1
|
Zhu S, Pang Y, Zhang X, Yang C, Gao J, Fang P, Zhang Y, Yao Y, Ju F, Ye F, Zhu H, Liao P, Yao L, Dai L, Xu J, Wu B, Pan J, Wu Y. Alteration of Thyroid Hormones in Mouse Models of Alzheimer's Disease and Aging. Neuroendocrinology 2024; 114:411-422. [PMID: 38228117 DOI: 10.1159/000536089] [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: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Aging is characterized by the deterioration of a wide range of functions in tissues and organs, and Alzheimer's disease (AD) is a neurodegenerative disease characterized by cognitive impairment. Hypothyroidism occurs when there is insufficient production of thyroid hormones (THs) by the thyroid. The relationship between hypothyroidism and aging as well as AD is controversial at present. METHODS We established an animal model of AD (FAD4T) with mutations in the APP and PSEN1 genes, and we performed a thyroid function test and RNA sequencing (RNA-Seq) of the thyroid from FAD4T and naturally aging mice. We also studied gene perturbation correlation in the FAD4T mouse thyroid, bone marrow, and brain by further single-cell RNA sequencing (scRNA-seq) data of the bone marrow and brain. RESULTS In this study, we found alterations in THs in both AD and aging mice. RNA-seq data showed significant upregulation of T-cell infiltration- and cell proliferation-related genes in FAD4T mouse thyroid. In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses revealed that upregulated genes were enriched in the functional gene modules of activation of immune cells. Downregulated energy metabolism-related genes were prominent in aging thyroids, which reflected the reduction in THs. GSEA showed a similar enrichment tendency in both mouse thyroids, suggesting their analogous inflammation state. In addition, the regulation of leukocyte activation and migration was a common signature between the thyroid, brain, and bone marrow of FAD4T mice. CONCLUSIONS Our findings identified immune cell infiltration of the thyroid as the potential underlying mechanism of the alteration of THs in AD and aging.
Collapse
Affiliation(s)
- Siyuan Zhu
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidan Pang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chunying Yang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Junjie Gao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fang
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaohui Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunjin Yao
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangyu Ju
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Ye
- Center for Stem Cell and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongyi Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Liao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lufeng Yao
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Lulu Dai
- Department of Ultrasound, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Xu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bo Wu
- Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Pan
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
2
|
Johnson CE, Duncan MJ, Murphy MP. Sex and Sleep Disruption as Contributing Factors in Alzheimer's Disease. J Alzheimers Dis 2024; 97:31-74. [PMID: 38007653 PMCID: PMC10842753 DOI: 10.3233/jad-230527] [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] [Indexed: 11/27/2023]
Abstract
Alzheimer's disease (AD) affects more women than men, with women throughout the menopausal transition potentially being the most under researched and at-risk group. Sleep disruptions, which are an established risk factor for AD, increase in prevalence with normal aging and are exacerbated in women during menopause. Sex differences showing more disrupted sleep patterns and increased AD pathology in women and female animal models have been established in literature, with much emphasis placed on loss of circulating gonadal hormones with age. Interestingly, increases in gonadotropins such as follicle stimulating hormone are emerging to be a major contributor to AD pathogenesis and may also play a role in sleep disruption, perhaps in combination with other lesser studied hormones. Several sleep influencing regions of the brain appear to be affected early in AD progression and some may exhibit sexual dimorphisms that may contribute to increased sleep disruptions in women with age. Additionally, some of the most common sleep disorders, as well as multiple health conditions that impair sleep quality, are more prevalent and more severe in women. These conditions are often comorbid with AD and have bi-directional relationships that contribute synergistically to cognitive decline and neuropathology. The association during aging of increased sleep disruption and sleep disorders, dramatic hormonal changes during and after menopause, and increased AD pathology may be interacting and contributing factors that lead to the increased number of women living with AD.
Collapse
Affiliation(s)
- Carrie E. Johnson
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
| | - Marilyn J. Duncan
- University of Kentucky, College of Medicine, Department of Neuroscience, Lexington, KY, USA
| | - M. Paul Murphy
- University of Kentucky, College of Medicine, Department of Molecular and Cellular Biochemistry, Lexington, KY, USA
- University of Kentucky, Sanders-Brown Center on Aging, Lexington, KY, USA
| |
Collapse
|
3
|
Yu ZW, Pu SD, Sun XT, Wang XC, Gao XY, Shan ZY. Impaired Sensitivity to Thyroid Hormones is Associated with Mild Cognitive Impairment in Euthyroid Patients with Type 2 Diabetes. Clin Interv Aging 2023; 18:1263-1274. [PMID: 37554512 PMCID: PMC10406107 DOI: 10.2147/cia.s413584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023] Open
Abstract
Purpose The prevalence of mild cognitive impairment (MCI) in patients with type 2 diabetes (T2D) is rapidly increasing. Thyroid hormones are key regulators of cognitive function in adults. The purpose of this study was to investigate the relationship between thyroid hormone sensitivity and MCI in euthyroid T2D patients. Patients and Methods A total of 400 euthyroid T2D patients were enrolled in this cross-sectional study, including 218 patients with normal cognition and 182 MCI patients. The Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function. The free triiodothyronine to free thyroxine (FT3/FT4) ratio was calculated as a measure of peripheral sensitivity to thyroid hormones; the thyroid-stimulating hormone index (TSHI), thyrotrophic thyroxine resistance index (TT4RI) and thyroid feedback quantile-based index (TFQI) were calculated as measures of central sensitivity to thyroid hormones. Linear regression analysis and logistic regression analysis were performed to explore the relationships between these indices of thyroid hormone sensitivity and the MoCA score and MCI, respectively. Results Compared with the normal cognitive function group, patients in the MCI group had higher TSHI, TT4RI and TFQI but a lower FT3/FT4 ratio (P<0.05). The MoCA score was positively correlated with the FT3/FT4 ratio but negatively correlated with TSHI, TT4RI and TFQI (P< 0.05). Multivariate logistic regression analysis showed that a low FT3/FT4 ratio and high TSHI, TT4RI and TFQI were independently associated with MCI (P<0.05). After adjustment for confounding factors, the odds ratio (OR) for the association between MCI and the highest tertile of the FT3/FT4 was 0.455 (95% CI: 0.264-0.785), for the highest tertile of TSHI, the OR was 2.380 (95% CI: 1.376-4.119), for the highest tertile of TT4RI, the OR was 2.342 (95% CI:1.353-4.054), and for the highest tertile of TFQI, the OR was 2.536 (95% CI: 1.466-4.387) (P< 0.05). Conclusion Impaired sensitivity to thyroid hormones is associated with MCI in euthyroid T2D patients.
Collapse
Affiliation(s)
- Zi-Wei Yu
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Sheng-Dan Pu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xiao-Tong Sun
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Xi-Chang Wang
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| | - Xin-Yuan Gao
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
| | - Zhong-Yan Shan
- Department of Endocrinology and Metabolism and the Institute of Endocrinology, The NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, First Hospital of China Medical University, Shenyang, 110001, People’s Republic of China
| |
Collapse
|
4
|
Odawara S, Shimbo T, Yamauchi T, Kobayashi D. Association of Low-Normal Free T4 Levels With Future Major Depression Development. J Endocr Soc 2023; 7:bvad096. [PMID: 37528949 PMCID: PMC10387582 DOI: 10.1210/jendso/bvad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 08/03/2023] Open
Abstract
Context Hyperthyroidism and overt and subclinical hypothyroidism are associated with major depression; however, the association of major depression across the spectrum of thyroid function within the normal range is unknown. Objective We investigated whether higher or lower levels of free thyroxine (T4) and thyrotropin (TSH) within the normal range are associated with major depression. Methods This was a retrospective cohort study of 66 960 participants with normal thyroid function who visited for health checkups (St. Luke's International Hospital, 2005-2018). The primary outcome was the development of major depression during the follow-up period. Participants were divided into 3 equal groups based on baseline free T4 or TSH values (low-, middle-, or high-normal), and the incidence of major depression was compared using the Cox proportional hazard model after adjusting for potential covariates. Results During the median follow-up of 1883 days, 1363 (2.0%) patients developed major depression. The low-normal free T4 group had a significantly higher risk of major depression (adjusted HR 1.15; 95% CI, 1.01-1.31), but not the high-normal free T4 group or TSH groups. The association between low-normal free T4 and the development of major depression was maintained, rather more obvious, upon exclusion of participants whose thyroid hormone levels became abnormal during follow-up compared with data from all participants (adjusted HR 1.24; 95% CI, 1.07-1.43). Conclusion In this cohort, low-normal free T4 was associated with an increased risk of future major depression, even if subsequent hormone levels were maintained within the normal range. The magnitude of the impact of low-normal free T4 was relatively mild.
Collapse
Affiliation(s)
- Sara Odawara
- Correspondence: Sara Odawara, MD, PhD, Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Takuro Shimbo
- Department of Medicine, Ohta Nishinouchi Hospital, Fukushima 963-8558, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki 300-0332, Japan
- Department of Medicine, Fujita Health University, Aichi 470-1192, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| |
Collapse
|
5
|
Su W, Zhao L, Bao S, Qin R, Cao J, Tian J, Han Y, Zhang T, Chen C, Shi Q, Guo Q, Shao F, Tian L. Alterations in gray matter morphology and functional connectivity in adult patients with newly diagnosed, untreated hypothyroidism. Thyroid 2023. [PMID: 37130043 DOI: 10.1089/thy.2022.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Untreated adult hypothyroidism may be associated with cognitive and emotional impairment, but the precise underlying neuropathological mechanism is unknown. We investigated the brain morphological and functional abnormalities associated with cognition and emotion in hypothyroidism. METHODS This is a cross-sectional observational study. Forty-four newly diagnosed adult hypothyroid patients and 54 well-matched healthy controls (HC) were enrolled. All participants underwent 3D T1WI and resting-state functional brain MRI. Morphological and seed-based functional connectivity (FC) analyses were performed to compare the inter-group differences. Neuropsychological tests, including the Montreal Cognitive Assessment Scale (MoCA), 24-item Hamilton Depression Rating Scale (HAMD-24), and Hamilton Anxiety Rating Scale (HAMA) were administered. Thyroid function test and blood lipid levels were measured. Correlations were computed between neuropsychological and biochemical measures with neuroimaging indices. Sensitive morphological or functional neuroimaging indicators were identified using ROC analysis. RESULTS Compared with HC, hypothyroid patients demonstrated lower total and subdomain scores on the MoCA and higher HAMD-24 and HAMA scores. Morphological analysis revealed the hypothyroid patients had significantly reduced gray matter (GM) volumes in the right superior frontal gyrus, superior temporal gyrus, left dorsolateral superior frontal gyrus, middle frontal gyrus, and supplementary motor area as well as significantly increased GM volumes in the bilateral cerebellar CrusⅠand left precentral gyrus. Furthermore, MRIs of hypothyroid patients showed increased FC between the right cerebellar CrusⅠand left precentral gyrus, triangular part of the inferior frontal gyrus, and angular gyrus of the inferior parietal lobe. The language scores of the MoCA were positively correlated with Jacobian values of the left supplementary motor area (r = 0.391, P = 0.046) and precentral gyrus (r = 0.401, P = 0.039). ROC analysis revealed FC value between cerebellar CrusⅠand angular gyrus could differentiate groups with relatively high accuracy (sensitivity: 75%, specificity: 77.8%, AUC: 0.794, 95% CI: 0.701-0.888, P < 0.001). CONCLUSION Untreated adult-onset hypothyroidism may be associated with impaired cognition and anxiety or depression. GM morphological alterations and FC of the cerebellum with subregions of the frontal and parietal lobes may represent key neuropathological mechanisms underlying the cognitive deterioration and mood dysregulation observed in hypothyroid adults.
Collapse
Affiliation(s)
- Wenxiu Su
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, Gansu, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China
- Ningxia Medical University, 105002, School of Clinical Medicine, Yinchuan, Ningxia, China;
| | - Lianping Zhao
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Shisan Bao
- The University of Sydney, 4334, School of Medical Sciences, Sydney, New South Wales, Australia;
| | - Rui Qin
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, Gansu, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China;
| | - Jiancang Cao
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Jing Tian
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Yalan Han
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Taotao Zhang
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, Gansu, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China;
| | - Chen Chen
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Qian Shi
- Gansu Provincial Hospital, 91589, Department of Radiology, Lanzhou, Gansu, China;
| | - Qian Guo
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, Gansu, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China;
| | - Feifei Shao
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, Gansu, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China;
| | - Limin Tian
- Gansu Provincial Hospital, 91589, Department of Endocrinology, Lanzhou, China
- Gansu Province, 118136, Gansu Clinical Research Center for Metabolic Diseases, Lanzhou, Gansu, China;
| |
Collapse
|
6
|
Lamichhane TR, Pant SP, Lamichhane B, Paudel S, Yadav BK, Lamichhane HP. Evaluation of Thyroid Hormones-Thyrotropin Interrelationships in Thyroid Dysfunction States from Population-Based Data Analysis with a Logistic Model. Biophysics (Nagoya-shi) 2022. [DOI: 10.1134/s0006350922020130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
Kotkowska Z, Strzelecki D. Depression and Autoimmune Hypothyroidism—Their Relationship and the Effects of Treating Psychiatric and Thyroid Disorders on Changes in Clinical and Biochemical Parameters Including BDNF and Other Cytokines—A Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15040391. [PMID: 35455388 PMCID: PMC9025086 DOI: 10.3390/ph15040391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Various autoimmune diseases, including autoimmune hypothyroidism (AHT), are associated with a higher risk of developing mood disorders throughout life. Depression is accompanied by the changes in the levels of inflammatory and trophic factors, including interleukins (IL-1beta, IL-2, IL-6), interferon alpha (IFN-alpha), tumor necrosis factor alpha (TNF-alpha), C-reactive protein (CRP), and brain derived neurotrophic factor (BDNF). Disclosure of the relationship between the coexistence of depression and AHT indicates that the pathomechanism of depression may be related to the changes in the immune system, it is also possible that both conditions may be caused by the same immune processes. The above hypothesis is indirectly supported by the observations that the treatment with both antidepressants and levothyroxine leads to a decrease in the levels of proinflammatory cytokines with an increase in BDNF concentrations, simultaneously correlating with an improvement in the clinical parameters. However, so far there are no long-term studies determining the causal relationship between depression, thyroid autoantibodies, and cytokine profile, which could bring us closer to understanding the interrelationships between them and facilitate the use of an adequate pharmacotherapy, not necessarily psychiatric. We consider the above issues to be insufficiently investigated but of great importance. This article is an overview of the available literature as well as an introduction to our research project.
Collapse
|
8
|
Perez-Zepeda MU, Almeda-Valdes P, Fernandez-Villa JM, Gomez-Arteaga RC, Borda MG, Cesari M. Thyroid stimulating hormone levels and geriatric syndromes: secondary nested case-control study of the Mexican Health and Aging Study. Eur Geriatr Med 2021; 13:139-145. [PMID: 34601711 DOI: 10.1007/s41999-021-00564-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the incidence of geriatric syndromes (GS) in community dwelling older adults with subclinical hypothyroidism. METHODS This is an analysis from the Mexican Health and Aging Study, of a subsample of 2089 subjects with TSH determination. From this last subsample, we included 1628 individuals with TSH levels in the subclinical range (4.5-10 µU/ml). RESULTS The multivariate analysis showed that when comparing data obtained from the 2012 wave with the 2015 wave results, there was a significant incidence of some GS such as falls (OR 1.79, CI 1.16-2.77, p = 0.0116), fatigue (OR 2.17, CI 1.40-3.38, p = 0.0348) and depression (OR 1.70, CI 1.06-2.71, p = 0.0246) among the subclinical hypothyroidism group. CONCLUSION This study showed a greater incidence of GS in subjects 50 years and older with sub-clinical hypothyroidism, when compared to those with normal thyroid function.
Collapse
Affiliation(s)
- Mario U Perez-Zepeda
- Research Department, INGER Instituto Nacional de Geriatria, Mexico City, Mexico.,Health Sciences Research Center (CICSA), FCS, Universidad Anahuac Mexico Campus Norte, Mexico City, Edo. de Mexico, Mexico
| | - Paloma Almeda-Valdes
- Research Center of Metabolic Diseases, Instituto Nacional de Ciencias Medicas Y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | | | - Miguel G Borda
- Semillero de Neurociencias y Envejecimiento, Instituto de Envejecimiento, Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia.,Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| |
Collapse
|
9
|
de Lima Junior NC, Camilo JF, do Carmo PR, de Andrade MN, Braz BF, Santelli RE, de Brito Gitirana L, Ferreira ACF, de Carvalho DP, Miranda-Alves L, Dias GRM. Subacute exposure to lead promotes disruption in the thyroid gland function in male and female rats. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 274:115889. [PMID: 33223335 DOI: 10.1016/j.envpol.2020.115889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
Exposure to heavy metals, such as lead, is a global public health problem. Lead has a long historic relation to several adverse health conditions and was recently classified as an endocrine disruptor. The aim of this study was to investigate the effects of subacute exposure to lead on the thyroid gland function. Adult male and female Wistar rats received a lead acetate solution containing 10 or 25 mg/kg, by gavage, three times a week, for 14 days. One week later, behavioral testing showed no alterations in anxiety and motor-exploratory parameters, as evaluated by Open-Field and Plus-Maze Tests, but impairment in learning and memory was found in the male 25 mg/kg lead-treated group and in both female lead-treated groups, as evaluated by the Inhibitory Avoidance Test. After one week, serum levels of tT3 were reduced in the 25 mg/kg female group and in the 10 mg∕ kg male group. However, tT4 levels were increased in the 25 mg/kg male group and in both female treated groups. TSH levels did not change and lead serum levels were undetectable. Morphologic alterations were observed in the thyroid gland, including abnormal thyroid parenchyma follicles of different sizes, epithelial stratification and vacuolization of follicular cells, decrease in colloid eosinophilia and vascular congestion, accompanied by morphometric alterations. An increase in collagen deposition was also observed. No differences were observed in TPO activity or protein expression, H2O2 generation by NADPH oxidases or hepatic D1 mRNA expression. However, thyroid NIS protein expression was considerably decreased in the male and female lead-treated groups, while TSHr expression was decreased in the 25 mg/kg female lead-treated group. These findings demonstrated that subacute exposure to lead acetate disrupts thyroid gland function in both sexes, leading to morphophysiological impairment and to changes in learning and memory abilities.
Collapse
Affiliation(s)
- Niedson Correia de Lima Junior
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Endocrinology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Franco Camilo
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Pâmella Rodrigues do Carmo
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcelle Novaes de Andrade
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Pharmacology and Medicinal Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Bernardo Ferreira Braz
- Department of Analytical Chemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ricardo Erthal Santelli
- Department of Analytical Chemistry, Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lycia de Brito Gitirana
- Laboratory of Integrative Histology, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andrea Claudia Freitas Ferreira
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Endocrinology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Denise Pires de Carvalho
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Endocrinology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Leandro Miranda-Alves
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Endocrinology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Pharmacology and Medicinal Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Glaecir Roseni Mundstock Dias
- Laboratory of Endocrine Physiology Doris Rosenthal, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Endocrinology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
10
|
Singh S, Panda V, S. S, Dande P. Protective effect of a polyherbal bioactive fraction in propylthiouracil-induced thyroid toxicity in ratsby modulation of the hypothalamic-pituitary-thyroid and hypothalamic-pituitary-adrenal axes. Toxicol Rep 2020; 7:730-742. [PMID: 32579134 PMCID: PMC7301176 DOI: 10.1016/j.toxrep.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
Hypothyroidism is the most frequent toxic effect of a large variety of chemical compounds. The polyherbal bioactive fraction exhibited a pro-thyroid effect in hypothyroidic rats. The polyherbal fraction restored the propylthiouracil-depleted thyroid hormone levels significantly. The polyherbal fraction may act through multiple mechanisms to exhibit a pro-thyroid effect.
Hypothyroidism is the most frequent consequence of the interaction of a large variety of drugs, environmental pollutants and industrial chemicals with the thyroid gland. It is associated with diminished endocrine function which may lead to hyperlipidemia, diabetes, Alzheimer’s disease, weight gain, and other metabolic disorders. The present study evaluates the pro-thyroid activity of a bioactive fraction from a polyherbal teabag in rats with hypothyroidism induced by propylthiouracil. The teabag was formulated to stimulate synthesis and/or release of T4 and affectthe conversion of T4 to T3. Phytoconstituents of the polyherbal teabag are potent antioxidants that may be responsible for the pro-thyroid activity. The tea-extract (1000 mg) was found to contain 1076 μg of gallic acid and 1131 μg of rutin from HPTLC analysis. Rats received propylthiouracil (8 mg/kg) for the first 15days followed by the polyherbal tea-extract (500, 1000 and 1500 mg/kg), the standard drug levothyroxine (0.1 mg/kg), aerobic exercise, and a combination of tea-extract (1000 mg/kg) and aerobic exercise daily along with propylthiouracil for the next 30 days. Finally, rats received their respective treatments alone without propylthiouracil for 15 more days. Lipid profile and levels of glucose, insulin, T3, T4, TSH, cortisol, homocysteine, creatinine, uric acid, malondialdehyde, glucose-6 phosphatase, and endogenous antioxidants were determined. All treatments attenuated significantly the propylthiouracil-elevated TSH, homocysteine, creatinine, uric acid, glucose-6-phosphatase, insulin, and malondialdehyde levels, and restored favorably the propylthiouracil-altered lipid profile, T3, T4, and endogenous antioxidant levels. The polyherbal tea-extract (1000 and 1500 mg/kg) treatment and thecombination treatment of tea-extract (1000 mg/kg) with aerobic exercise displayed significant restoration of the suboptimalthyroid function. This may be due to a favorablemodulation ofthe hypothalamic-pituitary–thyroid and the hypothalamic–pituitary–adrenal axes.
Collapse
Key Words
- AC, Abdominal circumference
- AE, Aerobic exercise
- Aerobic exercise
- CAT, Catalase;GA- Gallic acid
- GPx, Glutathione peroxidase
- GR, Glutathione reductase
- GSH, Reduced glutathione
- HDL, High-density lipoprotein
- HOMA, IR- Homeostatic model of insulin resistance
- HPTLC, High-performance thin layer chromatography
- Hcy, Homocysteine
- Hypothyroidism
- IR, Insulin resistance
- LDL, Low-density lipoprotein
- LPO, Lipid peroxidation
- MDA, Malondialedhyde
- NIS, Sodium-iodide symporter
- PTU, Propylthiouracil
- Polyherbal
- Propylthiouracil
- Ru, Rutin
- SOD, Superoxide dismutase
- T1000, Tea-extract 1000 mg/kg
- T1500, Tea-extract 1500 mg/kg
- T3, Triiodothyronine
- T4, thyroxine
- T500, Tea-extract 500 mg/kg
- TAE, T1000 mg/kg + Aerobic exercise
- TC, total cholesterol
- TG, Triglycerides
- TSH, Thyroid stimulating hormone
- Thyroid hormones
- VLDL, Very low-density lipoprotein
Collapse
Affiliation(s)
- Sneha Singh
- Department of Pharmacology & Toxicology, Prin. K. M. Kundnani College of Pharmacy, Jote Joy Building, RambhauSalgaonkar Marg, Cuffe Parade, Colaba, Mumbai, 400005, India
| | - Vandana Panda
- Department of Pharmacology & Toxicology, Prin. K. M. Kundnani College of Pharmacy, Jote Joy Building, RambhauSalgaonkar Marg, Cuffe Parade, Colaba, Mumbai, 400005, India
- Corresponding author.
| | - Sudhamani S.
- Department of Pathology, Dr. D.Y Patil Medical College, Nerul, Navi Mumbai, India
| | - Payal Dande
- Department of Pharmacognosy, SVKM’s NMIMS, School of Pharmacy & Technology Management Mukesh Patel Technology Park, Babulde, Mumbai-Agra Highway, Shirpur, India
| |
Collapse
|
11
|
Tan Y, Gao L, Yin Q, Sun Z, Man X, Du Y, Chen Y. Thyroid hormone levels and structural parameters of thyroid homeostasis are correlated with motor subtype and disease severity in euthyroid patients with Parkinson's disease. Int J Neurosci 2020; 131:346-356. [PMID: 32186220 DOI: 10.1080/00207454.2020.1744595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: This study is to investigate the relationship between thyroid function and Parkinson's disease (PD).Materials and Methods: Totally 77 PD patients were included, who were divided into tremor-dominant-type (TDT), akinetic-rigid-type (ART) and mixed-type (MXT) subgroups. Parkinsonism severity and stage was assessed by modified H-Y stage. Thyroid-stimulating hormone (TSH), fT3 and fT4 levels were detected to analyze thyroid function. Parameters of thyroid homeostasis, including thyroid's secretory capacity (SPINA-GT), the total deiodinase activity (SPINA-GD) and Jostel's TSH index and the thyrotroph thyroid hormone sensitivity index (TTSI), were calculated and compared.Results: Thyroid hormone levels in PD patients were lower than normal controls. Patients with TDT/MXT had significantly higher fT4 level than those with ART. TSH levels were 1.73 ± 0.93 and 2.06 ± 1.04 ulU/ml for patients with TDT/MXT and ART, respectively. The patients in the TDT/MXT group had significantly lower SPINA-GD while significantly higher SPINA-GT than ART group. The fT3 level was significantly higher in early group than advanced group. TSH index in the early group was significantly higher than the advanced group. The fT4 level was negatively correlated with UPDRS motor score. Univariate and multivariable logistic regression analysis indicated that fT4 was positively correlated with PD motor subtype, which disappeared after adjusting for confounding factors. The fT3 level was negatively correlated with PD disease severity, even after adjusting for confounding factors. In female PD patients, fT4 level in TDT/MXT group was significantly higher than ART group. Male PD patients had higher fT4 levels in early patients than advanced patients. Percentage of patients exhibiting ART was decreased significantly in higher fT4 level subgroups. With the increase of TSH index and TTSI, the proportion of advanced PD patients gradually decreased. The proportion of PD patients with TDT/MXT motor subtype gradually increased with the quartiles of SPINA-GT.Conclusion: Thyroid hormone levels and structural parameters of thyroid homeostasis are correlated with motor subtype and disease severity in euthyroid patients with PD.
Collapse
Affiliation(s)
- Yinyin Tan
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Gao
- The People Hospital of Huaiyin Jinan, Jinan, China
| | - Qingqing Yin
- Department of Geriatrics, Department of Geriatric Neurology, Shandong Provincial Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhanfang Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xiao Man
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yan Chen
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| |
Collapse
|
12
|
Maliković J, Feyissa DD, Kalaba P, Marouf BS, Höger H, Hartmann MF, Wudy SA, Schuler G, Lubec G, Aradska J, Korz V. Age and cognitive status dependent differences in blood steroid and thyroid hormone concentrations in intact male rats. Behav Brain Funct 2019; 15:10. [PMID: 31256760 PMCID: PMC6600892 DOI: 10.1186/s12993-019-0161-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022] Open
Abstract
Background Age-dependent alterations of hormonal states have been considered to be involved in age related decline of cognitive abilities. Most of the studies in animal models are based on hormonal substitution in adrenal- and/or gonadectomized rodents or infusion of steroid hormones in intact rats. Moreover, the manipulations have been done timely, closely related to test procedures, thus reflecting short-term hormonal mechanisms in the regulation of learning and memory. Here we studied whether more general states of steroid and thyroid hormone profiles, independent from acute experiences, may possibly reflect long-term learning capacity. A large cohort of aged (17–18 months) intact male rats were tested in a spatial hole-board learning task and a subset of inferior and superior learners was included into the analysis. Young male adult rats (16 weeks of age) were also tested. Four to 8 weeks after testing blood plasma samples were taken and hormone concentrations of a variety of steroid hormones were measured by gas chromatography-tandem mass spectrometry or radioimmunoassay (17β-estradiol, thyroid hormones). Results Aged good learners were similar to young rats in the behavioral task. Aged poor learners but not good learners showed higher levels of triiodothyronine (T3) as compared to young rats. Aged good learners had higher levels of thyroid stimulating hormone (TSH) than aged poor learning and young rats. Both aged good and poor learners showed significantly reduced levels of testosterone (T), 4-androstenedione (4A), androstanediol-3α,17β (AD), dihydrotestosterone (DHT), 17-hydroxyprogesterone (17OHP), higher levels of progesterone (Prog) and similar levels of 17β-estradiol (E2) as compared to young rats. The learning, but not the memory indices of all rats were significantly and positively correlated with levels of dihydrotestosterone, androstanediol-3α,17β and thyroxine (T4), when the impacts of age and cognitive division were eliminated by partial correlation analyses. Conclusion The correlation of hormone concentrations of individuals with individual behavior revealed a possible specific role of these androgen and thyroid hormones in a state of general preparedness to learn.
Collapse
Affiliation(s)
- Jovana Maliković
- Department of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | - Daniel Daba Feyissa
- Department of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | - Predrag Kalaba
- Department of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | - Babak Saber Marouf
- Department of Pharmaceutical Chemistry, University of Vienna, Vienna, Austria
| | - Harald Höger
- Core Unit of Biomedical Research, Division of Laboratory Animal Science and Genetics, Medical University of Vienna, Vienna, Austria
| | - Michaela F Hartmann
- Steroid Research & Mass Spectrometry Unit, Peptide Hormone Research Unit, Laboratory for Translational Hormone Analytics in Pediatric Endocrinology, Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Peptide Hormone Research Unit, Laboratory for Translational Hormone Analytics in Pediatric Endocrinology, Division of Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Gerhard Schuler
- Veterinary Clinic for Obstetrics, Gynecology and Andrology of Large and Small Animals, Faculty of Veterinary Medicine, Justus Liebig University, Giessen, Germany
| | - Gert Lubec
- Neuroscience Laboratory, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Jana Aradska
- Neuroscience Laboratory, Paracelsus Medical University, 5020, Salzburg, Austria.
| | - Volker Korz
- Neuroscience Laboratory, Paracelsus Medical University, 5020, Salzburg, Austria.
| |
Collapse
|
13
|
Delitala AP, Manzocco M, Sinibaldi FG, Fanciulli G. Thyroid function in elderly people: The role of subclinical thyroid disorders in cognitive function and mood alterations. Int J Clin Pract 2018; 72:e13254. [PMID: 30216651 DOI: 10.1111/ijcp.13254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/01/2018] [Accepted: 08/04/2018] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alessandro P Delitala
- U.O.C. di Medicina Interna 2 (Clinica Medica), Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Marta Manzocco
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Federico G Sinibaldi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giuseppe Fanciulli
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| |
Collapse
|
14
|
Pistollato F, Iglesias RC, Ruiz R, Aparicio S, Crespo J, Lopez LD, Manna PP, Giampieri F, Battino M. Nutritional patterns associated with the maintenance of neurocognitive functions and the risk of dementia and Alzheimer’s disease: A focus on human studies. Pharmacol Res 2018; 131:32-43. [DOI: 10.1016/j.phrs.2018.03.012] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/25/2022]
|
15
|
Evaluation of Cognitive Function in Patients with Type 2 Diabetes and Overt Hypothyroidism. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and Aims. Previous studies report the presence of cognitive impairment in patients with overt hypothyroidism. The thyroid hormones are essential for neurological and intellectual functions. Type 2 diabetes mellitus (T2DM) subjects are exposed to higher risk of cognitive function alteration compared to nondiabetic subjects. The aim of the present study was to analyze the cognitive function of T2DM subjects with overt hypothyroidism.
Materials and Methods. We performed an observational study between 2015-2017. A total of 12 patients (11 women and 1 men) with overt hypothyroidism and T2DM were recruited for this study. Their cognitive function was compared with that of subjects of a control group (16 patients - 12 women and 4 men with T2DM but without overt hypothyroidism). Cognitive function was evaluated using the Mini Mental State Examination (MMSE) test. Serum thyroid stimulating hormone (TSH) levels were measured by immunoradiometric assay, free thyroxine (FT4) by radioimmunoassay while fasting plasma glucose (FPG) levels were evaluated using automated devices.
Results. There were no significant differences between the two groups in respect of age and FPG. In the study group, mean TSH and FT4 levels were 11.76±4.43 mIU/L, resepectively 0.53±0.08 ng/dL while in the control group these were 2.60±0.40 mIU/L, respectively 1.12±0.19 ng/dL (p<0.001). Moderate cognitive impairment was present in 3 patients of the study group (25.00%) and in 2 subjects from the control group (12.50%). Mild cognitive impairment was present in 4 patients (33.33%) of the study group and in 2 subjects from the control group (12.50%).
Conclusion. This study showed that MMSE scores are significantly reduced in subjects with T2DM and hypothyroidism compared to subjects with T2DM without hypothyroidism (p<0.004). The study revealed a negative correlation between TSH and MMSE score in the study group.
Collapse
|
16
|
Szlejf C, Suemoto CK, Santos IS, Lotufo PA, Haueisen Sander Diniz MDF, Barreto SM, Benseñor IM. Thyrotropin level and cognitive performance: Baseline results from the ELSA-Brasil Study. Psychoneuroendocrinology 2018; 87:152-158. [PMID: 29096222 DOI: 10.1016/j.psyneuen.2017.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The role of subtle thyroid alterations, such as subclinical thyroid disease and low/high serum thyrotropin (TSH) within the normal range, on cognitive decline is controversial. The aim of this study was to evaluate the association of serum TSH and subclinical thyroid dysfunction with performance on cognitive tests in a large sample of Brazilian middle-aged adults without overt thyroid disease. METHODS In this cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health, we excluded individuals aged 65 years and older, with overt thyroid dysfunction, prevalent stroke, in use of medications that affect thyroid function or that indicate neurologic diseases, and from Asian or indigenous ethnicity. Thyroid status was assessed by serum TSH and free thyroxine (only when the TSH was altered). Individuals were divided according to TSH tertiles and classified according to thyroid function as euthyroidism, subclinical hypothyroidism, or subclinical hyperthyroidism. Cognition was evaluated using delayed word recall test, semantic verbal fluency test, and trail making test version B. The associations of cognitive tests performance with TSH tertiles (using the middle tertile as reference) and thyroid function were investigated using linear regression models, adjusted for an extensive set of possible confounders (sociodemographic characteristics, cardiovascular risk factors, and depression). RESULTS The mean age of the 10,362 participants was 49.5±7.4years, 52.3% women. After adjustment for confounders, the first TSH tertile was associate with worse performance on the trail making test (β=-0.05, 95% CI=-0.09; -0.01, p=0.017). When restricting the analysis to the 9769 individuals with TSH within the normal range, the association between TSH and performance on the trail making test remained significant (β=-0.05, 95% CI=-0.09; -0.01, p=0.020) on multiple linear regression. Subclinical thyroid disease was not associated with performance on cognitive tests. CONCLUSION Low TSH is associated with poorer performance on an executive function test in middle-aged adults without overt thyroid dysfunction.
Collapse
Affiliation(s)
- Claudia Szlejf
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Instituto Nacional de Geriatría, Mexico City, Mexico.
| | - Claudia K Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Global Health and Population, Harvard School of Public Health, Boston, USA
| | - Itamar S Santos
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Isabela M Benseñor
- Center for clinical and epidemiological research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
17
|
Novel spiroimidazopyridine derivative SAK3 improves methimazole-induced cognitive deficits in mice. Neurochem Int 2017; 108:91-99. [DOI: 10.1016/j.neuint.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/19/2022]
|
18
|
Juárez-Cedillo T, Basurto-Acevedo L, Vega-García S, Sánchez-Rodríguez Martha A, Retana-Ugalde R, Juárez-Cedillo E, Gonzalez-Melendez Roberto C, Escobedo-de-la-Peña J. Prevalence of thyroid dysfunction and its impact on cognition in older mexican adults: (SADEM study). J Endocrinol Invest 2017; 40:945-952. [PMID: 28343318 DOI: 10.1007/s40618-017-0654-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/07/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. METHODS We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0 IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3 IU/l and FT4 >23 pmol/l; (3) Overt hypothyroidism: TSH >4.8 IU/l, FT4 <13 pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3 IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8 IU/l, FT4: 13-23 pmol/l. RESULTS The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). CONCLUSIONS The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.
Collapse
Affiliation(s)
- T Juárez-Cedillo
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico.
- High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico.
| | - L Basurto-Acevedo
- Endocrine Research Unit, National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - S Vega-García
- Endocrine Research Unit, National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - A Sánchez-Rodríguez Martha
- Gerontology Research Unit. Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - R Retana-Ugalde
- Gerontology Research Unit. Faculty of High Studies (FES) Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - E Juárez-Cedillo
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico
| | | | - J Escobedo-de-la-Peña
- Unidad de Investigación en Epidemiología Clínica, Hospital General Regional No 1 Carlos McGregor Sánchez Navarro, Gabriel Mancera 222, Colonia Del Valle, Delegación, Benito Juárez, 03100, México, DF, Mexico
| |
Collapse
|
19
|
Roy S, Weinstock JL, Ishino AS, Benites JF, Pop SR, Perez CD, Gumbs EA, Rosenbaum JA, Roccato MK, Shah H, Contino G, Hunter K. Association of Cognitive Impairment in Patients on 3-Hydroxy-3-Methyl-Glutaryl-CoA Reductase Inhibitors. J Clin Med Res 2017; 9:638-649. [PMID: 28611866 PMCID: PMC5458663 DOI: 10.14740/jocmr3066w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular diseases are the leading cause of death in the United States. A reduction in cholesterol with 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (statin) significantly reduces mortality and morbidity. Statins may be associated with cognitive impairment or dementia. Our aim was to study the association of cognitive impairment or dementia in patients who were on a statin. METHODS Electronic medical records of 3,500 adult patients in our suburban internal medicine office were reviewed. RESULTS There were 720 (20.6%) patients in the statin treatment group. Dementia or cognitive impairment was an associated comorbid condition in 7.9% patients in the statin treatment group compared to 3.1% patients in the non-statin group (P < 0.001). Analysis of all of the patients with cognitive impairment or dementia showed that among the age ranges of 51 years through 100 years, the patients in the statin treatment group had a higher prevalence of cognitive impairment or dementia compared to the non-statin group. In the statin treatment group, we found significantly higher prevalence of hyperlipidemia (86.3%), hypertension (69.6%), diabetes mellitus (36.0%), osteoarthritis (31.5%), coronary artery disease (26.1%), hypothyroidism (21.5%) and depression (19.3%) compared to the non-statin group (P < 0.001). About 39.9% of the patients with dementia or cognitive impairment were on statin therapy compared to 18.9% patients who had no dementia or cognitive impairment and were on statin therapy (P < 0.001). Among the patients with cognitive deficit or dementia in the statin treatment group, the majority of the patients were either on atorvastatin (43.9%) or simvastatin (35.1%), followed by rosuvastatin (12.2%) and pravastatin (8.8%). We found greater odds of dementia or cognitive impairment with each year increase in age (1.3 times), in women (2.2 times), African American race (2.7 times), non-consumption of moderate amount of alcohol (two times), diabetes mellitus (1.6 times), hypothyroidism (1.7 times), cerebrovascular accident (3.2 times), and other rheumatological diseases (1.8 times). CONCLUSIONS The association of dementia or cognitive impairment was significantly higher in the patients who were on statin therapy compared to the patients who were not on a statin.
Collapse
Affiliation(s)
- Satyajeet Roy
- Department of Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | | | | | | | | | | | | | - Hely Shah
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Krystal Hunter
- Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, USA
| |
Collapse
|
20
|
Abstract
Mild cognitive impairment (MCI) occurs along a continuum from normal cognition to dementia. A roadblock to earlier diagnosis and potential treatment is the lack of consistency with screening for MCI. Universal screening would be ideal, but is limited. Once a diagnosis of MCI is made, it is important for the clinician to evaluate for reversible causes. At present time, there are no pharmacologic treatments proven to slow or cure progression of MCI to dementia; nonetheless, there is evidence that lifestyle modifications including diet, exercise, and cognitive stimulation may be effective.
Collapse
Affiliation(s)
- Angela M Sanford
- Department of Internal Medicine-Geriatrics, Saint Louis University School of Medicine, 1402 South Grand Boulevard, Suite M238, St Louis, MO 63104, USA.
| |
Collapse
|
21
|
Thyroid function and neuropsychological status in older adults. Physiol Behav 2016; 164:34-9. [DOI: 10.1016/j.physbeh.2016.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/18/2022]
|
22
|
Samuels MH, Kaimal R, Waring A, Fink HA, Yaffe K, Hoffman AR, Orwoll E, Bauer D. Thyroid Function Variations Within the Reference Range Do Not Affect Quality of Life, Mood, or Cognitive Function in Community-Dwelling Older Men. Thyroid 2016; 26:1185-94. [PMID: 27484219 PMCID: PMC5036313 DOI: 10.1089/thy.2016.0104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Variations in thyroid function within the laboratory reference range have been associated with a number of clinical outcomes. However, quality of life, mood, and cognitive function have not been extensively studied, and it is not clear whether mild variations in thyroid function have major effects on these neurocognitive outcomes. METHODS Data were analyzed from the Osteoporotic Fractures in Men (MrOS) Study, a cohort of community-dwelling men aged 65 years and older in the United States. A total of 539 participants who were not taking thyroid medications and had age-adjusted TSH levels within the reference range underwent detailed testing of quality of life, mood, and cognitive function at baseline. The same quality of life, mood, and cognitive outcomes were measured again in 193 of the men after a mean follow-up of 6 years. Outcomes were analyzed using thyrotropin (TSH) and free thyroxine (FT4) levels as continuous independent variables, adjusting for relevant covariates. RESULTS At baseline, there were no associations between TSH or FT4 levels and measures of quality of life, mood, or cognition in the 539 euthyroid men. Baseline thyroid function did not predict changes in these outcomes over a mean of 6 years in the 193 men in the longitudinal analysis. CONCLUSIONS Variations in thyroid function within the age-adjusted laboratory reference range are not associated with variations in quality of life, mood, or cognitive function in community-dwelling older men.
Collapse
Affiliation(s)
- Mary H. Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon
| | - Rajani Kaimal
- Biostatistics & Design Program, Oregon Health & Science University – Portland State University School of Public Health, Portland, Oregon
| | - Avantika Waring
- University of California San Francisco–San Francisco General Hospital, San Francisco, California
| | - Howard A. Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, Minnesota
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, San Francisco, California
| | | | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon
| | - Douglas Bauer
- Department of Medicine and Epidemiology & Biostatistics, University of California, San Francisco, California
| |
Collapse
|
23
|
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] [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
|
24
|
Wu Y, Pei Y, Wang F, Xu D, Cui W. Higher FT4 or TSH below the normal range are associated with increased risk of dementia: a meta-analysis of 11 studies. Sci Rep 2016; 6:31975. [PMID: 27558885 PMCID: PMC4997309 DOI: 10.1038/srep31975] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Observational studies of thyroid function and dementia have reported conflicting results. We reviewed cohort and case-control studies from MEDLINE, EMBASE, Web of Science and the Cochrane Library that focused on the association between serum thyroxine, thyrotropin and dementia. A total of 24,952 participants from three case-control and eight cohort studies were included. The relationships between dementia and the per standard deviation (SD) increment of free thyroxine (FT4) (random relative ratio (RR) = 1.08, 95% confidence interval (CI) 1.00–1.17) and thyroid-stimulating hormone (TSH) (fixed RR = 0.91, 95% CI 0.84–0.99) were well established. TSH levels in the low category were associated with an increased risk of dementia (fixed RR = 1.60, 95% CI 1.27–2.00). However, the positive association was confined to TSH levels below the normal range (fixed RR = 1.77, 95% CI 1.31–2.39), not those in the lower tertile of the normal range (fixed RR = 1.39, 95% CI 0.98–1.97). Additionally, dementia was not significantly associated with high TSH levels (fixed RR = 0.99, 95% CI 0.76–1.29). Furthermore, there was no positive association between dementia and the low or high categories of TSH in men. Thus, individuals with higher FT4 levels or those with TSH levels below the normal range have an increased risk of dementia.
Collapse
Affiliation(s)
- Yue Wu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuqing Pei
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Fei Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Danfei Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Cui
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
25
|
Hu Y, Wang ZC, Guo QH, Cheng W, Chen YW. Is thyroid status associated with cognitive impairment in elderly patients in China? BMC Endocr Disord 2016; 16:11. [PMID: 26897535 PMCID: PMC4761141 DOI: 10.1186/s12902-016-0092-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/10/2016] [Indexed: 11/21/2022] Open
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
|
26
|
Beydoun MA, Beydoun HA, Rostant OS, Dore GA, Fanelli-Kuczmarski MT, Evans MK, Zonderman AB. Thyroid hormones are associated with longitudinal cognitive change in an urban adult population. Neurobiol Aging 2015; 36:3056-3066. [PMID: 26329688 DOI: 10.1016/j.neurobiolaging.2015.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 12/27/2022]
Abstract
Recent evidence indicates that thyroid hormones may be closely linked to cognition among adults. We investigated associations between thyroid hormones and longitudinal cognitive change, within and outside of reference ranges, stratifying by sex and race. This longitudinal study used data from the Healthy Aging in Neighborhoods of Diversity Across the Lifespan study, set in Baltimore City, MD, 2004-2013, on adults aged 30-64 years at baseline visit, with a length of follow-up between visits 1 and 2 ranging from <1 to 8 years; mean ± standard deviation: 4.64 ± 0.93. The final analytic sample sizes ranged from 1486 to 1602 participants with 1.6-1.7 visits per participant (total visits: 2496-2757), depending on the cognitive test. Eleven cognitive test scores spanning domains of learning or memory, language or verbal, attention, visuospatial and/or visuoconstruction, psychomotor speed, executive function, and mental status were used. Mixed-effects regression models were conducted, interacting time of follow-up with several thyroid exposures. Whites performed better than African Americans, with only 4 cognitive test scores of 11 declining significantly over time. Importantly, above reference range thyroid stimulating hormone (vs. reference range, thyroid stimulating hormone, above reference range [TSHarr]) was linked to faster rates of decline on the digits span backwards test, reflecting working memory (TSHarr × time γ ± standard error: -0.14 ± 0.05, p = 0.006) and clock-command, at test of visuospatial and/or visuoconstruction abilities (TSHarr × Time γ ± standard error: -0.10 ± 0.04, p = 0.004). The latter finding was replicated when comparing normal thyroid function to "subclinical hypothyroidism". Within-reference ranges, a higher thyroid stimulating hormone was related to faster decline on the clock-command test scores in women. In sum, higher baseline thyroid stimulating hormone was associated with faster cognitive decline over-time among urban US adults, specifically in domains of working memory and visuospatial and/or visuoconstruction abilities.
Collapse
Affiliation(s)
- May A Beydoun
- NIH Biomedical Research Center, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - Hind A Beydoun
- Graduate Program in Public Health, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ola S Rostant
- NIH Biomedical Research Center, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Greg A Dore
- NIH Biomedical Research Center, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | | | - Michele K Evans
- NIH Biomedical Research Center, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B Zonderman
- NIH Biomedical Research Center, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| |
Collapse
|
27
|
Bojar I, Owoc A, Gujski M, Witczak M, Gnatowski M, Walecka I. Functional status of thyroid and cognitive functions after menopause. Med Sci Monit 2015; 21:1625-33. [PMID: 26042394 PMCID: PMC4467600 DOI: 10.12659/msm.892880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Thyroid activity plays a role in cognition. However, the relation between the functional state of thyroid and neuropsychiatric changes proceeding with age among people without clinical symptoms of thyroid dysfunction is still unknown. The aim of this study was analysis of cognitive function levels in reference to thyroid examination: thyroid-stimulating hormone (TSH), total thyroxin (TT4), triiodothyronine (TT3), free thyroxin (FT4), free triiodothyronine (FT3), thyroperoxidase antibodies (TPO-AB), and thyroglobulin antibodies (Tg-AB), TSH receptor antibodies (AB-TSHR) in women after menopause. Material/Methods A group of 383 women was recruited for the study. The inclusion criteria were: minimum two years after the last menstruation and no dementia signs on Montreal Cognitive Assessment (MoCA). Computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnostic cognitive functions. The blood plasma values were determined: TSH, FT3, FT4, TT3, TT4, TPO-AB, Tg-AB, and AB-TSHR. Statistical analysis was performed using Pearson’s correlation coefficient and analysis of variance in STATISTICA software. Results In women after menopause, TSH was negatively correlated with NCI results, executive functions, complex attention, and cognitive flexibility. FT4 was positively correlated with results of psychomotor speed. TT3 and TT4 were negatively correlated with results of memory and verbal memory. Furthermore, TT4 was negatively correlated with NCI, executive functions, and cognitive flexibility. TPO-AB was negatively correlated with results of memory, verbal memory, and psychomotor speed. Tg-AB was positively correlated with results of reaction time. AB-TSHR was negatively correlated with NCI results, memory, executive functions, psychomotor speed, complex attention, and cognitive flexibility. Conclusions Our study supports the importance of thyroid functionality in cognitive functioning in a group of women after menopause. The values of TSH, TT3, TT4, TPO-AB, and AB-TSHR were higher and FT4 was lower in examined women. The results were poorer in examination of cognitive functions measured with a battery of CNS-VS tests.
Collapse
Affiliation(s)
- Iwona Bojar
- Department for Health Problems of Ageing, Institute of Rural Health in Lublin, Lublin, Poland
| | - Alfred Owoc
- College of Public Health, Zielona Góra, Poland
| | - Mariusz Gujski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Maciej Gnatowski
- Department of Trauma-Orthopedic Surgery, District Hospital, Wołomin, Poland
| | - Irena Walecka
- Clinic of Dermatology, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland
| |
Collapse
|
28
|
Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients. Eur Arch Psychiatry Clin Neurosci 2015; 265:67-72. [PMID: 25193677 DOI: 10.1007/s00406-014-0529-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
Thyroid diseases are often associated with psychiatric disorders. The prevalence of autoimmune thyroiditis in the general population is estimated to be at about 5-14 %. A clinical study was conducted to evaluate the association between autoimmune thyroiditis and depression in psychiatric outpatients. Fifty-two patients with depression and nineteen patients with schizophrenia (serving as control group), attending a psychiatric outpatient unit, were included. In addition to the measurement of thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine, antithyroid peroxidase (anti-TPO) antibodies, and anti-thyroglobulin antibodies, ultrasound examination of the thyroid gland was performed. The proportion of pathologically increased anti-TPO levels in patients with depression was high. Furthermore, the distribution of pathologically increased anti-TPO levels was significantly (χ (2) = 5.5; p = 0.019) different between patients with depression (32.7 %) and patients with schizophrenia (5.3 %). In a gender- and age-adjusted logistic regression, the odds ratio of uni- or bipolar patients with depression for an autoimmune thyroiditis was ten times higher (95 % CI = 1.2-85.3) when compared with schizophrenia patients. TSH basal level did not differ between patients with depression and patients with schizophrenia. Our study demonstrates a strong association between anti-TPO levels, which are considered to be of diagnostic value for autoimmune thyroiditis (in combination with a hypoechoic thyroid in ultrasonography) with uni- or bipolar depression. It should be noted that the routinely measured TSH level is not sufficient in itself to diagnose this relevant autoimmune comorbidity.
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Overt hypothyroidism has major effects on neuropsychiatric function, but patients with mild hypothyroidism may attribute unrelated neuropsychiatric symptoms to their thyroid condition. This review will summarize data on neuropsychiatric effects of hypothyroidism, and provide guidelines regarding the relationship between hypothyroidism and neuropsychiatric issues, and treatment indications. RECENT FINDINGS Clinical investigations and functional imaging studies confirm that overt hypothyroidism is associated with affective and cognitive decrements, largely reversible with treatment. In contrast, subclinical hypothyroidism is not associated with major neuropsychiatric deficits, although studies utilizing sensitive measures show small deficits in memory and executive function. Neuropsychiatric complaints are more common when patients are aware of their thyroid disease, regardless of their thyroid function at the time of testing. SUMMARY Neuropsychiatric dysfunction is common in overt hypothyroidism and will improve (perhaps not completely resolve) with therapy. Deficits related to thyroid dysfunction are usually mild in subclinical hypothyroidism, and realistic expectations need to be set regarding symptom reversibility with treatment. Patients with mild hypothyroidism and significant distress related to neuropsychiatric symptoms, most likely, have independent diagnoses that should be evaluated separately.
Collapse
Affiliation(s)
- Mary H Samuels
- Professor of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, CR107, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, 503-494-5242,
| |
Collapse
|
30
|
Abstract
Overt hypothyroidism and thyrotoxicosis are associated with significant decrements in mood and cognitive function, and therapy usually leads to improvement in these symptoms. In contrast, major affective or cognitive dysfunction is not typical of subclinical thyroid disease. Subtle deficits in specific cognitive domains (primarily working memory and executive function) likely exist in subclinical hypothyroidism and thyrotoxicosis, but these are unlikely to cause major problems in most patients. Patients with mild thyroid disease and significant distress related to mood or cognition most likely have independent diagnoses that should be evaluated and treated separately.
Collapse
Affiliation(s)
- Mary H Samuels
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| |
Collapse
|
31
|
Yuan L, Tian Y, Zhang F, Dai F, Luo L, Fan J, Wang K. Impairment of attention networks in patients with untreated hyperthyroidism. Neurosci Lett 2014; 574:26-30. [DOI: 10.1016/j.neulet.2014.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
|
32
|
Parsaik AK, Singh B, Roberts RO, Pankratz S, Edwards KK, Geda YE, Gharib H, Boeve BF, Knopman DS, Petersen RC. Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study. JAMA Neurol 2014; 71:201-7. [PMID: 24378475 DOI: 10.1001/jamaneurol.2013.5402] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE An association of clinical and subclinical hypothyroidism with mild cognitive impairment (MCI) has not been established. OBJECTIVE To evaluate the association of clinical and subclinical hypothyroidism with MCI in a large population-based cohort. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional, population-based study was conducted in Olmsted County, Minnesota. Randomly selected participants were aged 70 to 89 years on October 1, 2004, and were without documented prevalent dementia [CORRECTED]. A total of 2050 participants were evaluated and underwent in-person interview, neurologic evaluation, and neuropsychological testing to assess performance in memory, attention/executive function, and visuospatial and language domains. Participants were categorized by consensus as being cognitively normal, having MCI, or having dementia according to published criteria. Clinical and subclinical hypothyroidism were ascertained from a medical records linkage system. MAIN OUTCOMES AND MEASURES Association of clinical and subclinical hypothyroidism with MCI. RESULTS Among 1904 eligible participants, the frequency of MCI was 16% in 1450 individuals with normal thyroid function, 17% in 313 persons with clinical hypothyroidism, and 18% in 141 individuals with subclinical hypothyroidism. After adjusting for covariates (age, educational level, sex, apolipoprotein E ε4, depression, diabetes mellitus, hypertension, stroke, body mass index, and coronary artery disease) we found no significant association between clinical or subclinical hypothyroidism and MCI (odds ratio [OR], 0.99 [95% CI, 0.66-1.48] and 0.88 [0.38-2.03], respectively). No effect of sex interaction was seen on these effects. In stratified analysis, the odds of MCI with clinical and subclinical hypothyroidism among men was 1.02 (95% CI, 0.57-1.82) and 1.29 (0.68-2.44) and, among women, was 1.04 (0.66-1.66) and 0.86 (0.37-2.02), respectively. CONCLUSIONS AND RELEVANCE In this population-based cohort of elderly people, neither clinical nor subclinical hypothyroidism was associated with MCI. Our findings need to be validated in a separate setting using the published criteria for MCI and confirmed in a longitudinal study.
Collapse
Affiliation(s)
- Ajay K Parsaik
- Department of Psychiatry and Behavior Sciences, The University of Texas Medical School, Houston2Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota3Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Balwinder Singh
- Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota3Department of Neurology, Mayo Clinic, Rochester, Minnesota4Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Fargo
| | - Rosebud O Roberts
- Department of Neurology, Mayo Clinic, Rochester, Minnesota5Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Shane Pankratz
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Kelly K Edwards
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Yonas E Geda
- Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona8Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Hossein Gharib
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bradley F Boeve
- Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota3Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - David S Knopman
- Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota3Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Ronald C Petersen
- Mayo Alzheimer's Disease Research Center, Mayo Clinic, Rochester, Minnesota3Department of Neurology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
33
|
Medici M, Direk N, Visser WE, Korevaar TIM, Hofman A, Visser TJ, Tiemeier H, Peeters RP. Thyroid function within the normal range and the risk of depression: a population-based cohort study. J Clin Endocrinol Metab 2014; 99:1213-9. [PMID: 24564323 DOI: 10.1210/jc.2013-3589] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Overt hypo- and hyperthyroidism are associated with an increased risk of depression. Little is known about the effects of variation in thyroid function within the normal range on the risk of depression. OBJECTIVE The objective of the study was to examine the association between normal-range thyroid function and the risk of depression. DESIGN, SETTING, AND PARTICIPANTS This was a cohort study in 1503 Dutch men and women, aged 70.6 (7.3) (mean [SD]) years. At baseline, serum TSH, thyroperoxidase antibody levels, and depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D)] were assessed. A CES-D of 16 or greater is indicative of a depressive disorder. During follow-up (mean 8.0 y), participants were continuously monitored for the occurrence of incident depressive syndromes (n = 156). RESULTS Cross-sectionally, persons in the lowest TSH tertile (0.3-1.0 mU/L) had more depressive symptoms [CES-D score (mean): 7.95 vs 6.63, P = .014] as well as an increased risk of a CES-D of 16 or greater [10.7% vs 5.0%, odds ratio (95% confidence interval) 2.22 (1.18-4.17)], compared with persons in the highest normal range TSH tertile (1.6-4.0 mU/L). In the prospective analyses, persons in the lowest TSH tertile who were depression free at baseline had a higher risk of incident depressive syndromes [12.3% vs 7.6%, odds ratio (95% confidence interval) 1.85 (1.10-3.11)]. Thyroid autoimmunity (thyroperoxidase antibody positivity) was not associated with CES-D scores or incident depressive syndromes. CONCLUSIONS Elderly persons with low-normal TSH levels have more concurrent depressive symptoms as well as a substantially increased risk of developing a depressive syndrome in the subsequent years. This study identifies low-normal TSH as an important risk factor for depression in the elderly.
Collapse
Affiliation(s)
- Marco Medici
- Departments of Internal Medicine (M.M., W.E.V., T.I.M.K., T.J.V., R.P.P.) and Epidemiology (N.D., A.H., H.T.), Erasmus Medical Center, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Dias GRM, de Almeida TM, Sudati JH, Dobrachinski F, Pavin S, Soares FAA, Nogueira CW, Barbosa NBV. Diphenyl diselenide supplemented diet reduces depressive-like behavior in hypothyroid female rats. Physiol Behav 2014; 124:116-22. [DOI: 10.1016/j.physbeh.2013.10.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/22/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022]
|
35
|
Roseni Mundstock Dias G, Medeiros Golombieski R, de Lima Portella R, Pires do Amaral G, Antunes Soares F, Teixeira da Rocha JB, Wayne Nogueira C, Vargas Barbosa N. Diphenyl diselenide modulates gene expression of antioxidant enzymes in the cerebral cortex, hippocampus and striatum of female hypothyroid rats. Neuroendocrinology 2014; 100:45-59. [PMID: 25012258 DOI: 10.1159/000365515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cellular antioxidant signaling can be altered either by thyroid disturbances or by selenium status. AIMS To investigate whether or not dietary diphenyl diselenide can modify the expression of genes of antioxidant enzymes and endpoint markers of oxidative stress under hypothyroid conditions. METHODS Female rats were rendered hypothyroid by continuous exposure to methimazole (MTZ; 20 mg/100 ml in the drinking water) for 3 months. Concomitantly, MTZ-treated rats were either fed or not with a diet containing diphenyl diselenide (5 ppm). mRNA levels of antioxidant enzymes and antioxidant/oxidant status were determined in the cerebral cortex, hippocampus and striatum. RESULTS Hypothyroidism caused a marked upregulation in mRNA expression of catalase, superoxide dismutase (SOD-1, SOD-3), glutathione peroxidase (GPx-1, GPx-4) and thioredoxin reductase (TrxR-1) in brain structures. SOD-2 was increased in the cortex and striatum, while TrxR-2 increased in the cerebral cortex. The increase in mRNA expression of antioxidant enzymes was positively correlated with the Nrf-2 transcription in the cortex and hippocampus. Hypothyroidism caused oxidative stress, namely an increase in lipid peroxidation and reactive oxygen species levels in the hippocampus and striatum, and a decrease in nonprotein thiols in the cerebral cortex. Diphenyl diselenide was effective in reducing brain oxidative stress and normalizing most of the changes observed in gene expression of antioxidant enzymes. CONCLUSION The present work corroborates and extends that hypothyroidism disrupts antioxidant enzyme gene expression and causes oxidative stress in the brain. Furthermore, diphenyl diselenide may be considered a promising molecule to counteract these effects in a hypothyroidism state.
Collapse
Affiliation(s)
- Glaecir Roseni Mundstock Dias
- Programa de Pós-Graduação em Bioquímica Toxicológica, Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Villanueva I, Alva-Sánchez C, Pacheco-Rosado J. The role of thyroid hormones as inductors of oxidative stress and neurodegeneration. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2013; 2013:218145. [PMID: 24386502 PMCID: PMC3872098 DOI: 10.1155/2013/218145] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/08/2013] [Indexed: 01/14/2023]
Abstract
Reactive oxygen species (ROS) are oxidizing agents amply implicated in tissue damage. ROS production is inevitably linked to ATP synthesis in most cells, and the rate of production is related to the rate of cell respiration. Multiple antioxidant mechanisms limit ROS dispersion and interaction with cell components, but, when the balance between ROS production and scavenging is lost, oxidative damage develops. Many traits of aging are related to oxidative damage by ROS, including neurodegenerative diseases. Thyroid hormones (THs) are a major factor controlling metabolic and respiratory rates in virtually all cell types in mammals. The general metabolic effect of THs is a relative acceleration of the basal metabolism that includes an increase of the rate of both catabolic and anabolic reactions. THs are related to oxidative stress not only by their stimulation of metabolism but also by their effects on antioxidant mechanisms. Thyroid dysfunction increases with age, so changes in THs levels in the elderly could be a factor affecting the development of neurodegenerative diseases. However, the relationship is not always clear. In this review, we analyze the participation of thyroid hormones on ROS production and oxidative stress, and the way the changes in thyroid status in aging are involved in neurodegenerative diseases.
Collapse
Affiliation(s)
- I. Villanueva
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, IPN. Prol. Carpio y Plan de Ayala, s/n, 11340 México City, DF, Mexico
| | - C. Alva-Sánchez
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, IPN. Prol. Carpio y Plan de Ayala, s/n, 11340 México City, DF, Mexico
| | - J. Pacheco-Rosado
- Departamento de Fisiología, Escuela Nacional de Ciencias Biológicas, IPN. Prol. Carpio y Plan de Ayala, s/n, 11340 México City, DF, Mexico
| |
Collapse
|
37
|
The reduced serum free triiodothyronine and increased dorsal hippocampal SNAP-25 and Munc18-1 had existed in middle-aged CD-1 mice with mild spatial cognitive impairment. Brain Res 2013; 1540:9-20. [DOI: 10.1016/j.brainres.2013.09.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/20/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
|
38
|
Thyroid and aging or the aging thyroid? An evidence-based analysis of the literature. J Thyroid Res 2013; 2013:481287. [PMID: 24106641 PMCID: PMC3782841 DOI: 10.1155/2013/481287] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/07/2013] [Indexed: 11/17/2022] Open
Abstract
Thyroid hormone production, metabolism, and action change with aging. The reference ranges for serum thyrotropin and thyroid hormones are derived mainly from younger populations. Thus, the prevalence of subclinical thyroid dysfunction is increased greatly in the elderly. However, it is unclear whether mild thyroid dysfunction in the elderly is associated with adverse outcomes. In this review, we discuss current evidence-based literature on thyroid function in the elderly and whether subclinical thyroid dysfunction in the elderly should be treated.
Collapse
|
39
|
Thyroid function and cognition in the euthyroid elderly: a case-control study embedded in Quebec longitudinal study - NuAge. Psychoneuroendocrinology 2013; 38:1772-6. [PMID: 23507188 DOI: 10.1016/j.psyneuen.2013.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/15/2013] [Accepted: 02/19/2013] [Indexed: 11/21/2022]
Abstract
It is presently unclear whether there is a significant association between thyroid function and cognitive decline in euthyroid elderly. This case-control study aimed to examine serum thyroid stimulating hormone (TSH), total thyroxine, free thyroxine, total triiodothyronine, and free triiodothyronine in relation to cognitive decline over a 3-year period in a subsample of 62 participants (31 pairs) aged 67 years and over at baseline from the NuAge study (Quebec longitudinal study). They were matched for age, sex and global cognition. In conditional regression logistic models, there was no significant association between any thyroid function indices and the 3-year risk of cognitive decline as measured with the Modified Mini-Mental State Examination (3MS). TSH and thyroid hormones do not appear to be associated with cognitive decline in euthyroid older persons. These findings need confirmation given the small number of pairs of subjects.
Collapse
|
40
|
Abstract
BACKGROUND A relationship between hypothyroidism and depression has been assumed for many years; however, the true nature of this association has been difficult to define with many conflicting studies. In recent years, our knowledge in this area has increased significantly with large cohort studies and genetically driven studies being published. OBJECTIVES We reviewed the literature on thyroid function and depression to determine if this relationship has been clarified. METHODS We performed a search on the Pubmed database using the terms 'thyroid
' and 'mental health
', 'depression
' and 'well-being
'. RESULTS Large epidemiological studies generally suggest no association between thyroid function and depression in subjects without thyroid disease. Subjects on thyroxine have poorer psychological well-being than subjects with no thyroid disease even if biochemically euthyroid, they also show an association between thyroid function and well-being. Whilst there is some early evidence that genetic factors can influence well-being on thyroxine and response to combination therapy, there is also evidence to suggest that much morbidity on thyroxine may be due to initial misdiagnosis and mis-attribution of symptoms. CONCLUSION Despite the large number of studies, the relationship between thyroid function and depression remains poorly defined. Clarification of the proportion of subjects on thyroxine incorrectly may assist the large (perhaps genetically driven) studies needed to move forward in this area, as it is expected that they cloud the results.
Collapse
Affiliation(s)
- Colin M. Dayan
- Cardiff University School of Medicine, Heath Park, Cardiff, UK
- *Colin M. Dayan, MA, FRCP, PhD, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN (UK), E-Mail
| | - Vijay Panicker
- Department of Endocrinology, Sir Charles Gairdner Hospital, Nedlands, W.A., Australia
| |
Collapse
|
41
|
Beydoun MA, Beydoun HA, Kitner-Triolo MH, Kaufman JS, Evans MK, Zonderman AB. Thyroid hormones are associated with cognitive function: moderation by sex, race, and depressive symptoms. J Clin Endocrinol Metab 2013; 98:3470-81. [PMID: 23690311 PMCID: PMC3733856 DOI: 10.1210/jc.2013-1813] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Recent evidence indicates that thyroid hormones may be closely linked to cognition among adults. OBJECTIVE We investigated associations between thyroid hormones and cognitive performance, while testing effect modification by sex, race, and elevated depressive symptoms (EDS). DESIGN This cross-sectional study used extensive data from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. SETTING The study was conducted in Baltimore, Maryland, from 2004 to 2009. PARTICIPANTS PARTICIPANTS were U.S. adults aged 30 to 64 years. The sample size ranged from 1275 to 1346. MAIN OUTCOME MEASURES Outcomes included 13 cognitive test scores spanning domains of learning/memory, language/verbal, attention, visuo-spatial/visuo-construction, psychomotor speed, executive function, and mental status. RESULTS Within reference ranges and after Bonferroni correction, elevated free thyroxine (fT4) was associated with better performance on tests of visuo-spatial/visuo-construction ability (overall, women, and African Americans) and learning/memory (women and African Americans), whereas a higher total thyroxine (tT4) level was associated with better performance in the domain of psychomotor speed (individuals without EDS) and higher levels of both fT4 and tT4 were linked to better language/verbal test performance among men. In contrast, higher T3(% uptake) was related to better performance on tests of visuo-spatial/visuo-construction ability and psychomotor speed among whites. When the above reference range was compared within the overall population and after Bonferroni correction, a within reference range fT4 was linked to better performance on visuo-spatial/visuo-constrution ability and psychomotor speed, whereas a below normal range TSH level (compared with the reference range) was linked to better performance in domains of psychomotor speed and attention. CONCLUSIONS Thyroid hormones and cognition are closely linked differentially by sex, race, and EDS status.
Collapse
Affiliation(s)
- M A Beydoun
- National Institutes of Health Biomedical Research Center, National Institute on Aging, Intramural Research Program, 251 Bayview Boulevard, Suite 100, Room 04B118, Baltimore, Maryland 21224, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Johansson P, Almqvist EG, Johansson JO, Mattsson N, Hansson O, Wallin A, Blennow K, Zetterberg H, Svensson J. Reduced cerebrospinal fluid level of thyroxine in patients with Alzheimer's disease. Psychoneuroendocrinology 2013; 38:1058-66. [PMID: 23159010 DOI: 10.1016/j.psyneuen.2012.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known of the association between thyroid hormones in the central nervous system and Alzheimer's disease (AD). We determined thyroid hormone levels in serum and cerebrospinal fluid (CSF) in a well-defined homogeneous mono-center population. METHODS Fifty-nine consecutive patients under primary evaluation for cognitive impairment were recruited. The participants included patients with AD or mild cognitive impairment (MCI) diagnosed with AD upon follow-up (n=31), patients with stable MCI (SMCI, n=13), patients with other dementias (n=15), and healthy controls (n=19). Thyroid hormones in serum and CSF and AD biomarkers in CSF were analyzed using established immunochemical assays. Cognitive impairment was estimated using mini-mental state examination (MMSE). RESULTS Serum levels of free and total thyroxine (T4) and triiodothyronine (T3) were similar in all groups whereas a marginal increase in serum thyroid-stimulating hormone (TSH) level was observed in the AD patients. The CSF level of total T4 was decreased in patients with AD and other dementias compared to SMCI (both P=0.01) and healthy controls (both P=0.001), whereas CSF levels of TSH and total T3 were unchanged. In the total study population, CSF total T4 level correlated positively with MMSE score (r=0.26, P<0.05) and negatively with CSF total-tau (T-Tau) level (r=-0.23, P<0.05). CONCLUSION Patients with AD as well as other dementias had signs of mild brain hypothyroidism, which could only to a small extent be detected in serum values.
Collapse
Affiliation(s)
- Per Johansson
- Department of Neuropsychiatry, Skaraborg Hospital, Falköping, Sweden
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Wijsman LW, de Craen AJM, Trompet S, Gussekloo J, Stott DJ, Rodondi N, Welsh P, Jukema JW, Westendorp RGJ, Mooijaart SP. Subclinical thyroid dysfunction and cognitive decline in old age. PLoS One 2013; 8:e59199. [PMID: 23554996 PMCID: PMC3595244 DOI: 10.1371/journal.pone.0059199] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/12/2013] [Indexed: 01/07/2023] Open
Abstract
Background Subclinical thyroid dysfunction has been implicated as a risk factor for cognitive decline in old age, but results are inconsistent. We investigated the association between subclinical thyroid dysfunction and cognitive decline in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Methods Prospective longitudinal study of men and women aged 70–82 years with pre-existing vascular disease or more than one risk factor to develop this condition (N = 5,154). Participants taking antithyroid medications, thyroid hormone supplementation and/or amiodarone were excluded. Thyroid function was measured at baseline: subclinical hyper- and hypothyroidism were defined as thyroid stimulating hormones (TSH) <0.45 mU/L or >4.50 mU/L respectively, with normal levels of free thyroxine (FT4). Cognitive performance was tested at baseline and at four subsequent time points during a mean follow-up of 3 years, using five neuropsychological performance tests. Results Subclinical hyperthyroidism and hypothyroidism were found in 65 and 161 participants, respectively. We found no consistent association of subclinical hyper- or hypothyroidism with altered cognitive performance compared to euthyroid participants on the individual cognitive tests. Similarly, there was no association with rate of cognitive decline during follow-up. Conclusion We found no consistent evidence that subclinical hyper- or hypothyroidism contribute to cognitive impairment or decline in old age. Although our data are not in support of treatment of subclinical thyroid dysfunction to prevent cognitive dysfunction in later life, only large randomized controlled trials can provide definitive evidence.
Collapse
Affiliation(s)
- Liselotte W. Wijsman
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anton J. M. de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stella Trompet
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - David J. Stott
- Academic Section of Geriatric Medicine, Faculty of Medicine, University of Glasgow, Glasgow, Scotland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselhospital, University of Bern, Bern, Switzerland
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudi G. J. Westendorp
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Institute for Evidence-Based Medicine in Old Age | IEMO, Leiden, The Netherlands
- * E-mail:
| |
Collapse
|
44
|
Joffe RT, Pearce EN, Hennessey JV, Ryan JJ, Stern RA. Subclinical hypothyroidism, mood, and cognition in older adults: a review. Int J Geriatr Psychiatry 2013; 28:111-8. [PMID: 22410877 PMCID: PMC3488161 DOI: 10.1002/gps.3796] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 02/06/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To perform a critical review of the literature on the mood and cognitive changes associated with subclinical hypothyroidism (SCH), with an emphasis on older adults. To evaluate these data against the Consensus Statement on the management of SCH from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. METHOD A comprehensive literature review. RESULTS Subclinical hypothyroidism may be associated with an increased risk of mood and cognitive dysfunction, although the strength of this association and the efficacy of replacement hormone therapy require further investigation. CONCLUSION It remains unclear whether SCH leads to significant mood and cognitive impairments in most older patients. More research is required to determine the nature and extent of this association and whether thyroid hormone replacement therapy is appropriate and effective in treating SCH-associated neurobehavioral impairments.
Collapse
Affiliation(s)
- Russell T Joffe
- Department of Psychiatry, Staten Island University Hospital, Staten Island, NY 10305, USA.
| | | | | | | | | |
Collapse
|
45
|
Persson N, Viitanen M, Almkvist O, Wahlin Å. A principal component model of medical health: implications for cognitive deficits and decline among adults in a population-based sample. J Health Psychol 2012. [PMID: 23180878 DOI: 10.1177/1359105312459877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Longitudinal blood- and cognitive data from 879 adults were analyzed to extract a multidimensional health structure for prediction of cognitive change. Six health components were identified and replicated at two waves. Following, cognitive outcomes were regressed on the health components. Large proportions of cognitive age related variations were accounted for by baseline health in both cross-sectional and prospective analyses. Less variation was accounted for when health change and cognitive change were contrasted. Cardiovascular health was particularly important for prediction of cognitive change. Our study underlines causal relations between health and cognitive functions, and suggests that some effects are long term.
Collapse
|
46
|
van de Ven AC, Muntjewerff JW, Netea-Maier RT, de Vegt F, Ross HA, Sweep FCGJ, Kiemeney LA, Vos PE, Buitelaar JK, Hermus ARMM, den Heijer M, Janzing JGE. Association between thyroid function, thyroid autoimmunity, and state and trait factors of depression. Acta Psychiatr Scand 2012; 126:377-84. [PMID: 22533798 DOI: 10.1111/j.1600-0447.2012.01870.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether thyroid function and thyroid peroxidase antibodies (TPOAb) are associated with depression, when using both state and trait parameters of depression. METHOD In 1125 participants of the Nijmegen Biomedical Study, thyroid-stimulating hormone (TSH), free thyroxine (FT4), and TPOAb were measured twice. The Beck Depression Inventory (BDI), a self-reported lifetime diagnosis of depression, and the neuroticism scale of the Eysenck Personality Questionnaire Revised Short Scale (EPQ-RSS) were used to evaluate the presence of state and trait features of depression. RESULTS We found no association between TSH and FT4 levels and BDI score, current depression, lifetime diagnosis of depression, and EPQ-RSS neuroticism score. Subjects with TPOAb had higher EPQ-RSS neuroticism scores in comparison with subjects without TPOAb, mean score 4.1 vs. 3.2 (regression coefficient 0.70; 95% CI 0.1-1.3; P-value 0.02 after adjustment for confounders). The prevalence of a lifetime diagnosis of depression was higher in subjects with positive TPOAb in comparison with participants without TPOAb: 24.2% vs. 16.7% (relative risk 1.4; 95% CI 1.0-2.1; P-value 0.04 after adjustment for confounders). CONCLUSION Thyroid peroxidase antibodies are positively associated with trait markers of depression. The presence of TPOAb may be a vulnerability marker for depression.
Collapse
Affiliation(s)
- A C van de Ven
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Gan EH, Pearce SHS. Clinical review: The thyroid in mind: cognitive function and low thyrotropin in older people. J Clin Endocrinol Metab 2012; 97:3438-49. [PMID: 22865905 PMCID: PMC3496329 DOI: 10.1210/jc.2012-2284] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Several studies have reported an association between low serum TSH, or subclinical hyperthyroidism (SH), and dementia, but little emphasis has been placed on this field because not all studies have demonstrated the same association. We performed a detailed systematic review to assess the evidence available to support the association between these two conditions. METHODS We performed a systematic search through the PubMed, Embase (1996 to 2012 wk 4), Cochrane Library, and Medline (1996 to January wk 4, 2012) electronic databases using key search terms encompassing subclinical hyperthyroidism, TSH, dementia, and cognitive impairment. RESULTS This review examines the 23 studies that provide information about the association between SH or lower serum TSH within the reference range and cognition. Fourteen of these studies, including several well-designed and well-powered cross-sectional and longitudinal analyses, have shown a consistent finding of an association between SH with cognitive impairment or dementia. CONCLUSION There is a substantial body of evidence to support the association between SH and cognitive impairment, but there is no clear mechanistic explanation for these associations. Nor is there an indication that antithyroid treatment might ameliorate dementia. Larger and more detailed prospective longitudinal or randomized controlled trials are required to inform these important questions.
Collapse
Affiliation(s)
- Earn H Gan
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, United Kingdom.
| | | |
Collapse
|
48
|
Diphenyl diselenide diet intake improves spatial learning and memory deficits in hypothyroid female rats. Int J Dev Neurosci 2012; 30:83-9. [DOI: 10.1016/j.ijdevneu.2011.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 12/16/2011] [Accepted: 12/26/2011] [Indexed: 12/22/2022] Open
|
49
|
Kirim S, Keskek SO, Köksal F, Haydardedeoglu FE, Bozkirli E, Toledano Y. Depression in patients with euthyroid chronic autoimmune thyroiditis. Endocr J 2012; 59:705-8. [PMID: 22673294 DOI: 10.1507/endocrj.ej12-0035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Depression and chronic autoimmune thyroiditis are common diseases. The aim of this study was to determine whether the frequency of depression is elevated in patients with chronic autoimmune thyroiditis and normal thyroid function. A total of 201 subjects were included, of whom 107 and 94 participants were healthy or had euthyroid chronic autoimmune thyroiditis, respectively. Serum thyroid hormone levels and thyroid auto-antibodies were measured in all subjects. All participants were evaluated with Hamilton Depression Rating Scale (HDRS). HDRS scores of patients with euthyroid chronic autoimmune thyroiditis were higher than in healthy participants. This study suggests a possible association between depression and chronic autoimmune thyroiditis. The depression risk may be increased in patients with chronic autoimmune thyroiditis and normal thyroid function.
Collapse
Affiliation(s)
- Sinan Kirim
- Department of Endocrinology, Adana Numune Education and Training Hospital, Turkey
| | | | | | | | | | | |
Collapse
|
50
|
Bender AR, Naveh-Benjamin M, Raz N. Associative deficit in recognition memory in a lifespan sample of healthy adults. Psychol Aging 2011; 25:940-8. [PMID: 20822256 DOI: 10.1037/a0020595] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advanced age is associated with decrements in episodic memory, which are more pronounced in memory for associations than for individual items. The associative deficit hypothesis (ADH) states that age differences in recognition memory reflect difficulty in binding components of a memory episode and retrieving bound units. To date, ADH has received support only in studies of extreme age groups, and the influence of sex, education, and health on age-related associative deficit is unknown. We address those issues using a verbal paired-associate yes-no recognition paradigm on a lifespan sample of 278 healthy, well-educated adults. In accord with the ADH, greater age was associated with lower hit and greater false alarm rates and more liberal response bias on associative recognition tests. Women outperformed men on recognition of items and associations, but among normotensive participants, women outperformed men only on memory for associations and not on item recognition. Thus, although supporting ADH in a large lifespan sample of healthy adults, the findings indicate that the effect may be partially driven by an age-related increase in liberal bias in recognition of associations. Sex differences and health factors may modify the associative deficit regardless of age.
Collapse
Affiliation(s)
- Andrew R Bender
- Department of Psychology, Wayne State University, Detroit, MI 48202, USA
| | | | | |
Collapse
|