking, diabetes, cerebrovascular disease history, subclinical hypothyroidism, and subclinical hyperthyroidism as variables. Subclinical hyperthyroidism was associated with the presence of clinically relevant depression (PHQ9 score ≥ 10), (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.75-9.31; P = 0.001), and clinically significant depression (PHQ9 score ≥ 15), (OR, 7.05; 95% CI, 1.67-29.67; P = 0.008), respectively. However, subclinical hypothyroidism was not associated with the presence of clinically relevant depression (OR, 1.15; 95% CI, 0.39-3.38; P = 0.800), or clinically significant depression (OR, 3.35; 95% CI, 0.71-15.79; P = 0.127). CONCLUSIONS We demonstrated that subclinical hyperthyroidism was independently associated with depressive symptoms in the Korean general population using national cross-sectional data.
Collapse
Affiliation(s)
- Jae Won Hong
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
- * E-mail:
| |
Collapse
|
25
|
Peterson SJ, Cappola AR, Castro MR, Dayan CM, Farwell AP, Hennessey JV, Kopp PA, Ross DS, Samuels MH, Sawka AM, Taylor PN, Jonklaas J, Bianco AC. An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction. Thyroid 2018; 28:707-721. [PMID: 29620972 PMCID: PMC6916129 DOI: 10.1089/thy.2017.0681] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Approximately 15% more patients taking levothyroxine (LT4) report impaired quality of life compared to controls. This could be explained by additional diagnoses independently affecting quality of life and complicating assignment of causation. This study sought to investigate the underpinnings of reduced quality of life in hypothyroid patients and to provide data for discussion at a symposium addressing hypothyroidism. METHODS An online survey for hypothyroid patients was posted on the American Thyroid Association Web site and forwarded to multiple groups. Respondents were asked to rank satisfaction with their treatment for hypothyroidism and their treating physician. They also ranked their perception regarding physician knowledge about hypothyroidism treatments, need for new treatments, and life impact of hypothyroidism on a scale of 1-10. Respondents reported the therapy they were taking, categorized as LT4, LT4 and liothyronine (LT4 + LT3), or desiccated thyroid extract (DTE). They also reported sex, age, cause of hypothyroidism, duration of treatment, additional diagnoses, and prevalence of symptoms. RESULTS A total of 12,146 individuals completed the survey. The overall degree of satisfaction was 5 (interquartile range [IQR] = 3-8). Among respondents without self-reported depression, stressors, or medical conditions (n = 3670), individuals taking DTE reported a higher median treatment satisfaction of 7 (IQR = 5-9) compared to other treatments. At the same time, the LT4 treatment group exhibited the lowest satisfaction of 5 (IQR = 3-7), and for the LT4 + LT3 treatment group, satisfaction was 6 (IQR = 3-8). Respondents taking DTE were also less likely to report problems with weight management, fatigue/energy levels, mood, and memory compared to those taking LT4 or LT4 + LT3. CONCLUSIONS A subset of patients with hypothyroidism are not satisfied with their current therapy or their physicians. Higher satisfaction with both treatment and physicians is reported by those patients on DTE. While the study design does not provide a mechanistic explanation for this observation, future studies should investigate whether preference for DTE is related to triiodothyronine levels or other unidentified causes.
Collapse
Affiliation(s)
- Sarah J. Peterson
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Colin M. Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Alan P. Farwell
- Division of Endocrinology, Diabetes and Nutrition, Boston Medical Center/Boston University, Boston, Massachusetts
| | - James V. Hennessey
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter A. Kopp
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Douglas S. Ross
- Thyroid Associates, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary H. Samuels
- Oregon Clinical and Translational Research Institute, Oregon Health and Science University, Portland, Oregon
| | - Anna M. Sawka
- University Health Network and University of Toronto, Toronto, Canada
| | - Peter N. Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - Antonio C. Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
26
|
Samuels MH, Kolobova I, Niederhausen M, Janowsky JS, Schuff KG. Effects of Altering Levothyroxine (L-T4) Doses on Quality of Life, Mood, and Cognition in L-T4 Treated Subjects. J Clin Endocrinol Metab 2018; 103:1997-2008. [PMID: 29509918 PMCID: PMC6457033 DOI: 10.1210/jc.2017-02668] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The brain is a critical target organ for thyroid hormone, but it is unclear whether variations in thyroid function within and near the reference range affect quality of life, mood, or cognition. METHODS A total of 138 subjects with levothyroxine (L-T4)-treated hypothyroidism and normal thyrotropin (TSH) levels underwent measures of quality of life (36-Item Short Form Health Survey, Underactive Thyroid-Dependent Quality of Life Questionnaire), mood (Profile of Mood States, Affective Lability Scale), and cognition (executive function, memory). They were then randomly assigned to receive an unchanged, higher, or lower L-T4 dose in double-blind fashion, targeting one of three TSH ranges (0.34 to 2.50, 2.51 to 5.60, or 5.61 to 12.0 mU/L). Doses were adjusted every 6 weeks based on TSH levels. Baseline measures were reassessed at 6 months. RESULTS At the end of the study, by intention to treat, mean L-T4 doses were 1.50 ± 0.07, 1.32 ± 0.07, and 0.78 ± 0.08 μg/kg (P < 0.001), and mean TSH levels were 1.85 ± 0.25, 3.93 ± 0.38, and 9.49 ± 0.80 mU/L (P < 0.001), respectively, in the three arms. There were minor differences in a few outcomes between the three arms, which were no longer significant after correction for multiple comparisons. Subjects could not ascertain how their L-T4 doses had been adjusted (P = 0.55) but preferred L-T4 doses they perceived to be higher (P < 0.001). CONCLUSIONS Altering L-T4 doses in hypothyroid subjects to vary TSH levels in and near the reference range does not affect quality of life, mood, or cognition. L-T4-treated subjects prefer perceived higher L-T4 doses despite a lack of objective benefit. Adjusting L-T4 doses in hypothyroid patients based on symptoms in these areas may not result in significant clinical improvement.
Collapse
Affiliation(s)
- Mary H Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon
- Correspondence and Reprint Requests: Mary H. Samuels, MD, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239. E-mail:
| | - Irina Kolobova
- Penn State Health St. Joseph, Family and Community Medicine Residency Program, Reading, Pennsylvania
| | - Meike Niederhausen
- Biostatistics & Design Program, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon
| | | | - Kathryn G Schuff
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
27
|
Abstract
Mild perinatal hypothyroidism may result from inadequate iodine intake, insufficient treatment of congenital hypothyroidism, or exposure to endocrine-disrupting chemicals. Because thyroid hormones are critical for brain development, severe hypothyroidism that is untreated in infancy causes irreversible cretinism. Milder hypothyroidism may also affect cognitive development; however, the effects of mild and/or moderate hypothyroidism on brain development are not fully understood. In this study, we examined the behavior of adult male mice rendered mildly hypothyroid during the perinatal period using low-dose propylthiouracil (PTU). PTU was administered through drinking water (5 or 50 ppm) from gestational day 14 to postnatal day 21. Cognitive performance, studied by an object in-location test (OLT), was impaired in PTU-treated mice at postnatal week 8. These results suggest that, although the hypothyroidism was mild, it partially impaired cognitive function. We next measured the concentration of neurotransmitters (glutamate, γ-aminobutyric acid, and glycine) in the hippocampus using in vivo microdialysis during OLT. The concentrations of neurotransmitters, particularly glutamate and glycine, decreased in PTU-treated mice. The expression levels of N-methyl-d-aspartate receptor subunits, which are profound regulators of glutamate neurotransmission and memory function, also were decreased in PTU-treated mice. These data indicate that mild perinatal hypothyroidism causes cognitive disorders in adult offspring. Such disorders may be partially induced secondary to decreased concentrations of neurotransmitters and receptor expression.
Collapse
Affiliation(s)
- Izuki Amano
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yusuke Takatsuru
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Miski Aghnia Khairinisa
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Michifumi Kokubo
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Asahi Haijima
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Gunma, Japan
| |
Collapse
|
28
|
Young Cho Y, Jeong Kim H, Won Jang H, Hyuk Kim T, Ki CS, Wook Kim S, Hoon Chung J. The relationship of 19 functional polymorphisms in iodothyronine deiodinase and psychological well-being in hypothyroid patients. Endocrine 2017; 57:115-124. [PMID: 28466400 DOI: 10.1007/s12020-017-1307-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Levothyroxine supplementation is insufficient for the management of one tenth of patients with hypothyroidism. Iodothyronine deiodinases have been suggested to play a role in residual hypothyroid symptoms of these patients by controlling local thyroid hormone homeostasis. Previous research has suggested a relationship between commonly inherited variations in type 2 iodothyronine deiodinase and impaired well-being. We evaluated the prevalence of iodothyronine deiodinase genotypes and their association with psychological well-being in the Korean hypothyroid population. METHODS A prospective observational study. We enrolled 196 hypothyroid subjects (136 chronic autoimmune thyroiditis and 60 thyroid cancer) and assessed baseline well-being using six validated questionnaires. Genotyping was conducted for 19 single nucleotide polymorphisms in type 1, 2, and 3 iodothyronine deiodinase using Sequenom MassARRAY matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in all patients. RESULTS Frequencies of iodothyronine deiodinase genotypes and well-being scores were not different in hypothyroid subjects according to their disease types. Minor genotypes of a few iodothyronine deiodinase 1 variants (rs11206244, rs2294512, and rs4926616) were associated with reduced psychological well-being. However, iodothyronine deiodinase 2 and 3 variants had no effect on baseline well-being. CONCLUSION Minor variations in iodothyronine deiodinase 1 were associated with decreased well-being in the Korean hypothyroid population, whereas iodothyronine deiodinase 2 and 3 were not. Due to controversial results among different ethnicities, further studies to clarify the effects of iodothyronine deiodinase polymorphisms on psychological well-being are warranted in hypothyroid individuals.
Collapse
Affiliation(s)
- Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hye Jeong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
29
|
Beck NC, Hammer JH, Robbins S, Tubbesing T, Menditto A, Pardee A. Highly Aggressive Women in a Forensic Psychiatric Hospital. J Am Acad Psychiatry Law 2017; 45:17-24. [PMID: 28270458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this study, we compared three groups of women admitted to a public forensic inpatient facility over the course of a two-year period. Detailed and systematic examination of social and psychiatric histories revealed that the group with the most persistent levels of aggression differed from the other two groups with respect to frequency of self-harming behavior, intellectual impairment, hypothyroidism, a childhood diagnosis of attention deficit-hyperactivity disorder (ADHD), and age of onset of psychiatric and behavioral symptoms. The high-aggression group also had the highest rate of childhood physical and sexual abuse, but the difference between that group and the two lower aggression groups did not achieve statistical significance. From the standpoint of childhood adversity, 94 percent of those in the high-aggression group had been placed outside of the original home by age 11. Eighty-nine percent were intellectually impaired. At admission, physical examinations revealed that 50 percent had a history of hypothyroidism and two-thirds were obese. Before admission, most had manifested severe aggression and emotional dysregulation, as evinced by high levels of self-harm, suicide attempts, and aggressive behavior in previous institutional settings that was both frequent and intense. Patients who share these characteristics are currently placed on a ward at the hospital with a milieu and individual therapy programs that are based on a dialectical behavior therapy approach that targets key symptoms of emotional and behavioral dysregulation.
Collapse
Affiliation(s)
- Niels C Beck
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO.
| | - Joseph H Hammer
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO
| | - Sharon Robbins
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO
| | - Tara Tubbesing
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO
| | - Anthony Menditto
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO
| | - Alicia Pardee
- Dr. Beck is Professor Emeritus, Dr. Robbins is Adjunct Assistant Professor, and Dr. Menditto is Adjunct Associate Professor, University of Missouri Medical School, Columbia, MO. Alicia Pardee is Staff Psychologist and Program Director, Fulton State Hospital, Fulton, MO. Dr. Hammer is Assistant Professor at the University of Kentucky, Lexington, KY. Dr. Tubbesing is Chief Psychologist at Northwest Missouri Psychiatric Rehabilitation Center, St. Joseph, MO
| |
Collapse
|
30
|
Wouters HJCM, van Loon HCM, van der Klauw MM, Elderson MF, Slagter SN, Kobold AM, Kema IP, Links TP, van Vliet-Ostaptchouk JV, Wolffenbuttel BHR. No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters, Health-Related Quality of Life, and Cognitive Functioning in a Large Population-Based Cohort Study. Thyroid 2017; 27:147-155. [PMID: 27786042 DOI: 10.1089/thy.2016.0199] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The presence of the Thr92Ala polymorphism of deiodinase-2 (D2) has been thought to have several effects. It may influence its enzymatic function, is associated with increased expression of genes involved in oxidative stress in brain tissue, and may predict favorable response to combination levothyroxine (LT4) plus triiodothyronine (T3) therapy. It was hypothesized that homozygous carriers of the D2-92Ala allele have different thyroid hormone parameters, and reduced health-related quality of life (HRQoL) and cognitive functioning. METHODS In 12,625 participants from the LifeLines cohort study with genome-wide genetic data available, the effects of the Thr92Ala polymorphism (rs225014) were evaluated in the general population and in 364 people treated with thyroid hormone replacement therapy, the latter mainly because of primary hypothyroidism. In addition to evaluating anthropometric data, medication use, and existence of metabolic syndrome, HRQoL was assessed with the RAND 36-Item Health Survey, and the Ruff Figural Fluency Test was used as a sensitive test for executive functioning. Data on thyrotropin, free thyroxine (fT4), and free T3 (fT3) levels were available in a subset of 4479 participants. RESULTS The mean age (±standard deviation) was 53 ± 12 years and the body mass index was 27.0 ± 4.5 kg/m2 in the LT4 users compared with 48 ± 11 years and 26.2 ± 4.1 kg/m2 in participants from the general population. The Ala/Ala genotype of the D2-Thr92Ala polymorphism was present in 11.3% of LT4 users and in 10.7% of the general population. In total, 3742/4479 subjects with thyroid hormone data available had normal TSH (0.4-4.0 mIU/L), and 88% of LT4 users were females. LT4 users had higher fT4, lower fT3, and a lower fT3/fT4 ratio, and female patients had lower scores on the HRQoL domains of physical functioning, vitality, mental health, social functioning, bodily pain, and general health compared with those not using LT4 (p < 0.005). Executive functioning scores, as part of cognitive functioning, were comparable between female LT4 users and the general population. In both groups, the D2-Thr92Ala polymorphism was not associated with differences in TSH, fT4, fT3, the fT3/fT4 ratio, presence of metabolic syndrome or other comorbidities, use of medication, HRQoL, and cognitive functioning. CONCLUSION The Thr92Ala polymorphism of D2 was not associated with thyroid parameters, HRQoL, and cognitive functioning in the general population and in participants on thyroid hormone replacement therapy.
Collapse
Affiliation(s)
- Hanneke J C M Wouters
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Hannah C M van Loon
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Melanie M van der Klauw
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Martin F Elderson
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Sandra N Slagter
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Anneke Muller Kobold
- 2 Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Ido P Kema
- 2 Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Thera P Links
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Jana V van Vliet-Ostaptchouk
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| | - Bruce H R Wolffenbuttel
- 1 Department of Endocrinology and Metabolism, University of Groningen, University Medical Center Groningen , Groningen, Netherlands
| |
Collapse
|
31
|
Zaccarelli-Marino MA, Saldiva André CD, Singer JM. Overt Primary Hypothyroidism in an Industrial Area in São Paulo, Brazil: The Impact of Public Disclosure. Int J Environ Res Public Health 2016; 13:E1161. [PMID: 27879691 PMCID: PMC5129371 DOI: 10.3390/ijerph13111161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/11/2016] [Accepted: 11/17/2016] [Indexed: 12/22/2022]
Abstract
Background: Primary hypothyroidism (PH) is the most common thyroid pathology. Purpose: to evaluate the impact of public disclosure of an unexpected number of PH cases on the frequency of patients seeking medical evaluation for endocrinological diseases. Methods: data on 6306 subjects (3356 living in the surroundings of a petrochemical complex and 2950 in a control region) were collected over a 15-year time span. Thyroid function was determined by serum levels of triiodothyronine, thyroxine, free thyroxine and thyrotrophin. Antithyroglobulin and antithyroperoxidase antibodies and sonographic scans of the thyroid were performed in all patients. The data were analyzed via log-linear models to compute odds and odds ratios. Results: An increasing trend in the odds of PH was detected along the observation period with greater slope in the study region than in the control region. The odds of PH in the post-disclosure period (2002 to 2004) are greater than the corresponding ones in the pre-disclosure period (1989 to 2001). Conclusions: This study shows that living in the surroundings of a petrochemical complex may be an important risk factor for PH for both adults and children. Furthermore, public disclosure of such risk factor contributes to the awareness of the problem and to the possibility of an early diagnosis.
Collapse
Affiliation(s)
| | - Carmen Diva Saldiva André
- Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo 05508-090, Brazil.
| | - Julio M Singer
- Department of Statistics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo 05508-090, Brazil.
| |
Collapse
|
32
|
Samuels MH, Kolobova I, Smeraglio A, Niederhausen M, Janowsky JS, Schuff KG. Effect of Thyroid Function Variations Within the Laboratory Reference Range on Health Status, Mood, and Cognition in Levothyroxine-Treated Subjects. Thyroid 2016; 26:1173-84. [PMID: 27338133 PMCID: PMC5036318 DOI: 10.1089/thy.2016.0141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND There has been recent debate within the thyroid field regarding whether current upper limits of the thyrotropin (TSH) reference range should be lowered. This debate can be better informed by investigation of whether variations in thyroid function within the reference range have clinical effects. One important target organ for thyroid hormone is the brain, but little is known about variations in neurocognitive measures within the reference range for thyroid function. METHODS This was a cross-sectional study of 132 otherwise healthy hypothyroid subjects receiving chronic replacement therapy with levothyroxine (LT4) who had TSH levels across the full span of the laboratory reference range (0.34-5.6 mU/L). Subjects underwent detailed tests of health status, mood, and cognitive function, with an emphasis on memory and executive functions. RESULTS Subjects with low-normal (≤2.5 mU/L) and high-normal (>2.5 mU/L) TSH levels did not differ on most tests of health status, mood, or cognitive function, and there were no correlations between TSH, free T4, or free T3 levels and most outcomes. There was, however, a suggestion that thyroid function affected performance on the Iowa Gambling Task, which mimics real life decision-making. Subjects with low-normal TSH levels made more advantageous decisions than those with high-normal TSH levels. CONCLUSIONS Variations in thyroid function within the laboratory reference range do not appear to have clinically relevant effects on health status, mood, or memory in LT4 treated subjects. However, decision making, which encompasses many executive functions, may be affected. Unless further studies strengthen this finding, these data do not support narrowing the TSH reference range.
Collapse
Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
| | - Irina Kolobova
- Department of Human Development and Family Science, East Carolina University, Greenville, North Carolina
| | - Anne Smeraglio
- Stanford University School of Medicine, Department of Internal Medicine, Stanford, California
| | - Meike Niederhausen
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
- Biostatistics and Design Program, OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
- Department of Mathematics, University of Portland, Portland, Oregon
| | | | - Kathryn G. Schuff
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
33
|
Shin YW, Choi YM, Kim HS, Kim DJ, Jo HJ, O'Donnell BF, Jang EK, Kim TY, Shong YK, Hong JP, Kim WB. Diminished Quality of Life and Increased Brain Functional Connectivity in Patients with Hypothyroidism After Total Thyroidectomy. Thyroid 2016; 26:641-9. [PMID: 26976233 PMCID: PMC4939446 DOI: 10.1089/thy.2015.0452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acute hypothyroidism induced by thyroid hormone withdrawal (THW) in patients with thyroid cancer after total thyroidectomy can affect mood and quality of life (QoL). While loss or dysregulation of thyroid hormone (TH) has these well-known behavioral consequences, the effects of TH alterations on brain function are not well understood. Resting state functional connectivity (FC) measured by functional magnetic resonance imaging (fMRI) allows non-invasive evaluation of human brain function. This study therefore examined whether THW affects resting state FC and whether changes in FC correlate with the mood or QoL of the patients with THW status. METHODS Twenty-one patients who had undergone total thyroidectomy for thyroid cancer were recruited. Resting state fMRI scanning of the brain, thyroid function tests, and administration of the 12-Item Short Form Health Survey (SF-12) and the Patient Health Questionnaire-9 (PHQ-9) were performed before and after two weeks of THW. Regional homogeneity (ReHo), one of the measures of resting state FC, was calculated, and each voxel was compared between before and after THW in 19 patients. The ReHo values were extracted from the regions of interest showing within-group differences in ReHo values after THW, and correlations of ReHo values with thyrotropin (TSH) levels, total score of the PHQ-9, and composite scores of the SF-12 were statistically evaluated. RESULTS Higher ReHo was observed after THW in the brain cortical regions across primary motor and sensory, visual, and association cortices. Among the regions, the ReHo values in the bilateral pre- and postcentral gyri, bilateral middle occipito-temporal cortices, the left precuneus, and the left lingual gyrus showed positive correlations with serum TSH levels after THW. Higher ReHo values in the bilateral pre- and postcentral gyri, the left middle temporo-occipital cortices, and the left ligual gyrus correlated with the lower mental component summary score from the SF-12, while higher ReHo values in the bilateral pre- and postcentral gyri correlated with higher total scores in the PHQ-9. CONCLUSIONS Local brain FC is increased in the acute hypothyroid state. Higher FC correlates with a poorer mental QoL and increased depression in the hypothyroid state.
Collapse
Affiliation(s)
- Yong-Wook Shin
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Hang Joon Jo
- Scientific and Statistical Computing Core, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Brian F. O'Donnell
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Eun Kyung Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
34
|
Sowiński J, Sawicka-Gutaj N, Ziółkowska P, Ruchała M. Effect of free triiodothyronine concentration on the quality of life of patients treated with levothyroxine. ACTA ACUST UNITED AC 2016; 126:293-6. [PMID: 27129087 DOI: 10.20452/pamw.3392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
35
|
Abstract
BACKGROUND The relationship between alterations in thyroid function and cognitive deficits has been investigated in several previous studies. Hypo-or hyperthyroidism and, to a lesser extent, subclinical thyroid dysfunction can negatively affect cognitive performance. However, limited data are available on the potential association of thyroid function with mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the elderly Chinese population. METHODS In the present study focusing on a population of elderly Chinese individuals ≥ 50 years of age, 77 cognitively normal controls, 64 patients with MCI, and 154 patients diagnosed with AD underwent assessment of thyroid status using thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4) levels as variables. Cognitive function was evaluated with the aid of comprehensive neuropsychological tests, such as the Mini-Mental State Examination (MMSE) and Memory and Executive Screening (MES). RESULTS Overall, 88.1 % of the subjects displayed normal thyroid function, 4.7 % were diagnosed with clinical hypothyroidism, 3.1 % with subclinical hypothyroidism, and 4.1 % with subclinical hyperthyroidism. After adjusting for covariates (age, sex, education years and body mass index), no association was evident between mild cognitive impairment or AD and thyroid dysfunction. However, lower serum TSH was correlated with risk of AD (odds ratio [OR]: 2.78, 95 % confidence interval [95% CI]: 1.11-6.99). CONCLUSION Neither hypothyroidism nor subclinical hyperthyroidism was associated with AD and MCI in this population-based elderly Chinese cohort. Our findings need to be confirmed in a longitudinal study.
Collapse
Affiliation(s)
- Yao Hu
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China.
| | - Zhi-cheng Wang
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Qi-hao Guo
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Wei Cheng
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| | - Yan-wen Chen
- Department of Laboratory Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China
| |
Collapse
|
36
|
Šterzl I, Absolonová K, Matucha P. [Psycho-immuno-endocrinology of the thyroid gland]. Vnitr Lek 2016; 62:107-114. [PMID: 27734702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Historically endocrinologists and psychiatrists are aware that disturbances in thyroid disease in beginning or even in clinically intensified states of thyrotoxicosis or hypothyroidism exhibit pathological mental manifestations, masking or potentiating the underlying disease. Immune system disorders cause thyroid organ-specific autoimmune process. This autoimmune thyroid disease binds with a number of disorders in both endocrine or non-endocrine organs. This appears in vascular, neurological, skin, connective tissue, gastrointestinal tract and mental pathology. These disorders are part of autoimmune polyglandular syndromes (APS) type I -III, especially the APS type III. Originally it was assumed that these mental disorders are caused by direct exposure to excess or deficiency of thyroid hormones. Recently, however, it appears that these psycho-immune-endocrine disorders have common etiologic mechanisms of formation and on cellular and molecular level they involve similar, if not in some cases, common mechanisms.Key words: antithyroid peroxidase antibody - autoimmune polyglandular syndrome type I., II., III. - autoimmune thyroid disease - bipolar disorder - depression - Hashimotos encephalopathy - postpartum psychosis - psycho-immuno-endocrinology - schizophrenia.
Collapse
|
37
|
Calvino C, Império GE, Wilieman M, Costa-E-Sousa RH, Souza LL, Trevenzoli IH, Pazos-Moura CC. Hypothyroidism Induces Hypophagia Associated with Alterations in Protein Expression of Neuropeptide Y and Proopiomelanocortin in the Arcuate Nucleus, Independently of Hypothalamic Nuclei-Specific Changes in Leptin Signaling. Thyroid 2016; 26:134-43. [PMID: 26538454 DOI: 10.1089/thy.2015.0384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thyroid hormone and leptin are essential regulators of energy homeostasis. Both hormones stimulate energy expenditure but have opposite effects on appetite. The mechanisms behind food intake regulation in thyroid dysfunctions are poorly understood. It has been shown that hypothyroid rats exhibited impaired leptin anorexigenic effect and signaling in total hypothalamus, even though they were hypophagic. It was hypothesized that hypothyroidism modulates the expression of neuropeptides: orexigenic neuropeptide Y (NPY) and anorexigenic proopiomelanocortin (POMC), independently of inducing nuclei-specific changes in hypothalamic leptin signaling. METHODS Adult male rats were rendered hypothyroid by administration of 0.03% methimazole in the drinking water for 21 days. Protein content of NPY, POMC, and leptin signaling (the signal transducer and activator of transcription 3 [STAT3] pathway) were evaluated by Western blot, and mRNA levels by real time reverse transcription polymerase chain reaction in arcuate (ARC), ventromedial (VMN), and paraventricular (PVN) hypothalamic nuclei isolated from euthyroid (eu) and hypothyroid (hypo) rats. Leptin anorexigenic effect was tested by recording food intake for two hours after intracerebroventricular (i.c.v.) administration of leptin. Statistical differences were considered significant at p ≤ 0.05. RESULTS Hypothyroidism was confirmed by decreased serum triiodothyronine, thyroxine, and increased thyrotropin, in addition to increased levels of pro-TRH mRNA in PVN and Dio2 mRNA in the ARC of hypo rats. Hypothyroidism decreased body weight and food intake associated with decreased protein content of NPY and increased content of POMC in the ARC. Conversely, hypothyroidism induced central resistance to the acute anorexigenic effect of leptin, since while euthyroid rats displayed reduced food intake after leptin i.c.v. injection, hypothyroid rats showed no response. Hypothyroid rats exhibited decreased leptin receptor (ObRb) protein content in ARC and VMN but not in PVN nucleus. ObRb protein changes were concomitant with decreased phosphorylated STAT3 in the ARC, and decreased total STAT3 in VMN and PVN. However, hypothyroidism did not affect mRNA levels of Lepr or Stat3 in the hypothalamic nuclei. CONCLUSIONS Experimental hypothyroidism induced a negative energy balance accompanied by decreased NPY and increased POMC protein content in the ARC, resulting in predominance of anorexigenic pathways, despite central leptin resistance and impairment of the leptin signaling cascade in a nuclei-specific manner.
Collapse
Affiliation(s)
- Camila Calvino
- 1 Laboratory of Molecular Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Güínever Eustáquio Império
- 2 Laboratory of Translational Endocrinology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Marianna Wilieman
- 1 Laboratory of Molecular Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | | | - Luana Lopes Souza
- 1 Laboratory of Molecular Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Isis Hara Trevenzoli
- 1 Laboratory of Molecular Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | | |
Collapse
|
38
|
Badihian S, Jalalpour P, Mirdamadi M, Moslehi M. Quality of Life, Anxiety and Depression in Patients with Differentiated Thyroid Cancer under Short Term Hypothyroidism Induced by Levothyroxine Withdrawal. Klin Onkol 2016; 29:439-444. [PMID: 27951721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND We studied quality of life (QOL), anxiety, and depression in patients with differentiated thyroid cancer (DTC) either during treatment with levothyroxine or during withdrawal from levothyroxine when whole-body scanning (WBS) needed to be performed. METHODS DTC patients projected to undergo WBS were included in the study. They were studied at two time-points - the day before levothyroxine withdrawal, and one month after levothyroxine withdrawal. They were asked to fill WHOQOL-Bref, BDI-II, and HADS questionnaires at both time-points, and blood samples were taken to measure TSH, Tg, and TgAb levels. RESULTS Twenty-nine subjects (11 males) with a mean age of 42.6 ± 14.1 years entered the study. From the first to second time-point, the mean TSH level increased from 0.73 to 106.9 U/ml and the mean Tg level increased from 20.4 to 63.6 ng/ml. QOL scores decreased in four dimensions (physical health: 67.8 to 25.7; psychological: 58.9 to 38.9; social relationship: 67.5 to 56; and environment: 57.2 to 48.8). Patients also felt more depressed (48.3% to 93.2%) and anxious (65.5% to 89.6%). All changes were statistically significant (p < 0.005). CONCLUSION We found decreased QOL after short-term hypothyroidism, especially in physical health and psychological dimensions. We also found that patients became significantly depressed and anxious after levothyroxine withdrawal. Our findings suggest that alternative therapies, such as those employing rhTSH, should be considered for these patients. Psycho-oncological support might also be useful in helping them overcome their symptoms during short-term hypothyroidism; however, considering the reversibility of their symptoms, supportive care might be more effective.Key words: quality of life - anxiety - depression - thyroid cancer - hypothyroidism - levothyroxine - whole body scanning.
Collapse
|
39
|
Päkkilä F, Männistö T, Hartikainen AL, Ruokonen A, Surcel HM, Bloigu A, Vääräsmäki M, Järvelin MR, Moilanen I, Suvanto E. Maternal and Child's Thyroid Function and Child's Intellect and Scholastic Performance. Thyroid 2015; 25:1363-74. [PMID: 26438036 PMCID: PMC4684651 DOI: 10.1089/thy.2015.0197] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal hypothyroidism and/or hypothyroxinemia have been associated with child's poor neuropsychological development, but the results have been inconsistent. METHODS The Northern Finland Birth Cohort 1986 included all expected births within a year (9362 women, 9479 children) from the two northernmost provinces of Finland. Maternal serum samples (n = 5791) were obtained in early pregnancy (M ± SD = 10.7 ± 2.8 weeks' gestation), and serum samples from their children were obtained at 16 years of age (n = 5829). All samples were analyzed for thyrotropin, free thyroxine (fT4), and thyroid peroxidase antibodies. The children's school performance was evaluated by their main teachers at eight years of age, as well as by the adolescents themselves at 16 years of age. Data on possible severe intellectual deficiency and mild cognitive limitation were collected from healthcare records and registries for all children. Logistic regression estimated the odds of poor school performance or severe intellectual deficiency/mild cognitive limitation associated with exposure to maternal thyroid dysfunction. The odds of poor school performance associated with the adolescents' own thyroid function at age 16 were also estimated. Results are presented as odds ratios (OR) with confidence intervals (CI), adjusted for maternal/family covariates and child's sex. RESULTS Girls of mothers with subclinical hypothyroidism had more self-evaluated difficulties in mathematics than did girls of euthyroid mothers (OR 1.62 [CI 1.06-2.49]). Boys of hypothyroxinemic mothers repeated a school class more often than did boys of euthyroid mothers (OR 5.46 [CI 1.19-25.06]). Adolescents of hyperthyroid mothers had increased odds of poor self-evaluated performance in mathematics (OR 1.61 [CI 1.01-2.49]). Maternal thyroid dysfunction did not increase the odds of a child having severe intellectual deficiency/mild cognitive limitation. At 16 years of age, girls with hyperthyroidism by laboratory measurements had more difficulties in Finnish language (OR 2.82 [CI 1.42-5.61]) than did euthyroid girls. Boys with hypothyroxinemia by laboratory measurement had higher odds of having difficulties in Finnish and/or mathematics (OR 2.13 [CI 1.26-3.62]) than did euthyroid boys. CONCLUSIONS Maternal thyroid dysfunction during early pregnancy was associated with poorer scholastic performance of the adolescent. Additionally, adolescents' own thyroid dysfunction was associated with difficulties in school performance assessed by self-evaluation.
Collapse
Affiliation(s)
- Fanni Päkkilä
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Tuija Männistö
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu, Finland
- Northern Finland Laboratory Centre Nordlab, Oulu University Hospital, Oulu, Finland
- Department of Clinical Chemistry, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Anna-Liisa Hartikainen
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Aimo Ruokonen
- Northern Finland Laboratory Centre Nordlab, Oulu University Hospital, Oulu, Finland
| | - Heljä-Marja Surcel
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Aini Bloigu
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Marja Vääräsmäki
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Department of Children, Young People, and Families, National Institute for Health and Welfare, Oulu, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, United Kingdom
| | - Irma Moilanen
- PEDEGO Research Unit, Department of Child Psychiatry, University of Oulu, Oulu, Finland
- Department of Child Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Eila Suvanto
- Department of Obstetrics and Gynecology, University of Oulu, Oulu, Finland
- Clinic of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
40
|
Abstract
BACKGROUND The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of dementia is not well-defined, especially in the elderly, where the assessment of central nervous system function is challenging. The aim of this systematic review and meta-analysis was to evaluate the possible effect of sHT on cognitive decline and the risk of dementia. METHODS Cognitive function was the primary outcome, evaluated as composite endpoint of incidence or prevalence of dementia or difference of Mini Mental State Examination, Wechsler Adult Intelligence Scale, and Wechsler Memory Scale-Revised scores. RESULTS Thirteen studies were included in the meta-analysis. A significant risk of cognitive alteration was observed only in sHT individuals younger than age 75 years: composite endpoint odds ratio (OR) 1.56 (95% confidence interval [CI] 1.07-2.27, P = .02, I(2) = 82.5%), risk of dementia OR 1.81 (95% CI 1.43-2.28, P < .01, I(2) = 35%). Mean serum thyroid-stimulating hormone (TSH) levels and the OR of composite endpoint were positively correlated. No significant effect of sHT was found when considering all the studies as a whole: composite endpoint OR 1.26 (95% CI 0.96-1.66, P = .09, I(2) = 87.2%), risk of dementia OR 1.42 (95% CI, 0.97-2.07, P = .07, I(2) = 66.8%), Mini Mental State Examination mean difference -0.059 (95% CI -0.464 to 0.346 P = .78, I(2) = 51.8%). CONCLUSIONS This meta-analysis demonstrates a relationship between sHT and cognitive impairment only in individuals younger than 75 years of age and those with higher TSH concentrations. No correlation was found while considering all the studies as a whole. The lack of utilization of age-related serum TSH reference ranges and consequent potential misdiagnosis of sHT in older people may account for this.
Collapse
Affiliation(s)
- Giuseppe Pasqualetti
- Geriatrics Unit (G.Pas., F.M.), Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; King's College London (G. Pag.), Department of Clinical Neuroscience, London, United Kingdom; Department of Translational Medical Sciences (G.Pag., G.R., N.F.), Federico II University of Naples, Naples, Italy; and Salvatore Maugeri Foundation (G.R., N.F.), IRCCS Institute of Telese Terme, Benevento, Italy
| | - Gennaro Pagano
- Geriatrics Unit (G.Pas., F.M.), Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; King's College London (G. Pag.), Department of Clinical Neuroscience, London, United Kingdom; Department of Translational Medical Sciences (G.Pag., G.R., N.F.), Federico II University of Naples, Naples, Italy; and Salvatore Maugeri Foundation (G.R., N.F.), IRCCS Institute of Telese Terme, Benevento, Italy
| | - Giuseppe Rengo
- Geriatrics Unit (G.Pas., F.M.), Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; King's College London (G. Pag.), Department of Clinical Neuroscience, London, United Kingdom; Department of Translational Medical Sciences (G.Pag., G.R., N.F.), Federico II University of Naples, Naples, Italy; and Salvatore Maugeri Foundation (G.R., N.F.), IRCCS Institute of Telese Terme, Benevento, Italy
| | - Nicola Ferrara
- Geriatrics Unit (G.Pas., F.M.), Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; King's College London (G. Pag.), Department of Clinical Neuroscience, London, United Kingdom; Department of Translational Medical Sciences (G.Pag., G.R., N.F.), Federico II University of Naples, Naples, Italy; and Salvatore Maugeri Foundation (G.R., N.F.), IRCCS Institute of Telese Terme, Benevento, Italy
| | - Fabio Monzani
- Geriatrics Unit (G.Pas., F.M.), Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy; King's College London (G. Pag.), Department of Clinical Neuroscience, London, United Kingdom; Department of Translational Medical Sciences (G.Pag., G.R., N.F.), Federico II University of Naples, Naples, Italy; and Salvatore Maugeri Foundation (G.R., N.F.), IRCCS Institute of Telese Terme, Benevento, Italy
| |
Collapse
|
41
|
Abstract
The coordinated expression and activity of the iodothyronine deiodinases regulate thyroid hormone levels in hypothyroidism. Once heralded as the pathway underpinning adequate thyroid-hormone replacement therapy with levothyroxine, the role of these enzymes has come into question as they have been implicated in both an inability to normalize serum levels of tri-iodothyronine (T3) and the incomplete resolution of hypothyroid symptoms. These observations, some of which were validated in animal models of levothyroxine monotherapy, challenge the paradigm that tissue levels of T3 and thyroid-hormone signalling can be fully restored by administration of levothyroxine alone. The low serum levels of T3 observed among patients receiving levothyroxine monotherapy occur as a consequence of type 2 iodothyronine deiodinase (DIO2) in the hypothalamus being fairly insensitive to ubiquitination. In addition, residual symptoms of hypothyroidism have been linked to a prevalent polymorphism in the DIO2 gene that might be a risk factor for neurodegenerative disease. Here, we discuss how these novel findings underscore the clinical importance of iodothyronine deiodinases in hypothyroidism and how an improved understanding of these enzymes might translate to therapeutic advances in the care of millions of patients with this condition.
Collapse
Affiliation(s)
- Balázs Gereben
- Department of Endocrine Neurobiology, Institute of Experimental Medicine, Hungarian Academy of Sciences, Szigony Street 43, Budapest H-1083, Hungary
| | - Elizabeth A McAninch
- Division of Endocrinology and Metabolism, Rush University Medical Center, 212 Cohn Building, 1735 West Harrison Street, Chicago, IL 60612, USA
| | - Miriam O Ribeiro
- Developmental Disorders Program, Center for Biological and Health Science, Mackenzie Presbyterian University, Rua da Consolação 930, Building 16, São Paulo, SP 01302, Brazil
| | - Antonio C Bianco
- Division of Endocrinology and Metabolism, Rush University Medical Center, 212 Cohn Building, 1735 West Harrison Street, Chicago, IL 60612, USA
| |
Collapse
|
42
|
Kelderman-Bolk N, Visser TJ, Tijssen JP, Berghout A. Quality of life in patients with primary hypothyroidism related to BMI. Eur J Endocrinol 2015; 173:507-15. [PMID: 26169304 DOI: 10.1530/eje-15-0395] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/13/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Many patients treated for primary hypothyroidism have an unexplained reduced quality of life (QOL). We studied the relation between QOL and various parameters in treated hypothyroid patients. DESIGN AND METHODS QOL analysis was done in 90 consecutive patients (77.8% females) treated for primary hypothyroidism. QOL was measured by the questionnaires Short-Form 36, Hospital Anxiety and Depression Scale and MFI20. Post hoc analysis was performed on the relation of QOL at baseline and BMI, thyroid hormones and other serum values. QOL in patients was also compared to the general population. RESULTS QOL was decreased compared to the general population. We found an inverse relationship between QOL and BMI. A relationship between QOL and serum thyroid parameters or auto-antibodies could not be found. Higher sex hormone binding globulin (SHBG) levels corresponded with a better QOL, which is explained by the negative association of SHBG with body weight and BMI. CONCLUSIONS A decreased QOL in hypothyroid patients on thyroxine treatment is related to a higher body weight (BMI). Weight gain needs more attention in the treatment of hypothyroidism.
Collapse
Affiliation(s)
- Nienke Kelderman-Bolk
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Theo J Visser
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan P Tijssen
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Arie Berghout
- Department of Internal MedicineMaasstad Hospital Rotterdam, Rotterdam, The NetherlandsDepartment of Internal MedicineErasmus Medical Center Rotterdam, Rotterdam, The NetherlandsDepartment of CardiologyAcademic Medical Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Ponto KA, Binder H, Diana T, Matheis N, Otto AF, Pitz S, Pfeiffer N, Kahaly GJ. Prevalence, Phenotype, and Psychosocial Well-Being in Euthyroid/Hypothyroid Thyroid-Associated Orbitopathy. Thyroid 2015; 25:942-8. [PMID: 26244413 DOI: 10.1089/thy.2015.0031] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND At the onset of thyroid-associated orbitopathy (TAO), most patients are hyperthyroid, while scarce data are available on euthyroid/hypothyroid TAO. The aim of this study was to assess the prevalence, phenotype, and psychosocial burden of patients with initially euthyroid/hypothyroid TAO. METHODS The medical records of 461 consecutive and unselected patients with TAO followed at a specialized joint thyroid-eye clinic were analyzed within this retrospective cross-sectional study. Main outcome measures were the prevalence of initially eu- or hypothyroid TAO as well as ophthalmic signs and symptoms, disease-specific quality of life (QoL), work impairment, and rate of psychotherapy in initially eu-/hypothyroid versus hyperthyroid TAO. RESULTS The prevalences of eu-/hypothyroid and hyperthyroid TAO were 4.3% (n=20; [confidence interval, CI, 2.6-6.3]) and 95.7% (n=441; [9.37-9.74]), respectively. In 12 patients (2.6% [CI 1.3-4.3]), Hashimoto's thyroiditis was present and in 8 (1.7% [CI 0.7-3.0]) no thyroid disease was noted at the time of inclusion. One (0.05%) patient with eu-/hypothyroid TAO and 172 (39%) with hyperthyroid TAO had clinically active TAO (p=0.001). In eu-/hypothyroid versus hyperthyroid patients, 14 (70%) versus 135 (30.6%) had a mild TAO, 6 (30%) versus 183 (64.2%) a moderate-to-severe TAO, and 0 versus 23 (5.4%) had a sight-threatening TAO (p<0.001). TAO was asymmetric in 4 (20%) eu-/hypothyroid and in 27 (6.1%) hyperthyroid patients (p=0.038). Only 5.3% versus 30.2% and 10.5% versus 44.1% of patients with eu-/hypothyroid and hyperthyroid TAO, respectively, were on sick leave (p=0.003) or work disabled (p=0.018). QoL was less impaired in eu-/hypothyroid versus hyperthyroid TAO (median visual functioning and appearance scores: 100 versus 75; p<0.001 and 81.25 versus 75; p=0.315). Of patients with eu-/hypothyroid and hyperthyroid TAO, 15% and 20.2% had psychotherapy respectively (p=0.409). Eu-/hypothyroid TAO was positively (odds ratio 7.05, p=0.060) and negatively (odds ratio: 0.09, p=0.026) associated with a unilateral involvement and thyrotropin-receptor autoantibodies respectively. CONCLUSIONS Compared with hyperthyroid TAO, QoL and working ability are less impaired in eu-/hypothyroid TAO with an often asymmetric and less severe clinical phenotype.
Collapse
Affiliation(s)
- Katharina A Ponto
- 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany
- 2 Center for Thrombosis and Hemostasis, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Harald Binder
- 3 Department of Biomedical Statistics, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Tanja Diana
- 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Nina Matheis
- 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Anna F Otto
- 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Susanne Pitz
- 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - Norbert Pfeiffer
- 1 Department of Ophthalmology, Johannes Gutenberg University Medical Center , Mainz, Germany
| | - George J Kahaly
- 4 Department of Medicine I, Johannes Gutenberg University Medical Center , Mainz, Germany
| |
Collapse
|
44
|
Nexø MA, Watt T, Cleal B, Hegedüs L, Bonnema SJ, Rasmussen ÅK, Feldt-Rasmussen U, Bjorner JB. Exploring the experiences of people with hypo- and hyperthyroidism. Qual Health Res 2015; 25:945-953. [PMID: 25294349 DOI: 10.1177/1049732314554093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Thyroid diseases evoke a complex range of psychological and physical symptoms. The psychosocial aspects of living with diseases causing hypo- or hyperthyroidism are poorly understood. In this article, we report the findings of a qualitative interview study in which we explored the lived experiences of 16 people with hypo- or hyperthyroidism. We purposefully selected participants from Danish outpatient clinics according to their diagnosis (Hashimoto's thyroiditis or Graves' disease with or without orbitopathy), age (18 to 65 years), and duration of treatment (more than 6 months). We used interpretative phenomenological analysis (IPA) as a theoretical frame and analytical approach and identified three superordinate themes: losing control over mental and physical states, ambiguous signs of disease, and negotiating sickness. We discuss the findings in the context of the recent literature on chronic illness and argue that these themes play an important role in the conceptualization and management of thyroid diseases.
Collapse
Affiliation(s)
- Mette A Nexø
- National Research Center for the Working Environment, Copenhagen, Denmark
| | - Torquil Watt
- Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND Hypothyroidism causes considerable morbidity. Low knowledge coupled with inadequate health literacy may lead to poor prevention and management. This study aimed to assess health information-seeking behavior and hypothyroid knowledge among South Indian hypothyroid patients. METHODS This cross-sectional study was conducted in October 2013 in Saveetha Medical College, Chennai, India. Hundred clinically diagnosed hypothyroid patients ≥18 years were interviewed in a hospital using a 57-item questionnaire to gather information on their socio-demographics, self-reported disease history, hypothyroid-related knowledge, health information sources, health literacy and health information-seeking behavior. Hypothyroidism was assessed by free T3 and T4 levels. RESULTS Mean age of participants was 38 years (SD=12) with median age of 39.5 years, majority of the participants being females (77%) and living in urban setting (52%). Mean free T3 level was 0.0137ng/dl (SD= 0.003) and mean free T4 was 0.7ng/dl (SD= 0.06). Ninety three percent of the participants received initial hypothyroidism education from their physicians at the time of diagnosis. Half of the participants had incorrect hypothyroidism-related knowledge; similar between both genders. Participants with inadequate health literacy had poor knowledge about the hypothyroidism. Hypothyroidism-related health information was sought almost exclusively from health professionals, predominantly regarding treatment, linked to their faith in qualified medical assistance. Economic status primarily determined healthcare-seeking behavior. Marital status, education level, annual household income and health literacy were significantly associated with knowledge. CONCLUSION Participants having higher educational qualification, higher annual household income and adequate health literacy had considerable knowledge about hypothyroidism. Developing multi-factorial and tailored health education for patients with marginal or inadequate health literacy is needed. Exploring healthcare institutions as a medium for delivery of such education should be explored.
Collapse
Affiliation(s)
- S S Perumal
- Saveetha Medical College & Hospital, Saveetha University, Saveetha Nagar, Chennai, Tamil Nadu ; Foundation of Healthcare Technologies Society, New Delhi, India
| | - S Prasad
- Foundation of Healthcare Technologies Society, New Delhi, India
| | - K M Surapaneni
- Saveetha Medical College & Hospital, Saveetha University, Saveetha Nagar, Chennai, Tamil Nadu ; Foundation of Healthcare Technologies Society, New Delhi, India
| | - A Joshi
- Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, USA
| |
Collapse
|
46
|
Yu D, Zhou H, Yang Y, Jiang Y, Wang T, Lv L, Zhou Q, Yang Y, Dong X, He J, Huang X, Chen J, Wu K, Xu L, Mao R. The bidirectional effects of hypothyroidism and hyperthyroidism on anxiety- and depression-like behaviors in rats. Horm Behav 2015; 69:106-15. [PMID: 25623236 DOI: 10.1016/j.yhbeh.2015.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/24/2014] [Accepted: 01/16/2015] [Indexed: 12/11/2022]
Abstract
Thyroid hormone disorders have long been linked to depression, but the causal relationship between them remains controversial. To address this question, we established rat models of hypothyroidism using (131)iodine ((131)I) and hyperthyroidism using levothyroxine (LT4). Serum free thyroxine (FT4) and triiodothyronine (FT3) significantly decreased in the hypothyroid of rats with single injections of (131)I (5mCi/kg). These rats exhibited decreased depression-like behaviors in forced swimming test and sucrose preference tests, as well as decreased anxiety-like behaviors in an elevated plus maze. Diminished levels of brain serotonin (5-HT) and increased levels of hippocampal brain-derived neurotrophic factor (BDNF) were found in the hypothyroid rats compared to the control saline-vehicle administered rats. LT4 treatment reversed the decrease in thyroid hormones and depression-like behaviors. In contrast, hyperthyroidism induced by weekly injections of LT4 (15μg/kg) caused a greater than 10-fold increase in serum FT4 and FT3 levels. The hyperthyroid rats exhibited higher anxiety- and depression-like behaviors, higher brain 5-HT level, and lower hippocampal BDNF levels than the controls. Treatment with the antidepressant imipramine (15mg/kg) diminished serum FT4 levels as well as anxiety- and depression-like behaviors in the hyperthyroid rats but led to a further increase in brain 5-HT levels, compared with the controls or the hypothyroid rats. Together, our results suggest that hypothyroidism and hyperthyroidism have bidirectional effects on anxiety- and depression-like behaviors in rats, possibly by modulating hippocampal BDNF levels.
Collapse
Affiliation(s)
- Dafu Yu
- School of Life Sciences, Yunnan University, Kunming 650091, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China; Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Heng Zhou
- School of Life Sciences, University of Science and Technology of China, Hefei, 230026, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Yuan Yang
- School of Life Sciences, Yunnan University, Kunming 650091, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China; Physiological Department, Kunming Medical University, Kunming 650500, China
| | - Yong Jiang
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Tianchao Wang
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Liang Lv
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Qixin Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Yuexiong Yang
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China
| | - Xuexian Dong
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Jianfeng He
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Xiaoyan Huang
- State Key Laboratory of Phytochemistry and Plant Resources in Southwest China, and Kunming Institute of Botany, Chinese Academy of Science, Kunming 650201, China
| | - Jijun Chen
- State Key Laboratory of Phytochemistry and Plant Resources in Southwest China, and Kunming Institute of Botany, Chinese Academy of Science, Kunming 650201, China
| | - Kunhua Wu
- Department of Nuclear Medicine, First People's Hospital of Yunnan Province, and Key Laboratory of Medical Imaging, Medical Faculty, Kunming University of Science and Technology, Kunming 650032, China
| | - Lin Xu
- School of Life Sciences, Yunnan University, Kunming 650091, China; School of Life Sciences, University of Science and Technology of China, Hefei, 230026, China; Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China.
| | - Rongrong Mao
- Key Laboratory of Animal Models and Human Disease Mechanisms, and KIZ/CUHK Joint Laboratory of Bioresources and Molecular Research in Common Disease, and Laboratory of Learning and Memory, Kunming Institute of Zoology, Chinese Academy of Science, Kunming 650223, China.
| |
Collapse
|
47
|
Abstract
BACKGROUND Hypothyroidism has been associated with cognitive and motor impairments that are likely to constitute hazards in the operation of motor vehicles and a public safety risk. However, there is a paucity of data that would provide an evidence basis for recommendations to hypothyroid patients. The purpose of this study was to determine the specific neurological and psychological deficits consequent to hypothyroidism and whether they are of sufficient magnitude to impede the safe operation of motor vehicles. METHODS Repeated measurements were obtained in euthyroid, hypothyroid, and euthyroid hormone replaced states of thyroid cancer outpatients, at an academic medical center, who underwent thyroid hormone withdrawal preparation for radioiodine scanning. Study design used a within-subjects longitudinal "A-B-A" with each subject tested at three visits in the same sequence: euthyroid, hypothyroid, and euthyroid for a total of 32 subjects. Data on clinical status and cognitive performance were collected using standard instruments, including ThyDQoL and ThySRQ measures, National Adult Reading Test, Boston Naming Test, Mini-Mental State Exam, Wechsler Adult Intelligence Test-Revised, Letter Fluency FAS, and Beck Depression Inventory. Fine-motor function was measured with an automated assessment panel, and driving performance on a commercial driving simulator. RESULTS In severe hypothyroidism (median thyrotropin 83.2 mIU/L), fine-motor performance of hands and reaction times in emergency braking tests were slowed, as well as subjective slowing reported on structured clinical scales. Depression was present, typified by vegetative and mood alterations, but lacking reported guilt and lowered self-esteem seen in other types of depression. Cognitive impairment was characterized by declines on speeded executive tests. In contrast, episodic memory performance improved over time regardless of thyroid hormone status. Braking times increased in hypothyroidism by 8.5%, equivalent to reports of effects from a blood alcohol level of 0.082 g/100 mL (above the U.S. legal driving limit). CONCLUSIONS Transient profound hypothyroidism is characterized by reversible depression, decreased fine-motor performance, slowed reaction times, and decreased processing speed. These data represent new empirical evidence that support the recommendation that complex activities requiring rapid responses, such as operating motor vehicles, should be avoided during hypothyroidism. This has broader implications regarding functional impairments and risk to public health.
Collapse
Affiliation(s)
- Charles D Smith
- 1 Department of Neurology, University of Kentucky College of Medicine , Lexington Kentucky
| | | | | | | | | | | |
Collapse
|
48
|
Zubarovskiy IN, Mikhailova MV, Osipenko SK. [LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH FOLLICULAR TUMORS OF THE THYROID]. Vestn Khir Im I I Grek 2015; 174:32-34. [PMID: 26983255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The article analyzed an experience of treatment of 51 patients with follicular tumors. It was proved, that there weren't any complications and recurrences in case of typically performed operation and adequate replacement therapy in postoperative period. It was noted a good quality of life from 2 to 5 years.
Collapse
|
49
|
Taylor PN, Okosieme OE, Murphy R, Hales C, Chiusano E, Maina A, Joomun M, Bestwick JP, Smyth P, Paradice R, Channon S, Braverman LE, Dayan CM, Lazarus JH, Pearce EN. Maternal perchlorate levels in women with borderline thyroid function during pregnancy and the cognitive development of their offspring: data from the Controlled Antenatal Thyroid Study. J Clin Endocrinol Metab 2014; 99:4291-8. [PMID: 25057878 DOI: 10.1210/jc.2014-1901] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Thyroid dysfunction is associated with impaired cognitive development. Perchlorate decreases thyroidal iodine uptake, potentially reducing thyroid hormone production. It is unclear whether perchlorate exposure in early life affects neurodevelopment. DESIGN Historical cohort analysis. PATIENTS From 2002 to 2006, 21,846 women at gestational age <16 weeks recruited from antenatal clinics in Cardiff, UK and Turin, Italy were enrolled in the Controlled Antenatal Thyroid Screening Study (CATS). We undertook a retrospective analysis of 487 mother-child pairs in mothers who were hypothyroid/hypothyroxinemic during pregnancy and analyzed whether first trimester maternal perchlorate levels in the highest 10% of the study population were associated with increased odds of offspring IQ being in the lowest 10% at 3 years of age. MAIN OUTCOME MEASURES Maternal urinary perchlorate, offspring IQ. RESULTS Urine perchlorate was detectable in all women (median 2.58 μg/L); iodine levels were low (median 72 μg/L). Maternal perchlorate levels in the highest 10% of the population increased the odds of offspring IQ being in the lowest 10% OR = 3.14 (95% CI 1.38, 7.13) P = .006 with a greater negative impact observed on verbal OR = 3.14 (95% CI 1.42, 6.90) P = .005 than performance IQ. Maternal levothyroxine therapy did not reduce the negative impact of perchlorate on offspring IQ. CONCLUSIONS This is the first study using individual-level patient data to study maternal perchlorate exposure and offspring neurodevelopment and suggests that high-end maternal perchlorate levels in hypothyroid/hypothyroxinemic pregnant women have an adverse effect on offspring cognitive development, not affected by maternal levothyroxine therapy. These results require replication in additional studies, including in the euthyroid population.
Collapse
Affiliation(s)
- Peter N Taylor
- Thyroid Research Group (P.N.T., O.E.O., C.H., C.M.D., J.H.L.), Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom CF14 4XN; Department of Paediatric Psychology (R.M., R.P., S.C.), St. David's Children's Centre, Cardiff, United Kingdom CF11 9XB; Città della Salute e della Scienza - Ospedale Sant'Anna (E.C., A.M.,), Turin, Italy 10100; Wolfson Institute of Preventive Medicine (M.J., J.P.B.), Barts and the London School of Medicine and Dentistry, London, United Kingdom B15 2TT; University College Dublin School of Medicine (P.S.), University College, Dublin, Ireland, Dublin 4; and Section of Endocrinology, Diabetes, and Nutrition (L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Singh S, Trivedi R, Singh K, Kumar P, Shankar LR, Khushu S. Diffusion tensor tractography in hypothyroidism and its correlation with memory function. J Neuroendocrinol 2014; 26:825-33. [PMID: 25131823 DOI: 10.1111/jne.12193] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 08/01/2014] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Abstract
Diffusion tensor tractography (DTT) was performed to determine the microstructural changes in the white matter fibre tracts of hypothyroid patients compared to controls and to correlate these changes with memory dysfunction scores. DTT and Postgraduate Institute Memory Scale test were performed in eight hypothyroid patients and eight healthy controls. Diffusion tensor imaging (DTI) measures [fractional anisotropy (FA) and mean diffusivity (MD)] from all of the major cerebral tracts were calculated and a comparison was made between the patient group and controls. Pearson's correlation was performed between Memory Dysfunction score and DTI measures. Significant changes in DTI measures were observed in various white matter fibre tracts in hypothyroid patients compared to controls. In hypothyroid patients, an inverse correlation of Memory Dysfunction score with FA was observed in the right and left inferior fronto-occipital fasciculus, whereas a positive correlation with MD was observed in the right anterior thalamic radiation among all white matter tracts. These findings suggest that microstructural changes in white matter fibres may contribute to the underlying dysfunction in memory in hypothyroid patients.
Collapse
Affiliation(s)
- S Singh
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), New Delhi, India
| | | | | | | | | | | |
Collapse
|