The recovery potential of central conduction disorder in hypothyroid rats

Does Hormone Supplementation With Levothyroxine Improve Hypothyroid Impaired Cognitive Dysfunction?

Hypothyroidism is a widespread condition in the United States, affecting approximately 5% of the adult population. Although the clinical use of levothyroxine is well understood, its effect on preventing dementia is not well established. While the exact role of thyroid hormones in the adult brain is unknown, it is apparent that poor thyroid function can lead to mood swings, cognitive impairment, and other psychiatric symptoms. Most studies demonstrate an association between thyroid health and cognition, specifically slow processing of information, decreased effectiveness of executive functions, and lack of learning. This study aims to review the effect of levothyroxine on dementia. We searched electronic databases such as PubMed, Google Scholar, Science Direct, Cochrane, gray literature, and the references of included articles to find relevant articles. Two investigators independently identified eligible studies, screened title/abstract, and extracted data. We identified a total of 319 citations through a database search with six studies (case-control, longitudinal, cross-sectional, randomized controlled trials) meeting the inclusion criteria. Studies with moderate to low risk of bias were evaluated using their respective quality check tools. Five of six studies showed a positive impact of levothyroxine (LT-4) on dementia. According to these studies, the plausible rationale behind the reversal of memory with LT-4 treatment is restoring thyroid-stimulating hormone (TSH), thyroxine (T4) levels, and gamma-aminobutyric acid (GABA) concentrations. People with abnormal thyroid function should be screened for cognitive dysfunction using specific neurocognitive tests and start treatment with LT-4 regardless of symptom presentation. Multi-dose randomized placebo-controlled intervention studies are recommended to assess the effect of LT-4 on lowering the risk of dementia in hypothyroid patients.

Thyroid disease and the nervous system

Thyroid disorders are common in the general population and in hospitalized patients. Thyroid disease may present first with neurological complications or else may occur concurrently in patients suffering other neurological disorders, particularly those with an autoimmune etiology. For this reason neurologists will commonly encounter patients with thyroid disease. This chapter provides an overview of the neurological complications and associations of disorders of the thyroid gland. Particular emphasis is placed on conditions such as thyrotoxic periodic paralysis and myxedema coma in which the underlying thyroid disorder may be occult leading to a first, often emergency, presentation to a neurologist. Information about clinical features, diagnosis, pathogenesis, therapy, and prognosis is provided. Emphasis is placed on those aspects most likely to be relevant to the practicing neurologist and the interested reader is directed to references to good, recent review articles for further information.

Levothyroxin restores hypothyroidism-induced impairment of hippocampus-dependent learning and memory: Behavioral, electrophysiological, and molecular studies

Hypothyroidism induces cognitive impairment in experimental animals and patients. Clinical reports are conflicting about the ability of thyroid hormone replacement therapy to fully restore the hypothyroidism-induced learning and memory impairment. In this study, we investigated the effects of L-thyroxin (thyroxin) treatment on hippocampus-dependent learning and memory in thyroidectomized adult rats. In the radial arm water maze (RAWM) task, thyroxin treated thyroidectomized animals made significantly fewer errors than the untreated hypothyroid animals in Trial 3 of the acquisition phase, short-term memory and long-term memory tests. In addition, the number of errors made by the thyroxin treated thyroidectomized animals was not different from that of the control group. Furthermore, the days-to-criterion (DTC) values for thyroxin treated thyroidectomized animals were not different from those of the control group but significantly lower than those of the untreated hypothyroid animals. In anesthetized rats, extracellular recording from hippocampal area CA1 of hypothyroid rats shows that thyroxin treatment restores impaired Late-phase long-term potentiation (L-LTP). Immunoblot analysis of signaling molecules, including cyclic-AMP response element binding protein (CREB), mitogen-activated protein kinases (MAPKp44/42; ERK1/2), in area CA1 revealed that thyroxin treatment reversed hypothyroidism-induced reduction of signaling molecules essential for learning and memory, and L-LTP. This study shows that thyroxin treatment reverses hypothyroidism-induced impairment of hippocampus-dependent cognition, and L-LTP, probably by restoring the levels of signaling molecule important for these processes.

Levothyroxin restores hypothyroidism-induced impairment of LTP of hippocampal CA1: Electrophysiological and molecular studies

Hypothyroidism impairs synaptic plasticity as well as learning and memory. Clinical reports are conflicting about the ability of thyroid hormone replacement therapy to fully restore the hypothyroidism-induced learning and memory impairment. Recently, we have shown that hypothyroidism impairs LTP and cognition in adult rats. We have studied the effect of thyroxin replacement therapy on hypothyroidism-induced LTP impairment using electrophysiological and molecular approaches. Recording from CA1 region of the hippocampus in anesthetized adult rat indicated that 6 weeks of thyroxin replacement therapy (20 microg/kg/day) fully restored LTP impaired by hypothyroidism. Western blotting showed reduction in phosphorylated (P)-CAMKII, total-CaMKII, neurogranin, and calmodulin basal levels in the CA1 region of the hippocampus of hypothyroid rats. The levels of these molecules were normalized by thyroxin replacement therapy. The hypothyroid-induced elevation of basal calcineurin levels and activity was also normalized by thyroxin treatment. However, thyroxin replacement therapy did not restore hypothyroidism-induced reduction in PKCgamma basal protein levels. Additionally, real-time PCR, showed a reduction in basal neurogranin mRNA level that was normalized by thyroxin replacement therapy. In the sham (control) rats, induction of LTP by high-frequency stimulation increases P-CaMKII, and total CaMKII levels as well as CaMKII phosphotransferase activity. However, in hypothyroid rats, the same stimulation protocol induced an increase only in total-CaMKII. Thyroxin treatment normalized the levels and activity of these molecules. The results demonstrated that thyroxin therapy normalized the electrophysiological and molecular effects of hypothyroidism on the CA1 region and emphasized the critical role P-CaMKII plays in hypothyroidism-induced LTP impairment.

Thyroid hormone regulation of N-methyl-D-aspartic acid receptor subunit mRNA expression in adult brain

Thyroid hormone is an essential modulator of brain development, but little is known about its actions in the adult brain. Hypothyroidism is associated with gene expression changes in both central and peripheral nervous tissue. Functional consequences of adult-onset hypothyroidism include an inability to produce long-term potentiation in rat hippocampus and impaired learning and memory in both rats and man. Long-term potentiation is a form of learning that is dependent on functional N-methyl-d-aspartic acid (NMDA)-preferring ionotropic glutamate receptors. This work examines the expression of ionotropic glutamate receptor subunit mRNA following surgical thyroidectomy with or without thyroid hormone replacement. In situ hybridization histochemistry was used to determine the mRNA levels of the NMDA receptor subunits NR1, NR2A, NR2B, the AMPA receptor subunit GluR1, and the kainate receptor subunit KA2. Reducing circulating concentrations of thyroid hormone by surgical removal of the thyroid gland 2 weeks before sacrifice decreased the expression of NR1 mRNA exclusively in the hippocampus. Conversely, hyperthyroidism selectively reduced NR2B mRNA expression in the dorsal hippocampus. Altering thyroid hormone status had no effect on the expression of KA2 or GluR1 subunit mRNA. The regulation of expression of NR1 and NR2B mRNA by thyroid hormone is a novel mechanism for explaining the relationship between thyroid hormone and cognitive function.

Hearing loss in congenital hypothalamic hypothyroidism: a wide therapeutic window

In this study, which aims to investigate for the first time auditoty sensitivity in congenital central hypothyroidism (CH), we concluded that: (1) permanent sensorineural hearing loss may be observed not only in congenital primary disorders of thyroid function, as reported hitherto; (2) it may also be found in patients with congenital CH, at least when substitutive treatment is started many years after thyroid failure presentation; (3) the concept of a 'critical therapeutic window' in preventing hearing impairment also holds true for children with congenital CH; (4) the therapeutic window in CH is wider than in primary hypothyroidism; (5) this is probably due to the less severe thyroid impairment in the cases with a central origin of hypothyroidism. These conclusions were suggested by the following data obtained in a cohort of 10 patients with congenital CH who were euthyroid at the time of audiological evaluation thanks to long-standing substitutive therapy: (a) four out of 10 patients exhibited a bilateral sensorineural hearing loss; (b) hearing impaired patients were the oldest of the entire series at diagnosis of hypothyroidism and none of them was aged less than 7 years at the time of the start of replacement therapy; (c) a strong positive relationship was found between age at therapy start and hearing loss.

Click-evoked otoacoustic emissions recorded from untreated congenital hypothyroid newborns

Thyroid hormone plays an important role in hearing development. Both a genetic or non-genetic hypothyroidism is often associated with congenital hearing loss. The exact incidence of hearing impairment in untreated congenital hypothyroid (CH) patients is unknown. This paper will present the results of measuring of the transient-evoked otoacoustic emissions (TEOAE) in a population of 29 newborns, who tested positive on a screening test for hypothyroidism (CH group) and in 68 well babies (control group) randomly chosen from all the newborns, classified as PASS, included in the Hearing Screening Program of the San Raffaele Hospital in Milan. TEOAE were recorded in all newborns within 1 month after birth and before beginning L-thyroxine treatment with conventional commercial instrumentation. Both temporal and time-frequency analyses of the emitted responses were conducted by means of a wavelet transform. The comparison of the characteristics of the temporal and frequency content of the responses of the two groups (CH and control) showed no statistically significant difference. No correlation was found between outer hair cell dysfunction and hypothyroidism.