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Yazkan Akgül G, Köprülü Ö. Examination of quality of life and psychiatric symptoms in childhood Graves' disease. J Pediatr Endocrinol Metab 2024; 37:445-450. [PMID: 38644701 DOI: 10.1515/jpem-2023-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/13/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES The aim of our study is to examine the emotional, behavioral problems, and psychiatric symptoms of children diagnosed with Graves' disease (GD), to assess their quality of life, and to compare with control group. METHODS The research was planned as a cross-sectional study and included 16 patients with GD (13 female and three male) and 29 healthy children for control group (19 female and 10 male). Sociodemographic form, Pediatric Quality of Life Inventory, Revised Child Anxiety and Depression Scale-Child Version (RCADS-CV), Strengths and Difficulties Questionnaire (SDQ), Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S), and Affective Reactivity Index scale were applied to the children and their families. RESULTS Eighty one percent of GD group (GG) (n=13, mean age 15.1 ± 2.2) and 66 % of control group (CG) (n=19, 14.6 ± 2.2) were girls. No significant difference was found between GG and CG in terms of quality of life, anxiety, and depression scores. GG had higher scores in affective reactivity index, SDQ-P total score, and T-DSM-IV-S total scores (p values 0.039; 0.009; 0.023, respectively). While no significant difference was detected in the T-DSM-IV-S-inattention and hyperactivity scores, significantly higher scores were detected in oppositional defiance and conduct disorder scores (p values 0.172; 0.294; 0.019; 0.027, respectively). CONCLUSIONS In children with GD, irritability, oppositional defiant, and conduct disorder symptoms have been detected. Children with these mental health symptoms experience behavioral and emotional difficulties in their daily lives. It is important to follow up children with GD for possible comorbid psychiatric disorders.
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Affiliation(s)
- Gözde Yazkan Akgül
- Child and Adolescent Psychiatry Department, School of Medicine, Marmara University, İstanbul, Türkiye
| | - Özge Köprülü
- Division of Pediatric Endocrinology, Tekirdağ IFC City Hospital, Tekirdağ, Türkiye
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Wu Q, Zhou J, Fang W, Jiang WH, Pu XY, Chen HH, Xu XQ, Hu H, Wu FY. Structural and Functional Brain Changes After Glucocorticoid Therapy in Thyroid-Associated Ophthalmopathy. J Clin Endocrinol Metab 2024; 109:649-658. [PMID: 37864850 DOI: 10.1210/clinem/dgad626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To investigate the brain structural and functional alterations in patients with thyroid-associated ophthalmopathy (TAO) before and after glucocorticoid therapy, using voxel-based morphometry (VBM) as well as resting-state functional magnetic resonance imaging (MRI) with amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo). METHODS Between 2019 and 2022, 32 patients with TAO and 23 healthy controls underwent pre-therapy MRI in Nanjing, China. Intravenous glucocorticoid therapy was administered to all patients. At 3 months after end of therapy, 26 patients were available for rescanned MRI. VBM, ALFF, and ReHo were used to evaluate the brain structural and functional differences. RESULTS Before therapy, TAO patients showed significantly decreased gray matter volume (GMV) in the left orbital part of superior frontal gyrus (ORBsup) and medial superior frontal gyrus (SFGmed) than healthy controls. Patients had higher ALFF values in bilateral gyrus rectus and olfactory cortex and lower values in bilateral cuneus. Patients also showed decreased ReHo values in bilateral lingual gyrus. After therapy, increased GMV in the left anterior cingulate gyrus and SFGmed, increased ALFF values in bilateral cuneus and superior occipital gyrus, and increased ReHo values in bilateral SFGmed were found in TAO patients compared to the pre-therapy cohort. Compared to controls, decreased GMV in left ORBsup was observed in post-therapy TAO patients. CONCLUSION Our results indicated that TAO might cause functional and structural deficits in the visual and emotional regions of the brain, with recovery in the former and partial restoration in the latter after effective glucocorticoid therapy. These findings may lead to deeper understanding of the pathophysiological mechanism behind TAO.
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Affiliation(s)
- Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Wei Fang
- Department of Radiology, Taicang Affiliated Hospital of Soochow University, Taicang 215006, China
| | - Wen-Hao Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Xiong-Ying Pu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China
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Wang C, Qiao J, Liu S, Piao S, Zhou Y, Hu Y, Wan C, Sun Y, Ning H, Chen L, Zhang H, Hu R, Wang H, Wang W, Zhao L, Mao J, Li M, Teng W, Shan Z, Li Y. Selenium in the treatment of mild-to-moderate Graves' orbitopathy: a 5-year prospective controlled cohort study. Endocrine 2024:10.1007/s12020-023-03672-5. [PMID: 38200401 DOI: 10.1007/s12020-023-03672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease. However, limited studies have investigated the actual efficacy of selenium in GO therapy. This longitudinal study explored the effect of selenium on QOL and prognosis of patients with mild-to-moderate GO. METHODS We conducted a 5-year prospective controlled cohort clinical trial to determine the effect of selenium on 74 patients with mild-to-moderate GO. Patients received selenium yeast or placebo orally for 6 months and were followed up at 6 months and at 5 years by biochemical examination, ophthalmologist evaluation and QOL questionnaire to assess oculopathy and QOL. RESULTS (1) During a follow-up period of 3-6 months, in the selenium group, the symptoms of tearing, grittiness and conjunctival congestion improved (P < 0.01); clinical activity scores and total GO-QOL scores increased relative to baseline (P < 0.01); TRAb was decreased at the 6-month evaluation (P = 0.003); and patients treated with selenium had a higher rate of improvement and a lower rate of worsening than patients treated with placebo (P < 0.05). (2) Exploratory evaluations at 6 months after drug withdrawal confirmed the earlier results; further changes included alleviation of blurred vision and double vision symptoms in the selenium group (P < 0.01). (3) At the 5-year follow-up, compared with baseline, proptosis, clinical activity scores, TRAb level and total GO-QOL scores in both the selenium and placebo groups were significantly improved (P < 0.01). CONCLUSION Six months of selenium supplementation may effectively change the early course of mild-to-moderate GO, but this regimen makes no difference in long-term outcomes.
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Affiliation(s)
- Chuyuan Wang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Jing Qiao
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
| | - Shanshan Liu
- Department of Second Medicine, Liaoning Provincial Corps Hospital of Chinese People's Armed Police Force, Shenyang, P.R. China
| | - Sichen Piao
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
| | - Yun Zhou
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Yuedong Hu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Chao Wan
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Yizhou Sun
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Hong Ning
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Lei Chen
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - He Zhang
- Department of Nutrition, The Fourth People's Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ruolin Hu
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
| | - Haoyu Wang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Weiwei Wang
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Lei Zhao
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
| | - Jinyuan Mao
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
| | - Min Li
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Weiping Teng
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China
| | - Zhongyan Shan
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China.
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China.
| | - Yushu Li
- The Endocrine Institute and The Liaoning Provincial Key Laboratory of Endocrine Diseases, Shenyang, P.R. China.
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, 110001, P.R. China.
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Luo L, Zhang L, Huang H, Guan J, Zhang X, Lin Y, Wu R. 3.0 T multi-parametric MRI reveals metabolic and microstructural abnormalities in the posterior visual pathways in patients with thyroid eye disease. Front Neurosci 2024; 17:1306364. [PMID: 38274503 PMCID: PMC10809795 DOI: 10.3389/fnins.2023.1306364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction We aim to explore the microstructural and metabolic changes in visual pathways in patients with thyroid eye disease (TED) using 3T multi-parametric MRI. Methods Thirty-four TED patients (inactive group = 20; active group = 14; acute group = 18; chronic group = 16) and 12 healthy controls (HC) were recruited from November 2020 to July 2021. Proton magnetic resonance spectroscopy (1H-MRS), glutamate chemical exchange saturation transfer (GluCEST) and diffusion kurtosis imaging (DKI) were performed on 3.0T MR scanner. Data analysis and group comparisons were performed after MR data processing. Results As compare to HC group, the levels of total choline (tCh) in optic radiation (OR) in active group ([1.404 ± 0.560] vs. [1.022 ± 0.260]; p < 0.05), together with tCh ([1.415 ± 0.507] vs. [1.022 ± 0.260]; p < 0.05) in OR in acute group were significantly increased. Glutamine (Gln) levels were higher in OR in the chronic group than those in HCs and were positively correlated with the levels of thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), free triiodothyronine (FT3) and FT4 in chronic group. Glutamate (Glu) levels by 1H-MRS did not show significant differences between any two groups. Interestingly, MTRasym (3.0 ppm) was higher in OL in inactive group, active group, acute group and chronic group than those in HCs, and was positively correlated with Glu levels in OL in 1H-MRS. Fractional anisotropy (FA) values from DKI in OR in acute group were significantly lower than those in HCs. Discussion Our initial study demonstrate that GluCEST performs better than 1H-MRS to monitor Glu alterations in visual pathway in TED patients. Changes of brain glutamine levels in TED patients are closely related to their associated hormones alterations, indicating that disease injury status could be reflected through non-invasive metabolites detection by brain 1H-MRS. FA is the most sensitive DKI index to reveal the visual pathway impairment in TED patients. Altogether, our study revealed that 3T multiparametric MR techniques are useful to demonstrate metabolic and microstructural alterations in visual pathways in TED patients. We found that damage to visual pathways occurs in mild TED cases, which not only offers a new approach to the diagnosis of dysthyroid optic neuropathy, but also demonstrates neuropathy in TED is a gradual and continuous spatio-emporal progression.
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Affiliation(s)
- Lan Luo
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
- Radiology Department, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, China
| | - Liling Zhang
- Endocrinology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Huaidong Huang
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Jitian Guan
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xiaolei Zhang
- Radiology Department, Huizhou Central People’s Hospital, Huizhou, Guangdong Province, China
| | - Yan Lin
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
| | - Renhua Wu
- Radiology Department, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, China
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Luccas R, Riguetto CM, Alves M, Zantut-Wittmann DE, Reis F. Computed tomography and magnetic resonance imaging approaches to Graves' ophthalmopathy: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1277961. [PMID: 38260158 PMCID: PMC10801040 DOI: 10.3389/fendo.2023.1277961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Graves' ophthalmopathy (GO) affects up to 50% of patients with Graves' disease (GD) ranging from mild ocular irritation to vision loss. The initial diagnosis is based on clinical findings and laboratory tests. Orbital imaging, such as magnetic resonance imaging (MRI) and computed tomography (CT), is an important tool to assess orbital changes, being also useful for understanding disease progression and surgical planning. In this narrative review, we included 92 studies published from 1979 to 2020 that used either MRI and/or CT to diagnose and investigate GO, proposing new methods and techniques. Most of the methods used still need to be corroborated and validated, and, despite the different methods and approaches for thyroid eye disease (TED) evaluation, there is still a lack of standardization of measurements and outcome reports; therefore, additional studies should be performed to include these methods in clinical practice, facilitating the diagnosis and approach for the treatment of TED.
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Affiliation(s)
- Rafael Luccas
- Graduate Program of Neuroscience, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Cinthia Minatel Riguetto
- Division of Endocrinology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | | | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Hu H, Zhou J, Fang W, Chen HH, Jiang WH, Pu XY, Xu XQ, Gu WH, Wu FY. Increased brain iron in patients with thyroid-associated ophthalmopathy: a whole-brain analysis. Front Endocrinol (Lausanne) 2023; 14:1268279. [PMID: 38034014 PMCID: PMC10687634 DOI: 10.3389/fendo.2023.1268279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Background To investigate the whole-brain iron deposition alternations in patients with thyroid-associated ophthalmopathy (TAO) using quantitative susceptibility mapping (QSM). Methods Forty-eight patients with TAO and 33 healthy controls (HCs) were enrolled. All participants underwent brain magnetic resonance imaging scans and clinical scale assessments. QSM values were calculated and compared between TAO and HCs groups using a voxel-based analysis. A support vector machine (SVM) analysis was performed to evaluate the performance of QSM values in differentiating patients with TAO from HCs. Results Compared with HCs, patients with TAO showed significantly increased QSM values in the bilateral caudate nucleus (CN), left thalamus (TH), left cuneus, left precuneus, right insula and right middle frontal gyrus. In TAO group, QSM values in left TH were positively correlated with Hamilton Depression Rating Scale (HDRS) scores (r = 0.414, p = 0.005). The QSM values in right CN were negatively correlated with Montreal Cognitive Assessment (MoCA) scores (r = -0.342, p = 0.021). Besides that, a nearly negative correlation was found between QSM values in left CN and MoCA scores (r = -0.286, p = 0.057). The SVM model showed a good performance in distinguishing patients with TAO from the HCs (area under the curve, 0.958; average accuracy, 90.1%). Conclusion Patients with TAO had significantly increased iron deposition in brain regions corresponding to known visual, emotional and cognitive deficits. QSM values could serve as potential neuroimaging markers of TAO.
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Affiliation(s)
- Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Fang
- Department of Radiology, Taicang Affiliated Hospital of Soochow University, The First People’s Hospital of Taicang, Taicang, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen-Hao Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiong-Ying Pu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen-Hao Gu
- Department of Radiology, Taicang Affiliated Hospital of Soochow University, The First People’s Hospital of Taicang, Taicang, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Jiang W, Liu J, Zhou J, Wu Q, Pu X, Chen H, Xu X, Wu F, Hu H. Altered dynamic brain activity and functional connectivity in thyroid-associated ophthalmopathy. Hum Brain Mapp 2023; 44:5346-5356. [PMID: 37515416 PMCID: PMC10543102 DOI: 10.1002/hbm.26437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Although previous neuroimaging evidence has confirmed the brain functional disturbances in thyroid-associated ophthalmopathy (TAO), the dynamic characteristics of brain activity and functional connectivity (FC) in TAO were rarely concerned. The present study aims to investigate the alterations of temporal variability of brain activity and FC in TAO using resting-state functional magnetic resonance imaging (rs-fMRI). Forty-seven TAO patients and 30 age-, gender-, education-, and handedness-matched healthy controls (HCs) were enrolled and underwent rs-fMRI scanning. The dynamic amplitude of low-frequency fluctuation (dALFF) was first calculated using a sliding window approach to characterize the temporal variability of brain activity. Based on the dALFF results, seed-based dynamic functional connectivity (dFC) analysis was performed to identify the temporal variability of efficient communication between brain regions in TAO. Additionally, correlations between dALFF and dFC and the clinical indicators were analyzed. Compared with HCs, TAO patients displayed decreased dALFF in the left superior occipital gyrus (SOG) and cuneus (CUN), while showing increased dALFF in the left triangular part of inferior frontal gyrus (IFGtriang), insula (INS), orbital part of inferior frontal gyrus (ORBinf), superior temporal gyrus (STG) and temporal pole of superior temporal gyrus (TPOsup). Furthermore, TAO patients exhibited decreased dFC between the left STG and the right middle occipital gyrus (MOG), as well as decreased dFC between the left TPOsup and the right calcarine fissure and surrounding cortex (CAL) and MOG. Correlation analyses showed that the altered dALFF in the left SOG/CUN was positively related to visual acuity (r = .409, p = .004), as well as the score of QoL for visual functioning (r = .375, p = .009). TAO patients developed abnormal temporal variability of brain activity in areas related to vision, emotion, and cognition, as well as reduced temporal variability of FC associated with vision deficits. These findings provided additional insights into the neurobiological mechanisms of TAO.
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Affiliation(s)
- Wen‐Hao Jiang
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jun Liu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jiang Zhou
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Qian Wu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiong‐Ying Pu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Huan‐Huan Chen
- Department of EndocrinologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xiao‐Quan Xu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Fei‐Yun Wu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hao Hu
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Lee TC, Radha-Saseendrakumar B, Delavar A, Ye GY, Ting MA, Topilow NJ, Bass J, Korn BS, Kikkawa DO, Baxter SL, Liu CY. Evaluation of Depression and Anxiety in a Diverse Population With Thyroid Eye Disease Using the Nationwide NIH All of Us Database. Ophthalmic Plast Reconstr Surg 2023; 39:281-287. [PMID: 36727790 DOI: 10.1097/iop.0000000000002318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the prevalence of depression and anxiety among individuals with thyroid eye disease (TED) and identify sociodemographic risk factors using the NIH All of Us database. METHODS Three hundred ninety eight cases with TED were compared with 1,592 controls with demographics matching the 2020 US Census. Primary outcomes were diagnosed depression or anxiety; Patient Health Questionnaire-9 (PHQ-9) scores and General Anxiety Disorder-7 (GAD-7) scores were included as secondary outcomes. We performed multivariable logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between TED and depression and anxiety. RESULTS Patients with TED were more likely to have depression (OR 2.72, 95% CI 2.08-3.56, p < 0.001) and anxiety (OR 2.82, 95% CI 2.16-3.70, p < 0.001) than controls. In patients with TED, female gender was an independent risk factor for both depression (OR 1.72; 95% CI 1.00-5.07, p = 0.05) and anxiety (OR 2.17, 95% CI 1.25-3.85, p = 0.006). Unemployment (OR 1.72, 95% CI 1.03-2.94, p = 0.04) and lower income (OR 0.88 for income as a continuous variable, 95% CI 0.79-0.99, p = 0.03) were risk factors for anxiety. Risk factors for more severe depression as assessed by PHQ-9 included lower income (OR 0.70, 95% CI 0.57-0.85, p < 0.001), and protective factors included Black race (OR 0.12, 95% CI 0.02-0.45, p = 0.002). Lower income was associated with more severe anxiety as assessed by GAD-7 (OR 0.77, 95% CI 0.64-0.94, p = 0.009). CONCLUSIONS Patients with TED were more likely to develop depression and anxiety compared with controls. This study highlights the psychosocial impact of TED and associated socioeconomic risk factors.
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Affiliation(s)
- Tonya C Lee
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
| | - Bharanidharan Radha-Saseendrakumar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Arash Delavar
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Gordon Y Ye
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Michelle A Ting
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Nicole J Topilow
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jeremy Bass
- Department of Psychiatry, University of California San Diego, La Jolla, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, California, U.S.A
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, La Jolla, California, U.S.A
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9
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Zhu X, Zhang Y, Zhao X, Zhang X, Ru Z, Wu Y, Yang X, Hou B, Qiao H. The relationship between atherosclerotic disease and relapse during ATD treatment. Front Cardiovasc Med 2022; 9:1039829. [DOI: 10.3389/fcvm.2022.1039829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundClinical relapse is a potential risk for traditional antithyroid drug (ATD) treatment in hyperthyroid patients. Evidence suggests that atherosclerotic disease is closely associated with hyperthyroidism, while the relationship between atherosclerosis and relapse remains unclear.MethodsTwo hundred and twenty-five patients with GD who underwent ATD as their first treatment were studied; 88 and 137 patients were categorized as drug reduction relapse and drug reduction remission, respectively. Logistic regression was used to analyze risk factors of drug reduction relapse in patients with GD.ResultsDuring a median of 48 months followed up 88 patients who relapsed. According to multivariate analyses, atherosclerosis related diseases, FT4, goiter, and anxiety rating scores are independent risk factors for drug reduction. According to K-M survival analysis, patients with atherosclerosis related diseases, FT4 > 18.82 pmol/L, anxiety rating scores > 23, and gradation of goiter ≥ Grade II had a higher risk of relapse than those with lower levels. ROC analysis shown atherosclerosis related diseases significantly improved the predictive accuracy of relapse.ConclusionsAtherosclerotic disease is closely related to the relapse of hyperthyroidism, ATD treatment in hyperthyroid patients with atherosclerosis should be given more attention.
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10
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Zhou J, Chen W, Wu Q, Chen L, Chen HH, Liu H, Xu XQ, Wu FY, Hu H. Reduced cortical complexity in patients with thyroid-associated ophthalmopathy. Brain Imaging Behav 2022; 16:2133-2140. [PMID: 35821157 DOI: 10.1007/s11682-022-00683-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/02/2022]
Abstract
Psychical and functional disturbances of thyroid-associated ophthalmopathy (TAO) patients are drawing increasingly attention, despite the characterized ophthalmic symptoms. We aimed to investigate the alterations of structural complexity using fractal dimension (FD) analysis in patients with TAO. Thirty-nine TAO patients and 25 healthy controls underwent high-resolution 3.0 T structural brain magnetic resonance imaging (MRI). FD values of brain regions were calculated by Computational Anatomy Toolbox (CAT12) and compared between groups. The associations between clinical variables and FD values were further estimated. We found that TAO patients exhibited significantly decreased FD values in right caudal anterior cingulate cortex, right lingual gyrus, right pars orbitalis and right cuneus cortex (FDR corrected p < 0.05). FD values of right cuneus cortex were positively correlated with visual acuity, and FD values of right caudal anterior cingulate cortex were also positively correlated with cognitive performance. Meanwhile, FD values of right lingual gyrus were found to be negatively correlated with emotional function. Our study indicated disturbed cortical complexity in brain regions corresponding to known functional deficits of vision, emotion and cognition in TAO. FD might be a potential marker for reflecting the underlying neurobiological basis of TAO.
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Affiliation(s)
- Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China.
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, 210029, China.
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11
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Jiang WH, Chen HH, Chen W, Wu Q, Chen L, Zhou J, Xu XQ, Hu H, Wu FY. Altered Long- and Short-Range Functional Connectivity Density in Patients With Thyroid-Associated Ophthalmopathy: A Resting-State fMRI Study. Front Neurol 2022; 13:902912. [PMID: 35812093 PMCID: PMC9259934 DOI: 10.3389/fneur.2022.902912] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Although previous neuroimaging studies have demonstrated emotion- and psychology-associated brain abnormalities in patients with thyroid-associated ophthalmopathy (TAO), the changes of brain functional connectivity in TAO were seldom focused. We aimed to investigate interregional and intraregional functional interactions in patients with TAO by using resting-state functional MRI (rs-fMRI) with long- and short-range functional connectivity density (FCD) analysis. Methods Thirty patients with TAO and 30 well-matched healthy controls (HCs) were recruited in our study. Long- and short-range FCD values were calculated and compared between the two groups. Correlations between long- and short-range FCD values and clinical indicators were analyzed. Results Compared with HCs, patients with showed both increased long- and short-range FCDs in the left middle frontal gyrus (MFG), orbital part of superior frontal gyrus (ORBsup), and dorsolateral part of superior frontal gyrus (SFGdor); meanwhile, both decreased long- and short-range FCDs in bilateral postcentral gyrus (PoCG), left superior parietal gyrus (SPG), and inferior parietal (IPL). In addition, patients with TAO showed increased short-range FCD in the right SFGdor, bilateral medial part of superior frontal gyrus (SFGmed), left orbital part of middle frontal gyrus (ORBmid), and orbital part of inferior frontal gyrus (ORBinf), as well as decreased short-range FCD in the right supplementary motor area (SMA) and the left paracentral lobule (PCL) than HCs. Moreover, the short-range value in the left SFGdor showed a negative correlation with Montreal Cognitive Assessment (MoCA) score (r = −0.501, p = 0.005). Conclusion Our findings complemented the functional neural mechanism of TAO, and provided potential neuroimaging markers for assessing the psychiatric, visual, and emotional disturbances in patients with TAO.
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Affiliation(s)
- Wen-Hao Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Hao Hu
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Fei-Yun Wu
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Gunn AH, Frisco N, Thomas SM, Stang MT, Scheri RP, Kazaure HS. Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease. Thyroid 2022; 32:54-64. [PMID: 34663089 PMCID: PMC8917896 DOI: 10.1089/thy.2021.0285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Graves' disease accounts for ∼80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality of life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. Methods: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015, to November 20, 2020, on a longitudinal basis. Survey responses were categorized as before surgery (≤120 days), short term after surgery (<30 days; ST), and long term after surgery (≥30 days; LT). Negative binomial regression was used to estimate the association of select covariates with PROs. Results: Eighty-five patients with Graves' disease were included. The majority were female (83.5%); 47.1% were non-Hispanic white and 35.3% were non-Hispanic black. The median thyrotropin (TSH) value before surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (before surgery mean of 56.88 vs. ST 39.60, p < 0.001), demonstrating improvement in PROs. Furthermore, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (thyroid symptoms, before surgery 13.88 vs. ST 8.62 and LT 7.29; quality of life, before surgery 16.16 vs. ST 9.14 and LT 10.04, all p < 0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (thyroid symptoms, rate ratio [RR] 0.55, confidence interval [CI]: 0.42-0.72; quality of life, RR 0.57, CI: 0.40-0.81) and LT (thyroid symptoms, RR 0.59, CI: 0.44-0.79; quality of Life, RR 0.43, CI: 0.28-0.65). Conclusions: Quality of life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline before surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.
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Affiliation(s)
- Alexander H. Gunn
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Nicholas Frisco
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samantha M. Thomas
- Duke University Cancer Institute, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Michael T. Stang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Randall P. Scheri
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Hadiza S. Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Address correspondence to: Hadiza S. Kazaure, MD, Department of Surgery, Duke University Medical Center, 466G Seeley Mudd Building, Durham, NC 27710, USA
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Park SY, Kim BH, Kim M, Hong AR, Park J, Park H, Choi MS, Kim TH, Kim SW, Kang HC, Chung JH. The longer the antithyroid drug is used, the lower the relapse rate in Graves' disease: a retrospective multicenter cohort study in Korea. Endocrine 2021; 74:120-127. [PMID: 33860431 DOI: 10.1007/s12020-021-02725-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/03/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Current literature suggests 12-18 months of antithyroid drug (ATD) treatment for patients with Graves' disease, but the risk of relapse is high. Although some studies reported better outcomes of long-term ATD treatment, recent data that suggest the optimal treatment duration are limited. METHODS We performed a multicenter retrospective cohort study of 908 patients newly diagnosed with Graves' disease between 2006 and 2013. The relapse rate according to ATD treatment duration was analyzed. RESULTS After initial ATD treatment, 338 patients (37.2%) had relapsed. The relapse rate according to ATD treatment duration was 42.4% at 1 year, 38.5% at 2 years, 33.8% at 3 years, 31.7% at 4 years, 30.2% at 5 years, 27.8% at 6 years, and 19.1% at more than 6 years, respectively, demonstrating a significant decreasing trend (p = 0.003). In a multivariable Cox regression analysis, ATD treatment duration was an independent risk factor for relapse (p = 0.043). CONCLUSIONS The longer that ATD therapy is used, the lower the relapse rate is in patients with Graves' disease. Long-term ATD treatment may be considered in Graves' patients who do not show complications or an economic burden from hyperthyroidism.
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Affiliation(s)
- So Young Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunju Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, 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
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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14
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Abstract
Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.
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15
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Happel C, Kranert WT, Gröner D, Baumgarten J, Halstenberg J, Bockisch B, Sabet A, Grünwald F. Focus on radioiodine-131 biokinetics: the influence of methylprednisolone on intratherapeutic effective half-life of 131I during radioiodine therapy of Graves' disease. Endocrine 2021; 73:125-130. [PMID: 33439464 PMCID: PMC8211592 DOI: 10.1007/s12020-020-02593-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
AIM Radioiodine therapy (RIT) may trigger the development of Graves' ophthalmopathy (GO) or exacerbate pre-existing subclinical GO. Therefore, glucocorticoid administration is recommended for patients with pre-existing GO. Aim of this study was to analyze the influence of glucocorticoid therapy with methylprednisolone on intratherapeutic effective half-life (EHL) of radioiodine-131 in patients with Graves' disease (GD) as recent studies showed an effect for prednisolone. METHODS In a retrospective study, 264 patients with GD who underwent RIT without any additional antithyroid medication were evaluated. Intrathyroidal EHL was determined pre- and intratherapeutically. Patients with co-existing GO (n = 43) received methylprednisolone according to a fixed scheme starting 1 day prior to RIT, patients without GO (n = 221) did not receive any protective glucocorticoid medication. The ratios of EHL during RIT and during radioiodine uptake test (RIUT) were compared. RESULTS Patients receiving methylprednisolone showed a slight decrease of the mean EHL from 5.63 d (RIUT) to 5.39 d (RIT) (p > 0.05). A comparable result was obtained in patients without glucocorticoids (5.71 d (RIUT) to 5.47 d (RIT); p > 0.05). The ratios of the EHL between RIT and RIUT failed to show a significant difference between the two groups. EHL is therefore not significantly influenced by an additional protective treatment with methylprednisolone. CONCLUSIONS In the present study a decreased intrathyroidal EHL under glucocorticoid medication with methylprednisolone could not be detected. Therefore, co-medication with methylprednisolone in patients with GO may be preferred to avoid an intratherapeutic decrease of EHL by accompanying protective glucocorticoides.
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Affiliation(s)
- C Happel
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany.
| | - W T Kranert
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - D Gröner
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Baumgarten
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Halstenberg
- Department of Anesthesiology, Alice-Hospital, Darmstadt, Germany
| | - B Bockisch
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - A Sabet
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - F Grünwald
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
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16
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Lane LC, Rankin J, Cheetham T. A survey of the young person's experience of Graves' disease and its management. Clin Endocrinol (Oxf) 2021; 94:330-340. [PMID: 33128233 DOI: 10.1111/cen.14359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/16/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE A suboptimal quality of life (QoL) has been reported in patients with Graves' disease treated in adult life, but long-term QoL in those treated in childhood and adolescence is unclear. We wanted to understand how Graves' disease and its management impact on the physical, psychological and social well-being of young people and their longer-term QoL. DESIGN, PATIENTS AND MEASUREMENTS Two questionnaires were used to assess QoL and patient experience of Graves' disease; PedsQL™ Generic Core Scales and a Graves' disease questionnaire devised for this project. The anonymized questionnaires were sent to young people (<30 years) diagnosed with Graves' disease in childhood and adolescence and managed at a tertiary paediatric endocrine unit in the North of England. Respondent QoL scores were compared with a healthy UK cohort. RESULTS Questionnaires were sent to 51 young people, and 26 responded (51%). Graves' patients reported a lower total QoL score compared with the healthy cohort (p = .003). This was particularly apparent in the psychosocial domain (p = .0016). No patient regretted having definitive treatment (surgery/radioiodine), and all said they would recommend it to others. Half of those who had received definitive treatment still did not feel recovered. There was no difference in the long-term QoL in those who did/did not receive definitive treatment (p = .40). CONCLUSIONS This study highlights short- and long-term impacts on the QoL and general well-being of young people with Graves' disease. There were no regrets regarding the choice of definitive treatment. This information will help inform the counselling of patients and their families.
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Affiliation(s)
- Laura Claire Lane
- Department of Paediatric Endocrinology, The Great North Children's Hospital, Newcastle-upon-Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, Newcastle-upon-Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Tim Cheetham
- Department of Paediatric Endocrinology, The Great North Children's Hospital, Newcastle-upon-Tyne, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, Newcastle-upon-Tyne, UK
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Hoppe E, Lee ACH, Hoppe D, Kahaly GJ. Predictive Factors for Changes in Quality of Life after Steroid Treatment for Active Moderate-to-Severe Graves' Orbitopathy: A Prospective Trial. Eur Thyroid J 2021; 9:313-320. [PMID: 33718255 PMCID: PMC7923875 DOI: 10.1159/000508071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/22/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To investigate the predictive factors for changes in the quality of life (GO-QoL) of patients with Graves' orbitopathy (GO) prior to and after specific treatment. METHODS A prospective follow-up study was conducted at an academic tertiary referral orbital center with a joint thyroid-eye clinic on 100 consecutive patients with GO. Before and after the standard 12-week course of weekly intravenous methylprednisolone (cumulative dose 4.5 g), the GO-QoL questionnaire provided by the European Group on Graves' Orbitopathy (EUGOGO) was completed. Endocrine and ophthalmic assessments were performed at each visit. RESULTS All patients were biochemically euthyroid and untreated for GO at baseline and presented with active and moderate-to-severe disease. Both GO-QoL subscales (visual functioning [VF] and appearance [AP]) significantly increased after immunosuppressive therapy and showed a sustained improvement for 6 months. At baseline, demographic variables (sex, age, and smoking) influenced QoL in the stepwise linear regression (p < 0.01, adjusted R 2 = 0.24 for VF and p < 0.01, adjusted R 2 = 0.21 for AP). In contrast, 6 months after treatment, the improved QoL was now exclusively associated with ophthalmic parameters (p < 0.01, adjusted R 2 = 0.47 for VF; p < 0.01, adjusted R 2 = 0.23 for AP). CONCLUSIONS Predictive factors for GO-QoL differed not only between the 2 subscales but also before and after the first treatment of GO.
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Affiliation(s)
- Elena Hoppe
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
- Department of Paediatrics, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Alan Chun Hong Lee
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - David Hoppe
- Department of Psychology, Technical University of Darmstadt, Darmstadt, Germany
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
- *George J. Kahaly, MD, PhD, Department of Medicine I, Johannes Gutenberg University Medical Center, Langenbeckstrasse 1, DE–55131 Mainz (Germany),
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18
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Wu Q, Hu H, Chen W, Chen HH, Chen L, Xu XQ, Wu FY. Morphological and microstructural brain changes in thyroid-associated ophthalmopathy: a combined voxel-based morphometry and diffusion tensor imaging study. J Endocrinol Invest 2020; 43:1591-1598. [PMID: 32253727 DOI: 10.1007/s40618-020-01242-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/28/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To explore the morphological and microstructural changes of grey and white matter in the patients of thyroid-associated ophthalmopathy (TAO). METHODS Twenty-five TAO patients and 25 well-matched healthy controls were recruited. Structural T1- and diffusion-weighted magnetic resonance imaging data were analyzed using voxel-based morphometry and voxel-based analysis of diffusion tensor imaging. RESULTS Compared with healthy controls, TAO group showed significantly decreased grey matter volume in the brain region of the right middle frontal gyrus. Meanwhile, TAO group showed significantly decreased fractional anisotropy (FA), but increased mean, axial and radial diffusivities in the brain regions of the right superior occipital gyrus, middle occipital gyrus and cuneus in TAO group. In addition, the FA value in significant brain regions showed a positive correlation with visual acuity (r = 0.456, P = 0.025) and a negative correlation with disease duration (r = - 0.609, P = 0.003). CONCLUSION Significant morphological and microstructural abnormalities in areas corresponding to known functional deficits of vision and cognition could be found in TAO patients. These results extended our understanding of neural relationships with TAO.
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Affiliation(s)
- Q Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - H Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - W Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - H-H Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - L Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China
| | - X-Q Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China.
| | - F-Y Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China.
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Factors Affecting Vision and Visio-Spatial Intelligence (VSI) in Sport: A Review of the Literature. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.101670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
: Sport has become increasingly competitive, prompting the need to determine, as far as possible, any likely performance advantage. While the focus of athletic research, testing, and training is on the physiological and physical characteristics of the sport, visual abilities not only affect sport performance directly, but also affect the acquisition of motor skills. Vision, and visual-spatial intelligence (VSI), are a relatively new and underexplored area of athletic performance. As with physiological and physical parameters, a range of factors affect vision and VSI in sporting activities. This review of the literature is a first attempt to summarize and compile an overview of the factors affecting vision and VSI in athletes, covering those previously connected with sport, as well as those hitherto not associated with athletic activities, but that could also play a part in sports performance. The evidence from this review suggests that while current research still tends to focus on single factors affecting vision and VSI, a large number of such factors have been identified that could affect vision and VSI. This offers new opportunities for researchers to investigate the effects of a combination of factors, and for conditioning and/or sports vision specialists to explore further possibilities for competitive advantage.
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Mukherjee B. Commentary: Thyroid eye disease in India: A wake-up call? Indian J Ophthalmol 2020; 68:1614-1615. [PMID: 32709789 PMCID: PMC7640877 DOI: 10.4103/ijo.ijo_546_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bipasha Mukherjee
- Orbit, Oculoplasty, Reconstructive and Aesthetics Services, Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India
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Hirtz R, Keesen A, Hölling H, Hauffa BP, Hinney A, Grasemann C. No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study. Front Endocrinol (Lausanne) 2020; 11:454. [PMID: 32982959 PMCID: PMC7492205 DOI: 10.3389/fendo.2020.00454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous. Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study ("The German Health Interview and Examination Survey for Children and Adolescents") were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors. Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism. Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.
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Affiliation(s)
- Raphael Hirtz
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- *Correspondence: Raphael Hirtz
| | - Anne Keesen
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Heike Hölling
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Berthold P. Hauffa
- Division of Pediatric Endocrinology and Diabetology, Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Department of Pediatrics and Center for Rare Diseases Ruhr CeSER, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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Lumyongsatien M, Keeratidamkerngsakul B, Pornpanich K, Vangveeravong S, Saonanon P, Wiwatwongwana D, Mahaisavariya P, Aryasit O, Pongpirul K. Development and psychometric properties of the Thai Graves' ophthalmopathy quality of life (GO-QOL) questionnaire. J Patient Rep Outcomes 2019; 4:1. [PMID: 31893319 PMCID: PMC6938528 DOI: 10.1186/s41687-019-0164-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose To develop and assess the psychometric properties of the Thai version of the Graves’ Ophthalmopathy Quality of Life (GO-QOL) questionnaire. Background Graves’ ophthalmopathy (GO) is a chronic condition that causes negative self-image and impaired visual function. These conditions impact quality of life (QOL) but are rarely documented. Graves’ Ophthalmopathy Quality of Life Questionnaire (GO-QOL) has good validity, reliability and responsiveness. In this study we developed a Thai GO-QOL questionnaire by translating the questionnaire from English to the Thai language and evaluated its reliability and validity. Patients and methods Forward and backward translations were performed independently by four translators with extensive experience in both English and Thai. Seventy patients at the thyroid clinic responded to the Thai translated version upon their first visit and again 2–3 weeks afterwards. Validity was assessed by the content validity index (CVI) and correlation with relevant clinical parameters. Reliability was evaluated by Cronbach’s alpha, the intraclass correlation coefficient, and the Bland-Altman plot. Results The Thai GO-QOL version showed high CVI (0.97) and a moderate negative correlation of the functional QOL score with disease severity (r = − 0.49), the clinical activity score (r = − 0.31), and exposure parameter (r = − 0.32). It showed good reliability with a high intraclass correlation coefficient (0.92) and high Cronbach’ s coefficient (0.86). Conclusion The Thai GO-QOL has good validity and reliability. It can be used to evaluate the quality of life of Graves’ ophthalmopathy patients as a consequence of their disease in thyroid treatment programs.
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Affiliation(s)
- Mingkwan Lumyongsatien
- Department of Ophthalmology, Mettapracharak Hospital, Sampran, District, 52 moo2 Rhikhing, Sampran, Nakhon Pathom, 73210, Thailand.
| | - Benjama Keeratidamkerngsakul
- Department of Ophthalmology, Mettapracharak Hospital, Sampran, District, 52 moo2 Rhikhing, Sampran, Nakhon Pathom, 73210, Thailand
| | - Kanokrat Pornpanich
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Arun amarin road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand
| | - Sumalee Vangveeravong
- Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Arun amarin road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand
| | - Preamjit Saonanon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, 1873, Praram 4 road. Prathumwan, Bangkok, 10330, Thailand
| | - Damrong Wiwatwongwana
- Department of Ophthalmology, Faculty of Medicine, Chiangmai University, 110, Intawaroros, Sripoom, Chiangmai, 50200, Thailand
| | - Pornchai Mahaisavariya
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270, Praram 6 road, Thung Phaya thai, Ratchatevi, Bangkok, 10400, Thailand
| | - Orapan Aryasit
- Department of Ophthalmology, Prince of Songkla University, 15 Kanjanawanich road, Hatyai, Songkla, 90110, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873, Praram 4 Rd. Prathumwan, Bangkok, 10330, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Bumrungrad International Hospital, 33 Sukhumvit road. Soi3, Khlong Toei Nuea, Wattana, Bangkok, 10110, Thailand
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Minatel Riguetto C, Minicucci WJ, Moura Neto A, Tambascia MA, Zantut-Wittmann DE. Value of Infrared Thermography Camera Attached to a Smartphone for Evaluation and Follow-up of Patients with Graves' Ophthalmopathy. Int J Endocrinol 2019; 2019:7065713. [PMID: 31210762 PMCID: PMC6532296 DOI: 10.1155/2019/7065713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Graves' ophthalmopathy (GO) is the most common extra-thyroid manifestation of Graves' disease (GD). The Clinical Activity Score (CAS) has been widely used to evaluate GO inflammation severity and response to treatment; however, it is quite subjective. Infrared thermography (IRT) is a portable and low-cost device to evaluate local temperature and assess inflammation. The aim was to evaluate ocular temperature by IRT as an instrument for measuring inflammatory activity in GO and its correlation with CAS. METHODS This is a cross-sectional study involving 136 consecutive GD patients (12 with CAS ≥ 3/7, 62 with CAS < 3 and 62 without apparent GO) with 62 healthy controls. Patients with active ophthalmopathy were prospectively evaluated. Exophthalmometry, CAS, and thermal images from caruncles and upper eyelids were acquired from all subjects. RESULTS All eye areas of thermal evaluation had higher temperatures in GD patients with active ophthalmopathy (caruncles, p<0.0001; upper eyelids, p<0.0001), and it was positively correlated with CAS (r=0.60 and p<0.0001 at caruncles; r=0.58 and p<0.0001 at upper eyelids). No difference in temperature was found between other groups. Patients with active ophthalmopathy were prospectively evaluated after 6 or 12 months of the treatment and a significant difference was found in ophthalmometry (p=0.0188), CAS (p=0.0205), temperature of caruncles (p=0.0120), and upper eyelids (p=0.0066). CONCLUSIONS IRT was an objective and simple tool for evaluation and follow-up of inflammation in GO, allowed evidencing patients with significant inflammatory activity, and had a good correlation with the CAS score.
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Affiliation(s)
- Cínthia Minatel Riguetto
- Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, 13084-971 Campinas, São Paulo, Brazil
| | - Walter José Minicucci
- Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, 13084-971 Campinas, São Paulo, Brazil
| | - Arnaldo Moura Neto
- Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, 13084-971 Campinas, São Paulo, Brazil
| | - Marcos Antonio Tambascia
- Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, 13084-971 Campinas, São Paulo, Brazil
| | - Denise Engelbrecht Zantut-Wittmann
- Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, 13084-971 Campinas, São Paulo, Brazil
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Yuan L, Zhang Y, Luan D, Xu X, Yang Q, Zhao S, Zhou Z. Reversible Affective Symptoms and Attention Executive Control Network Impairment Following Thyroid Function Normalization in Hyperthyroidism. Neuropsychiatr Dis Treat 2019; 15:3305-3312. [PMID: 32063707 PMCID: PMC6884974 DOI: 10.2147/ndt.s227386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Affective symptoms and attention impairments are found in patients with hyperthyroidism. Our previous data have revealed that the patients with hyperthyroidism experience impairments of the attention networks, but it remains unclear whether these disorders persist after the treatment of hyperthyroidism. METHODS Twenty healthy controls and 25 hyperthyroid patients were recruited and performed the attention network test (ANT) which can simultaneously examine the alertness, orientation and execution control components of the participants. The effect of treatment on affective symptom and attention networks impairments were examined in the patient group after 1-year anti-thyroid medication and reaching euthyroidism for at least 3 months. RESULTS Anxiety and depression scores of patients with hyperthyroidism were significantly higher than those of the healthy control group. The patients with hyperthyroidism had impairments of the alerting and executive control networks. Meanwhile, the score of HAMA correlated significantly with thyroid hormone and TSH levels, and there was a negative significant correlation between the score of HAMD and TSH level in all subjects. There was a positive correlation between the value of the executive control network and thyroid hormones' levels in all subjects and in the hyperthyroidism group. Anxiety and depression symptoms were improved with methimazole treatment after euthyroidism was reached. The value of the executive control network no longer differed from that of healthy controls, but deficits in the alerting network of hyperthyroidism still persisted after treatment. CONCLUSION The patients with hyperthyroidism existed affective symptoms and attention networks impairments. Affective symptoms and attention executive control network impairment were improved following thyroid function normalization in hyperthyroidism.
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Affiliation(s)
- Lili Yuan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Yuanxiang Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Di Luan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Xiangjun Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Shoucai Zhao
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
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