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Yang R, Li Z, Zhu Y, Wu Y, Lu X, Zhao X, Liu J, Du X, Zhang X. Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China. BMC Psychiatry 2024; 24:413. [PMID: 38834989 DOI: 10.1186/s12888-024-05860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD. METHODS A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt. RESULTS Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32). CONCLUSION Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.
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Affiliation(s)
- Ruchang Yang
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yingzhao Zhu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yuxuan Wu
- Suzhou Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
| | - Xiangdong Du
- Suzhou Medical College of Soochow University, Suzhou, China.
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
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Holmberg M, Malmgren H, Berglund PF, Johansson B, Nyström HF. Psychiatric complications in Graves' disease. Eur Thyroid J 2024; 13:e230247. [PMID: 38215285 PMCID: PMC10895301 DOI: 10.1530/etj-23-0247] [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: 11/29/2023] [Accepted: 01/12/2024] [Indexed: 01/14/2024] Open
Abstract
Background Mood disorders are common in Graves' disease despite treatment. The pathogenic mechanisms involved are unknown and so is whether previous psychiatric disease influences these symptoms. Methods This is a longitudinal study conducted in Sweden on 65 women with newly diagnosed Graves' disease and 65 matched controls. Participants were examined during hyperthyroidism and after 15 months of treatment. Examinations included blood sampling, and psychiatric testing with the Comprehensive Psychopathological Rating Scale for Affective Syndromes and the Structured Clinical Interview for DSM-IV - Axis I Disorders. We also performed two analyses of a national population-based registry to determine previous psychiatric diagnoses and previous prescriptions of psychoactive drugs in (i) all patients we asked to participate and (ii) all Swedish women given a diagnosis of hyperthyroidism during 2013-2018, comparing them to matched controls. Results There was no increased previous psychiatric comorbidity in Graves' patients compared to controls. There was no higher prevalence of psychiatric diagnoses and prescriptions of psychoactive drugs between (i) included GD patients compared to those who declined participation and (ii) women with a hyperthyroidism diagnosis in 5 years prior to their diagnosis, compared to matched controls. Depression scores and anxiety scores were higher in patients compared to controls both during hyperthyroidism (depression (median (IQR): 7.5 (5.0-9.5) vs 1.0 (0.5-2.5) P < 0.001), anxiety: 7.7 (5.0-11) vs 2.5 (1.0-4.0) P < 0.001) and after treatment (depression: 2.5 (1.5-5.0) vs 1.5 (0.5-3.5) P < 0.05), anxiety: 4.0 (2.5-7.5) vs 3.0 (1.5-5.0) P < 0.05). Patients with a previous psychiatric condition, mild eye symptoms, and a younger age had more anxiety at 15 months compared to patients without these symptoms and a higher age (all p<0.05). Conclusion Graves' disease affects patients' mood despite treatment. A previous psychiatric condition, mild eye symptoms, and a younger age increase the vulnerability for long-lasting symptoms and require specific attention.
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Affiliation(s)
- Mats Holmberg
- ANOVA, Karolinska University Hospital, Norra Stationsgatan 69, Stockholm, Sweden
- Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Wallenberg's Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden
| | - Helge Malmgren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Peter F Berglund
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Birgitta Johansson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Helena Filipsson Nyström
- Wallenberg's Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
- Gothenburg Centre for Person Centred-Care (GPCC), Göteborg, Sweden
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Kothari S, Townsend W, Chaudhry Z, Kalin S, Freeman K. Psychosis secondary to thyrotoxicosis that persisted post-thyroidectomy: a case report. BMC Psychiatry 2023; 23:750. [PMID: 37833705 PMCID: PMC10576329 DOI: 10.1186/s12888-023-05227-4] [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: 08/03/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND This case report is of a patient with psychosis secondary to thyrotoxicosis that persisted and reemerged after definitive treatment of thyroidectomy, which is a unique occurrence in the literature. CASE PRESENTATION This patient is a male between 30 and 35 years of age with a history of Graves Disease and no past psychiatric history who was admitted to the hospital due to psychosis secondary to thyrotoxicosis. The thyrotoxicosis was treated with surgical removal, but the psychotic symptoms persisted after surgery and normalization of standard thyroid functional measures. The symptoms were of sufficient significance for inpatient psychiatric hospitalization, a rare occurrence. Ultimately after an extended stay in the psychiatric unit, the patient's symptoms stabilized with a second-generation antipsychotic, and the patient was discharged from the psychiatric unit. CONCLUSION This case is evidence that the link between psychosis and hyperthyroidism is still poorly understood due to the patient's psychotic symptoms persisting after the definitive treatment of thyroidectomy and the fact that it required anti-psychotic medications for normalization.
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Affiliation(s)
- Shiva Kothari
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA.
| | - William Townsend
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Zuhaib Chaudhry
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Seth Kalin
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
| | - Kevin Freeman
- University of Mississippi Medical Center Jackson, MS 39216, Jackson, USA
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Yang R, Zhu F, Yue Y, Lu X, Zhu P, Li Z, Zhao X, Yang X, Zhou Y, Du X. Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China. Heliyon 2023; 9:e16770. [PMID: 37303557 PMCID: PMC10248252 DOI: 10.1016/j.heliyon.2023.e16770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Backgrounds Thyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents. Methods A total of 679 adolescent patients (aged 12-18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively. Results The prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels. Conclusions Our results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.
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Affiliation(s)
- Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Feng Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yan Yue
- Medical College of Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xinchuan Lu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ping Zhu
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xueli Zhao
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xuna Yang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yongjie Zhou
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xiangdong Du
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
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Depressive Pseudodementia with Reversible AD-like Brain Hypometabolism: A Case Report and a Review of the Literature. J Pers Med 2022; 12:jpm12101665. [PMID: 36294804 PMCID: PMC9605211 DOI: 10.3390/jpm12101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Recent European guidelines recommend using brain FDG-PET to differentiate between Alzheimer's disease (AD) and depressive pseudodementia (DP), with specific hypometabolism patterns across the former group, and typically normal or frontal hypometabolism in the latter. We report the case of a 74 years-old man with DP (MMSE 16/30), whose FDG-PET visual rating and semiquantitative analysis closely mimicked the typical AD pattern, showing severe hypometabolism in bilateral precuneus, parietal and temporal lobes, and sparing frontal areas, suggesting the diagnosis of moderate AD. Shortly after starting antidepressant polytherapy, he underwent formal NPS testing, which revealed moderate impairment of episodic memory and mild impairment on executive and visuospatial tests, judged consistent with neurodegenerative dementia and concomitant depression. Over the following two years, he improved dramatically: repeated NPS assessment did not show significant deficits, and FDG-PET showed restoration of cerebral metabolism. The confirmation of PET findings via semiquantitative analysis, and their reversion to normality with antidepressant treatment, proved the non-neurodegenerative origin of the initial AD-like FDG-PET abnormalities. We review similar cases and provide a comprehensive analysis of their implications, concluding that reversible FDG-PET widespread hypometabolism might represent a biomarker of pseudodementia. Therefore, we suggest caution when interpreting FDG-PET scans of depressed patients with cognitive impairment.
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Kim HK, Song J. Hypothyroidism and Diabetes-Related Dementia: Focused on Neuronal Dysfunction, Insulin Resistance, and Dyslipidemia. Int J Mol Sci 2022; 23:ijms23062982. [PMID: 35328405 PMCID: PMC8952212 DOI: 10.3390/ijms23062982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
The incidence of dementia is steadily increasing worldwide. The risk factors for dementia are diverse, and include genetic background, environmental factors, sex differences, and vascular abnormalities. Among the subtypes of dementia, diabetes-related dementia is emerging as a complex type of dementia related to metabolic imbalance, due to the increase in the number of patients with metabolic syndrome and dementia worldwide. Thyroid hormones are considered metabolic regulatory hormones and affect various diseases, such as liver failure, obesity, and dementia. Thyroid dysregulation affects various cellular mechanisms and is linked to multiple disease pathologies. In particular, hypothyroidism is considered a critical cause for various neurological problems-such as metabolic disease, depressive symptoms, and dementia-in the central nervous system. Recent studies have demonstrated the relationship between hypothyroidism and brain insulin resistance and dyslipidemia, leading to diabetes-related dementia. Therefore, we reviewed the relationship between hypothyroidism and diabetes-related dementia, with a focus on major features of diabetes-related dementia such as insulin resistance, neuronal dysfunction, and dyslipidemia.
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Affiliation(s)
- Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, 264 Seoyangro, Hwasun 58128, Korea;
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Hwasun 58128, Korea
- BioMedical Sciences Graduate Program (BMSGP), Chonnam National University, 264 Seoyangro, Hwasun 58128, Korea
- Correspondence: ; Tel.: +82-61-379-2706; Fax: +82-61-375-5834
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Nechiporuk VM, Pentyuk LO, Shushkovskaya YY, Niushko TY, Korda MM. SUBMICROSCOPIC CHANGES IN THE SENSORIMOTOR AREA OF THE CEREBRAL CORTEX UNDER THE CONDITIONS OF EXPERIMENTAL HYPERHOMOCYSTEINEMIA, HYPER- AND HYPOTHYREOSIS AND THEIR COMBINED INFLUENCE. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2022. [DOI: 10.29254/2077-4214-2022-3-166-398-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - M. M. Korda
- I. Horbachevsky Ternopil State Medical University
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8
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Wu SQ, Feng F, Zou RJ, Fu HL, Sun JW, Jia XZ, Yin YF, Wang H. Abnormal Brain Glucose Metabolism in Papillary Thyroid Cancer Patients 4 Weeks After Withdrawal of Levothyroxine: A Cross-Sectional Study Using 18F-FDG PET/CT. Front Endocrinol (Lausanne) 2021; 12:595933. [PMID: 33776909 PMCID: PMC7992039 DOI: 10.3389/fendo.2021.595933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background There is no doubt that thyroid dysfunction is associated with psychiatric disorders. A large amount of thyroid carcinoma patients displayed mood disorders after the withdrawal of levothyroxine (LT4). However, it is unclear whether the disorders are related to the transient withdrawal of LT4, and if yes, what the possible underlying mechanism is. This study aims to investigate the abnormal regional cerebral glucose metabolism (rCMRglu) in a group of papillary thyroid cancer (PTC) patients without LT4 for 4 weeks and prove the relationship between the abnormal rCMRglu with depression and anxiety. Methods Brain 18F-FDG PET/CT data of 38 consecutive PTC patients with high/intermediate-risk from June 2016 to December 2017 have been analyzed. Of the 38 patients, 23 are in the LT4 withdrawal group (WG) and 15 in the LT4 replacement group (RG). These patients were also evaluated for depressive and anxiety symptoms within 24 h after the scans based on the Hamilton Depression Rating Scale (17 items, HRDS-17) and the Hamilton Anxiety Rating Scale (HAMA) respectively. Results Thirty-eight patients (12 men, 26 women; age range, 25-69 years; mean age, 45.8 years) were selected in the study. Compared with the RG, patients in WG showed depression and anxiety with higher total scores of HRDS-17 and HAMA (14.7 ± 5.8 vs 3.8 ± 5.5, t = -5.74, p = 0.00; 9.3 ± 4.3 vs 2.7 ± 4.1, t = -4.74, p = 0.00, respectively). In the brain glucose metabolism analysis, the WG patients showed lower rCMRglu in Occipital_Mid_R and Postcentral_L. On the other hand, data illustrated significant rCMRglu increases in the Frontal_Sup_Orb_L. Compared with the healthy group (HG), the rCMRglu of the Postcentral_L and Precuneus_L showed hypoactivity, but the Hippocampus_R and the Temporal_Inf_L showed hyperactivity. This analysis yielded a significant correlation between abnormal rCMRglu with the free thyroxine level, the serum thyroid-stimulating hormone level, HRDS-17, and HAMA scores. Conclusions The findings showed that more PTC patients exhibited depression and anxiety after LT4 withdrawal for 4 weeks. More attention should be paid to these hypothyroid patients while they were in the hospital. Such a short-term LT4 withdrawal also likely induced abnormal rCMRglu. Our study attempts to explain the possible mechanism of mood disorders related to transient hypothyroidism.
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Affiliation(s)
- Shu-qi Wu
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fang Feng
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ren-jian Zou
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hong-liang Fu
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-wei Sun
- School of Information and Electronics Technology, Jiamusi University, Jiamusi, China
| | - Xi-ze Jia
- Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Ya-fu Yin
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Eslami-Amirabadi M, Sajjadi SA. The relation between thyroid dysregulation and impaired cognition/behaviour: An integrative review. J Neuroendocrinol 2021; 33:e12948. [PMID: 33655583 PMCID: PMC8087167 DOI: 10.1111/jne.12948] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/19/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
Despite decades of research on the relation between thyroid diseases and cognition, the nature of this relationship remains elusive. An increasing prevalence of cognitive impairment and thyroid dysfunction has been consistently observed with ageing. Also, there appears to be an association between thyroid disorders and cognitive decline. Given the increasing global burden of dementia, elucidating the relationship between thyroid disorders as a potentially modifiable risk factor of cognitive impairment was the main goal of this review. We summarise the current literature examining the relationship between thyroid hormonal dysregulation and cognition or behaviour. We present the available imaging and pathological findings related to structural and functional brain changes related to thyroid hormonal dysregulation. We also propose potential mechanisms of interaction between thyroid hormones, autoantibodies and cognition/behaviour. Effects of gender, ethnicity and environmental factors are also briefly discussed. This review highlights the need for long-term prospective studies to capture the course of brain functional changes associated with the incidence and progression of thyroid dysregulations along with the confounding effects of non-modifiable risk factors such as gender and ethnicity. Moreover, double-blind controlled clinical trials are necessary to devise appropriate treatment plans to prevent cognitive consequences of over or undertreatment of thyroid disorders.
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Emoto N, Okazaki-Hada M, Yamaguchi Y, Okajima F, Goto R, Sugihara H. Risk Preferences, Rationality of Choices, and Willingness to Pay for Preventive Medicine in Patients with Graves' Thyrotoxicosis. Patient Prefer Adherence 2021; 15:1971-1979. [PMID: 34522090 PMCID: PMC8434921 DOI: 10.2147/ppa.s323472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Patients with thyrotoxicosis show neuropsychological changes, and these may damage the quality of informed consent in clinical practice. Therefore, we examined patients' real-life preferences to assess whether change in risk preferences was dependent on thyroid function state. PATIENTS AND METHODS The participants were 86 patients who were newly diagnosed with Graves' thyrotoxicosis between 1 January and 31 December 2018 (group A), and an additional 33 euthyroid patients diagnosed before 2018 (group B). In a survey conducted via a questionnaire based on the concept of behavioral economics, we sought to determine risk preferences, rationality of choices, and other relevant factors. An identical second survey was completed 6-12 months later by 36 patients in group A after their thyroid functions had been normalized by treatment, and by 11 euthyroid patients in group B. We performed paired analysis of the first and second surveys in 32 patients of group A and single regression analysis of a total of 140 surveys obtained from 119 patients by combining the first and second surveys of groups A and B with serum level of FT3 as an independent variable. RESULTS The paired analysis indicated that there was no significant difference in any survey item. The single regression analysis revealed that willingness-to-pay (WTP) for preventive medicine and monthly average out-of-pocket (OOP) expenditure on medical care were both significantly positively associated with serum level of FT3. Patients in the hyperthyroid state tend to have high WTP for preventive medicine, which may be accelerated by the anchoring effect of OOP expenditure. CONCLUSION Almost all risk preferences of patients with Graves' disease are constant, rational, and reproducible in the hyperthyroid and euthyroid states. However, medical professionals should be aware that the willingness of patients with thyrotoxicosis to pay for medical costs may change after the normalization of thyroid function.
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Affiliation(s)
- Naoya Emoto
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Chiba, Japan
- Correspondence: Naoya Emoto Diabetes & Thyroid Clinic, Sakura Chuo Hospital, 20-4, Sakaecho, Sakura City, Chiba, 285-0014, JapanTel +81-43-486-1311Fax +81-43-486-1314 Email
| | - Mikiko Okazaki-Hada
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuji Yamaguchi
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Fumitaka Okajima
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Department of Diabetes, Endocrinology and Metabolism, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Tokyo, Japan
| | - Hitoshi Sugihara
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Aslan K, Gunbey HP, Cortcu S, Ozyurt O, Avci U, Incesu L. Diffusion tensor imaging in hyperthyroidism: assessment of microstructural white matter abnormality with a tract-based spatial statistical analysis. Acta Radiol 2020; 61:1677-1683. [PMID: 32202136 DOI: 10.1177/0284185120909960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Metabolic, morphological, and functional brain changes associated with a neurological deficit in hyperthyroidism have been observed. However, changes in microstructural white matter (WM), which can explain the underlying pathophysiology of brain dysfunctions, have not been researched. PURPOSE To assess microstructural WM abnormality in patients with untreated or newly diagnosed hyperthyroidism using tract-based spatial statistics (TBSS). MATERIAL AND METHODS Eighteen patients with hyperthyroidism and 14 age- and sex-matched healthy controls were included in this study. TBSS were used in this diffusion tensor imaging study for a whole-brain voxel-wise analysis of fractional anisotropy, mean diffusivity, axial diffusivity (AD), and radial diffusivity (RD) of WM. RESULTS When compared to the control group, TBSS showed a significant increase in the RD of the corpus callosum, anterior and posterior corona radiata, posterior thalamic radiation, cingulum, superior longitudinal fasciculus, and the retrolenticular region of the internal capsule in patients with hyperthyroidism (P < 0.05), as well as a significant decrease in AD in the anterior corona radiata and the genu of corpus callosum (P < 0.05). CONCLUSION This study showed that more regions are affected by the RD increase than the AD decrease in the WM tracts of patients with hyperthyroidism. These preliminary results suggest that demyelination is the main mechanism of microstructural alterations in the WM of hyperthyroid patients.
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Affiliation(s)
- Kerim Aslan
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hediye Pinar Gunbey
- Department of Radiology, Health Sciences University Kartal Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Sumeyra Cortcu
- Department of Radiology, Kastamonu State Hospital, Kastamonu, Turkey
| | - Onur Ozyurt
- Telemed Solutions Teknopark, Bogazici University, İstanbul, Turkey
| | - Ugur Avci
- Department of Endocrinology and Metabolism, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
| | - Lutfi Incesu
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Affiliation(s)
- David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary H Samuels
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon, USA
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Fetene DM, Betts KS, Alati R. The role of maternal prenatal thyroid function on offspring depression: Findings from the ALSPAC cohort. Dev Psychopathol 2020; 32:189-196. [PMID: 30688193 DOI: 10.1017/s0954579418001657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Maternal thyroid dysfunction during pregnancy may contribute to offspring neurobehavioral disorders. In this paper, we investigate the relationship between maternal thyroid function during pregnancy and offspring depression and anxiety. Data were taken from the Avon Longitudinal Study of Parents and Children. A total of 2,920 mother-child pairs were included. Thyroid-stimulating hormone levels, free thyroxine (FT4), and thyroid peroxidase antibodies were assessed during the first trimester of pregnancy because maternal supply is the only source of thyroid hormone for the fetus during the first 12 weeks of gestation. Child symptoms of depression and anxiety were assessed using the Development and Well-Being Assessment at ages 7.5 and 15 years. The odds of presenting with depression and anxiety were estimated using the generalized estimating equation. The level of FT4 during the first trimester of pregnancy was associated with child depression combined at ages 7.5 and 15 (odds ratio = 1.21, 95% confidence interval [1.00, 1.14]. An increase of 1 standard deviation of FT4 during pregnancy increased the odds of child depression by 28% after adjustment made for potential confounders. No association was found among maternal levels of thyroid-stimulating hormone, FT4, and thyroid peroxidase antibodies and childhood anxiety. In conclusion, increased levels of FT4 during the first trimester of pregnancy appear be linked to greater risk of offspring depression.
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Affiliation(s)
- Dagnachew Muluye Fetene
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Kim S Betts
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Rosa Alati
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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Cerebral glucose metabolism and Cerebral blood flow in thyroid dysfunction: An Activation Likelihood Estimation Meta-analysis. Sci Rep 2020; 10:1335. [PMID: 31992803 PMCID: PMC6987231 DOI: 10.1038/s41598-020-58255-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
Thyroid dysfunction is frequently associated with functional disturbances of the brain. We performed a meta-analysis of previous positron emission tomography and single-photon emission computed tomography studies using a coordinate-based technique of activation-likelihood estimation (ALE) to investigate the potential background of neuropsychiatric complications in patients with hypo- and hyperthyroidism. We performed a systematic search of MEDLINE and EMBASE for English-language publications using the keywords of “positron emission tomography”, “single-photon emission computed tomography”, and “thyroid”. The software GingerALE ver 2.3.6 was used to transform all reported coordinates into stereotactic Montreal Neurological Institute space. A threshold of uncorrected p < 0.001 (minimum volume of 200 mm3) was applied to the resulting ALE map using cerebral metabolic rate of glucose (CMRglu), and cerebral blood flow (CBF). Six studies were eligible for inclusion in the study; 4 studies of cerebral metabolic rate of CMRglu, and 2 studies of CBF. In hypothyroidism, significant decreases in CMRglu were identified in 3 clusters including left anterior cingulate, right inferior occipital gyrus, and right cuneus. In hyperthyroidism, a significant decrease in CMRglu was identified in right superior frontal gyrus. In hypothyroidism, a significant decrease in CBF was observed in left postcentral gyrus. In conclusion, several brain regions showed altered CMRglu and CBF in patients with thyroid dysfunction compared with euthyroid controls. These findings might account for underlying mechanisms of thyroid hormones on psychological and physiological effects on brain.
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Holmberg MO, Malmgren H, Berglund P, Bunketorp-Käll L, Heckemann RA, Johansson B, Klasson N, Olsson E, Skau S, Nystrom Filipsson H. Structural brain changes in hyperthyroid Graves' disease: protocol for an ongoing longitudinal, case-controlled study in Göteborg, Sweden-the CogThy project. BMJ Open 2019; 9:e031168. [PMID: 31685507 PMCID: PMC6858258 DOI: 10.1136/bmjopen-2019-031168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cognitive impairment and reduced well-being are common manifestations of Graves' disease (GD). These symptoms are not only prevalent during the active phase of the disease but also often prevail for a long time after hyperthyroidism is considered cured. The pathogenic mechanisms involved in these brain-derived symptoms are currently unknown. The overall aim of the CogThy study is to identify the mechanism behind cognitive impairment to be able to recognise GD patients at risk. METHODS AND ANALYSIS The study is a longitudinal, single-centre, case-controlled study conducted in Göteborg, Sweden on premenopausal women with newly diagnosed GD. The subjects are examined: at referral, at inclusion and then every 3.25 months until 15 months. Examinations include: laboratory measurements; eye evaluation; neuropsychiatric and neuropsychological testing; structural MRI of the whole brain, orbits and medial temporal lobe structures; functional near-infrared spectroscopy of the cerebral prefrontal cortex and self-assessed quality of life questionnaires. The primary outcome measure is the change in medial temporal lobe structure volume. Secondary outcome measures include neuropsychological, neuropsychiatric, hormonal and autoantibody variables. The study opened for inclusion in September 2012 and close for inclusion in October 2019. It will provide novel information on the effect of GD on medial temporal lobe structures and cerebral cortex functionality as well as whether these changes are associated with cognitive and affective impairment, hormonal levels and/or autoantibody levels. It should lead to a broader understanding of the underlying pathogenesis and future treatment perspectives. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Regional Ethical Review Board in Göteborg, Sweden. The results will be actively disseminated through peer-reviewed journals, national and international conference presentations and among patient organisations after an appropriate embargo time. TRIAL REGISTRATION NUMBER 44321 at the public project database for research and development in Västra Götaland County, Sweden (https://www.researchweb.org/is/vgr/project/44321).
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Affiliation(s)
- Mats Olof Holmberg
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
| | - Helge Malmgren
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Berglund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Lina Bunketorp-Käll
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Rolf A Heckemann
- Division of Brain Sciences, Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, Göteborg, Sweden
| | - Birgitta Johansson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Niklas Klasson
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Erik Olsson
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
| | - Simon Skau
- MedTech West, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg, Sweden
| | - Helena Nystrom Filipsson
- Institute of Medicine, University of Gothenburg, Sahlgrenska Academy, Göteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
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Burmeister LA. Coma in Thyroid Storm: Review of Aggregated English-Language Case Reports. J Endocr Soc 2019; 3:1261-1274. [PMID: 31214663 PMCID: PMC6570633 DOI: 10.1210/js.2019-00076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 04/17/2019] [Indexed: 01/15/2023] Open
Abstract
CONTEXT Coma is a serious manifestation of thyroid storm (TS) about which little is known. OBJECTIVE To describe the features, duration, treatment response, and prognosis of coma in the setting of TS. DESIGN Aggregate analysis of individual English-language case reports of coma in the setting of TS from 1935 to January 2019. SETTING Hospitals. PATIENTS Sixty-five cases were identified, 29 from case reports and 36 from case series. INTERVENTIONS Antithyroid drugs, corticosteroids, beta-blockers, iodine, intubation, plasmapheresis, antibiotics, thyroidectomy, radioiodine, dialysis, and l-carnitine. MAIN OUTCOME MEASURES Awakening and death rates overall and in relation to administered treatments, day of coma presentation, and time from coma onset; symptoms associated with coma; TS and coma scales; thyroid and cerebrospinal laboratory tests; electroencephalogram; brain imaging; and autopsy results. RESULTS Mortality was 38% in the setting of TS-related coma, 11% during the years 1978 to 2019 compared with 70% for 1935 to 1977. Both awakening and death commonly occurred within the first 2 days of coma onset. Reduction in total and free T4 values, and possibly also total T3 value, correlated with awakening from coma. Lower death rates were associated with use of antithyroid drugs, corticosteroids, beta-blockers, and intubation. Plasmapheresis was associated with awakening in 67% of cases but not with lower death rates. CONCLUSIONS Prognosis of coma associated with TS remains poor. Current guidelines for the early use of plasmapheresis in unresolving TS are advocated and should be considered urgently at the point of confusion or delirium in an effort to abort coma.
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Affiliation(s)
- Lynn A Burmeister
- Division of Diabetes, Endocrinology & Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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17
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Kumar M, Rana P, Modi S, Tyagi R, Kaur P, Kanwar R, Sekhri T, D'souza M, Khushu S. Aberrant intra and inter network resting state functional connectivity in thyrotoxicosis. J Neuroendocrinol 2019; 31:e12683. [PMID: 30600576 DOI: 10.1111/jne.12683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/02/2018] [Accepted: 12/28/2018] [Indexed: 11/28/2022]
Abstract
Thyroid hormones epigenetically play an important role in the regularisation of neural networks and in neural differentiation during brain development. The present study aimed to explore the intra and inter network resting state functional connectivity changes underlying the neurobehavioural symptoms in thyrotoxicosis. To understand the pathophysiological changes, we investigated the correlation between functional connectivity and clinical and behavioural measures. Twenty-eight freshly diagnosed thyrotoxicosis patients suffering with symptoms such as palpitation, loss of weight, trembling and heat intolerance from days to weeks and 28 healthy controls were recruited for the study. Thyrotoxicosis patients showed significantly decreased functional connectivity in sensorimotor network, fronto-temporal network, default mode network, right fronto-parietal network, left fronto-parietal network and salience network. Inter network functional connectivity was significantly reduced between the basal ganglia network and sensorimotor network and increased between the salience network and fronto-temporal network in thyrotoxicosis. Cognitive functions such as visual retention, recognition of objects, mental balance and performance on neuropsychological tests (ie, the Bender Gestalt test, Nahar-Benson test and Mini Mental State Examination) also showed significant decline in thyrotoxicosis patients. The altered intrinsic resting state functional connectivity might underlie these cognitive deficits. The increased functional connectivity between the salience network and fronto-temporal network suggests the recruitment of additional neuronal circuitry needed to compensate for the neuropathology in the primary neural network in thyrotoxicosis.
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Affiliation(s)
- Mukesh Kumar
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | - Poonam Rana
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | - Shilpi Modi
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | - Ritu Tyagi
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | - Prabhjot Kaur
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | | | - Tarun Sekhri
- Thyroid Research Centre, INMAS, DRDO, New Delhi, India
| | - Maria D'souza
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
| | - Subash Khushu
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), DRDO, New Delhi, India
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Yuan L, Zhang Y, Luan D, Xu X, Yang Q, Zhao S, Zhou Z. Reversible Affective Symptoms and Attention Executive Control Network Impairment Following Thyroid Function Normalization in Hyperthyroidism. Neuropsychiatr Dis Treat 2019; 15:3305-3312. [PMID: 32063707 PMCID: PMC6884974 DOI: 10.2147/ndt.s227386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Affective symptoms and attention impairments are found in patients with hyperthyroidism. Our previous data have revealed that the patients with hyperthyroidism experience impairments of the attention networks, but it remains unclear whether these disorders persist after the treatment of hyperthyroidism. METHODS Twenty healthy controls and 25 hyperthyroid patients were recruited and performed the attention network test (ANT) which can simultaneously examine the alertness, orientation and execution control components of the participants. The effect of treatment on affective symptom and attention networks impairments were examined in the patient group after 1-year anti-thyroid medication and reaching euthyroidism for at least 3 months. RESULTS Anxiety and depression scores of patients with hyperthyroidism were significantly higher than those of the healthy control group. The patients with hyperthyroidism had impairments of the alerting and executive control networks. Meanwhile, the score of HAMA correlated significantly with thyroid hormone and TSH levels, and there was a negative significant correlation between the score of HAMD and TSH level in all subjects. There was a positive correlation between the value of the executive control network and thyroid hormones' levels in all subjects and in the hyperthyroidism group. Anxiety and depression symptoms were improved with methimazole treatment after euthyroidism was reached. The value of the executive control network no longer differed from that of healthy controls, but deficits in the alerting network of hyperthyroidism still persisted after treatment. CONCLUSION The patients with hyperthyroidism existed affective symptoms and attention networks impairments. Affective symptoms and attention executive control network impairment were improved following thyroid function normalization in hyperthyroidism.
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Affiliation(s)
- Lili Yuan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Yuanxiang Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Di Luan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Xiangjun Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Shoucai Zhao
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China
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Cognitive Deficit-Related Interhemispheric Asynchrony within the Medial Hub of the Default Mode Network Aids in Classifying the Hyperthyroid Patients. Neural Plast 2018; 2018:9023604. [PMID: 30532774 PMCID: PMC6250039 DOI: 10.1155/2018/9023604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose Recent studies suggest that abnormal structure and function in the brain network were related to cognitive and emotional impairment in hyperthyroid patients (HPs). The association between altered voxel-mirrored homotopic connectivity (VMHC) and neuropsychological impairment in HPs remains unclear. This study is aimed at investigating the association between the disrupted functional coordination and psychological dysfunction in hyperthyroidism. Method Thirty-three hyperthyroid patients and thirty-three matched healthy controls (HCs) were recruited, and they received resting-state functional magnetic resonance imaging (fMRI) scans and neuropsychological evaluation. The VMHC value was computed to reveal the functional coordination between homotopic regions in both groups. The neurobehavioral relevancy method was employed to explore the relationship between the altered VMHC and emotional, cognition measures. Further receiver operating characteristic (ROC) curve analysis was adopted to examine the power of changed regional VMHC in classifying the patients with hyperthyroidism. Results Compared with the HCs, the HPs exhibited significantly declined VMHC values in the bilateral medial frontal gyrus (MeFG). The interhemispheric asynchrony in the MeFG was positively correlated with Z scores of episodic memory. The ROC analysis further determined that abnormal VMHC in the MeFG could efficiently distinguish the HPs from the HCs (area under the curve (AUC) = 0.808, P < 0.001). Conclusion The altered interhemispheric coordination in the hub of the default mode network may implicated in the modulation of episodic memory in HPs patients and the distinct feature of the interhemispheric asynchrony may be treated as a potential target for the early recognition and intervention for the HPs with cognitive impairments. Clinical Trial Registration This is a study of the neurological basis for dysfunction of mood and cognition in hyperthyroid patients: a resting-state fMRI study (registration number: ChiCTR-OOC-16008607).
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20
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Zhi M, Hou Z, We Q, Zhang Y, Li L, Yuan Y. Abnormal spontaneous brain activity is associated with impaired emotion and cognition in hyperthyroidism: A rs-fMRI study. Behav Brain Res 2018; 351:188-194. [DOI: 10.1016/j.bbr.2018.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022]
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Liu B, Wen L, Ran Q, Zhang S, Hu J, Gong M, Zhang D. Dysregulation within the salience network and default mode network in hyperthyroid patients: a follow-up resting-state functional MRI study. Brain Imaging Behav 2018; 14:30-41. [PMID: 30259292 DOI: 10.1007/s11682-018-9961-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated the aberrant connectivity of the salience network (SN) and default mode network (DMN) and the relevance between these abnormalities and symptom improvement in hyperthyroid patients using resting-state functional magnetic resonance imaging (rs-fMRI). Seed-based functional connectivity (FC) analyses were performed on state fMRI data to reveal possible differences in critical node connectivity in the SN and DMN between 41 new-onset, untreated hyperthyroid patients and 41 healthy controls. Subsequently, follow-up data were available for 25 patients treated with methimazole for one month. Compared with the healthy controls, the patients exhibited abnormal internetwork FC from the SN to the DMN and the executive control network (ECN) and decreased intra-network FC within the SN. Relative to the hyperthyroid state, the antithyroid therapy induced reversible connectivity of the left insula to the dorsal anterior cingulate cortex(dACC)and ECN, and persistently increased connectivity between the SN and DMN in patients with improved thyroid function. Finally, Pearson's correlation analyses were performed among the abnormal FC, neuropsychological assessment and serum free triiodothyronine(FT3)level data. The results indicated that aberrant intra- and internetwork FC in the SN and DMN might underlie the pathogenesis of hyperthyroidism, and antithyroid treatment could regulate the FC of certain key brain regions within the SN and DMN in hyperthyroid patients.
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Affiliation(s)
- Bo Liu
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Li Wen
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Qian Ran
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Si Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Junhao Hu
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Mingfu Gong
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China
| | - Dong Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, People's Republic of China.
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Salazar P, Cisternas P, Martinez M, Inestrosa NC. Hypothyroidism and Cognitive Disorders during Development and Adulthood: Implications in the Central Nervous System. Mol Neurobiol 2018; 56:2952-2963. [PMID: 30073507 DOI: 10.1007/s12035-018-1270-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023]
Abstract
Thyroid hormones (THs) play a critical function in fundamental signaling of the body regulating process such as metabolism of glucose and lipids, cell maturation and proliferation, and neurogenesis, to name just a few. THs trigger biological effects both by directly affecting gene expression through the interaction with nuclear receptors (genomic effects) and by activating protein kinases and/or ion channels (short-term effects). For years, a close relationship between the THs hormones and the central nervous system (CNS) has been described, not only for neuronal cells but also for glial development and differentiation. A deficit in thyroid hormones triiodothyronine (T3) and thyroxine (T4) is observed in the hypothyroid condition, generated by a iodine deficiency or an autoimmune response of the body. In the hypothyroid condition, several cellular deregulation and alterations have been described in dendrite spine morphology, cell migration and proliferation, and impaired synaptic transmission in the hippocampus, among others. The aim of this review is to describe the role of the thyroid hormones with focus in brain function and neurodegenerative disorders.
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Affiliation(s)
- Paulina Salazar
- Centro de Envejecimiento y Regeneración (CARE UC), Departamento de Biología Celular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro Cisternas
- Centro de Envejecimiento y Regeneración (CARE UC), Departamento de Biología Celular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milka Martinez
- Centro de Envejecimiento y Regeneración (CARE UC), Departamento de Biología Celular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nibaldo C Inestrosa
- Centro de Envejecimiento y Regeneración (CARE UC), Departamento de Biología Celular, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,Centro de Excelencia en Biomedicina de Magallanes (CEBIMA), Universidad de Magallanes, Punta Arenas, Chile. .,CARE UC Biomedical Research Center, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Av. Bernardo O'Higgins 340, P. O. Box 114, -D, Santiago, Chile.
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Desai D, Zahedpour Anaraki S, Reddy N, Epstein E, Tabatabaie V. Thyroid Storm Presenting as Psychosis. J Investig Med High Impact Case Rep 2018; 6:2324709618777014. [PMID: 29796397 PMCID: PMC5960855 DOI: 10.1177/2324709618777014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/21/2018] [Accepted: 03/24/2018] [Indexed: 11/19/2022] Open
Abstract
Thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1% to 2%. It is a systemic condition of excessive thyroid hormone production and release leading to thermoregulatory, adrenergic, neuropsychiatric, cardiovascular, and abdominal manifestations. Although it is a rare condition, it carries a significant mortality rate. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment. In this article, we present an unusual case of a young woman who presented with psychosis as the manifesting symptom of thyroid storm. She did not respond adequately to conventional medical treatment, requiring plasmapheresis and a definitive thyroidectomy, which ultimately led to the return of patient’s baseline mental status and a dramatic recovery.
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Affiliation(s)
- Dimpi Desai
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Neetha Reddy
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Epstein
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vafa Tabatabaie
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Li L, Zhi M, Hou Z, Zhang Y, Yue Y, Yuan Y. Abnormal brain functional connectivity leads to impaired mood and cognition in hyperthyroidism: a resting-state functional MRI study. Oncotarget 2018; 8:6283-6294. [PMID: 28009983 PMCID: PMC5351631 DOI: 10.18632/oncotarget.14060] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/13/2016] [Indexed: 12/18/2022] Open
Abstract
Patients with hyperthyroidism frequently have neuropsychiatric complaints such as lack of concentration, poor memory, depression, anxiety, nervousness, and irritability, suggesting brain dysfunction. However, the underlying process of these symptoms remains unclear. Using resting-state functional magnetic resonance imaging (rs-fMRI), we depicted the altered graph theoretical metric degree centrality (DC) and seed-based resting-state functional connectivity (FC) in 33 hyperthyroid patients relative to 33 healthy controls. The peak points of significantly altered DC between the two groups were defined as the seed regions to calculate FC to the whole brain. Then, partial correlation analyses were performed between abnormal DC, FC and neuropsychological performances, as well as some clinical indexes. The decreased intrinsic functional connectivity in the posterior lobe of cerebellum (PLC) and medial frontal gyrus (MeFG), as well as the abnormal seed-based FC anchored in default mode network (DMN), attention network, visual network and cognitive network in this study, possibly constitutes the latent mechanism for emotional and cognitive changes in hyperthyroidism, including anxiety and impaired processing speed.
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Affiliation(s)
- Ling Li
- Department of Endocrinology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Mengmeng Zhi
- Department of Endocrinology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Zhenghua Hou
- Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Yuqun Zhang
- Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Yingying Yue
- Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, China.,Neuropsychiatric Institute, Affiliated ZhongDa Hospital, Southeast University, Nanjing, Jiangsu, 210009, China
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Prieto-Almeida F, Panveloski-Costa AC, Crunfli F, da Silva Teixeira S, Nunes MT, Torrão ADS. Thyroid hormone improves insulin signaling and reduces the activation of neurodegenerative pathway in the hippocampus of diabetic adult male rats. Life Sci 2018; 192:253-258. [DOI: 10.1016/j.lfs.2017.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022]
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Liu B, Ran Q, Liu D, Zhang S, Zhang D. Changes in Resting-State Cerebral Activity in Patients with Hyperthyroidism: A Short-Term Follow-Up Functional MR Imaging Study. Sci Rep 2017; 7:10627. [PMID: 28878279 PMCID: PMC5587688 DOI: 10.1038/s41598-017-10747-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/14/2017] [Indexed: 12/20/2022] Open
Abstract
To investigate the brain functional abnormality of hyperthyroid patients before and after treatment for one month using resting-state functional magnetic resonance imaging (rs-fMRI). Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) analysis were performed in 27 new-onset untreated hyperthyroid patients relative to 30 healthy controls. In addition, follow-up data were available for 19 patients treated with methimazole for one month. Compared with healthy controls, patients exhibited lower ALFF in the right posterior cingulate cortex (PCC); increased FC in the bilateral anterior insula (AI), bilateral posterior insula (PI) and left anterior lobe of the cerebellum (ALC); and decreased FC in the bilateral lateral prefrontal cortex (LPFC), the right medial temporal gyrus (MTG) and the bilateral PCC. Compared with the hyperthyroid status, patients with improved thyroid function showed increased FC in the right LPFC and right dorsolateral prefrontal cortex (DLPFC). Subsequently, Pearson’s correlation analyses were performed between abnormal ALFF, FC, neuropsychological assessment and serum free triiodothyronine (FT3) levels. The results indicated that the alterations in regional and network-level brain functions, which might underlie different psychiatric complications were dynamic and interactional processes in hyperthyroidism. Moreover, the improvement in regional brain FC was correlated with the efficacy of anti-thyroid medication.
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Affiliation(s)
- Bo Liu
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, P.R. China
| | - Qian Ran
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, P.R. China
| | - Daihong Liu
- Department of Radiology, Southwest Hosptial, Third Military Medical University, ChongQing, 400038, P.R. China
| | - Si Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, P.R. China
| | - Dong Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing, 400037, P.R. China.
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Nam HY, Jun S, Pak K, Kim IJ. Concurrent Low Brain and High Liver Uptake on FDG PET Are Associated with Cardiovascular Risk Factors. Korean J Radiol 2017; 18:392-401. [PMID: 28246520 PMCID: PMC5313528 DOI: 10.3348/kjr.2017.18.2.392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 10/24/2016] [Indexed: 12/31/2022] Open
Abstract
Objective Concurrent low brain and high liver uptake are sometimes observed on fluorine-18-labeled fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET). We investigated the potential clinical significance of this uptake pattern related to metabolic syndrome (MS). Materials and Methods We retrospectively reviewed data from 264 consecutive males who had undergone general health check-ups, including FDG PET/CT scans. After an overnight fast, the men had their peripheral blood drawn and the levels of various laboratory parameters measured; an FDG PET/CT scan was performed on the same day. We measured the maximum standardized uptake values of the brain and liver from regions of interest manually placed over the frontal cortex at the level of the centrum semiovale and the right lobe of the liver parenchyma, respectively. Results Fasting blood glucose (FBG; odds ratio [OR] = 1.063, p < 0.001) and glycated hemoglobin (HbA1c; OR = 3.634, p = 0.010) were the strongest predictive factors for low brain FDG uptake, whereas waist circumference (OR = 1.200, p < 0.001) and γ-glutamyl transpeptidase (OR = 1.012, p = 0.001) were the strongest predictive factors for high liver uptake. Eleven subjects (4.2%) showed concurrent low brain and high liver FDG uptake, and all but one of these subjects (90.9%) had MS. Systolic blood pressure, waist circumference, FBG, triglyceride, alanine aminotransferase, insulin resistance (measured by homeostasis model assessment), insulin, HbA1c, and body mass index were higher in subjects with this FDG uptake pattern than in those without (all, p < 0.001). Conclusion Concurrent low brain and high liver FDG uptake were closely associated with MS. Moreover, subjects with this pattern had higher values for various cardiovascular risk factors than did those without.
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Affiliation(s)
- Hyun-Yeol Nam
- Department of Nuclear Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
| | - Sungmin Jun
- Department of Nuclear Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - In Joo Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
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Göbel A, Heldmann M, Göttlich M, Dirk AL, Brabant G, Münte TF. Effect of Mild Thyrotoxicosis on Performance and Brain Activations in a Working Memory Task. PLoS One 2016; 11:e0161552. [PMID: 27536945 PMCID: PMC4990413 DOI: 10.1371/journal.pone.0161552] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/08/2016] [Indexed: 11/18/2022] Open
Abstract
AIMS Disturbed levels of thyroid hormones are associated with neuropsychiatric disorders, including memory impairments. The aim of this study was to evaluate effects of mild induced thyrotoxicosis on working memory and its neural correlates. METHODS Twenty-nine healthy, male subjects with normal thyroid state participated in the study. Functional MRI was acquired during a working memory task (n-back task) before and after ingesting 250 μg L-thyroxin per day for a period of eight weeks. In addition, neuropsychological tests were performed. RESULTS In the hyperthyroid condition the subjects showed slower reaction times, but a higher accuracy in the 0-back version of the memory tasks. Fewer differences between euthyroid and hyperthyroid state were seen for the more difficult conditions of the n-back task. FMRI revealed effects of difficulty in the parahippocampal gyrus, supplementary motor area, prefrontal cortex, anterior cingulate cortex, posterior cerebellum, rolandic operculum and insula (p<0.05, FWE corrected). When comparing euthyroid and hyperthyroid condition in relation to task-induced activation, differences of activation were found in the right prefrontal cortex as well as in the right parahippocampal area. In the psychological assessment, the alerting effect in the Attention Network Task (ANT) and four out of five parameters of the auditory verbal learning test (AVLT) showed an increase from euthyroid to hyperthyroid state. CONCLUSIONS It can be concluded that even a short-term intake of thyroid hormones leads to an activation of brain areas associated with working memory and to an improvement of accuracy of working memory tasks.
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Affiliation(s)
- Anna Göbel
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Martin Göttlich
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
| | - Anna-Luise Dirk
- Department of Internal Medicine I, University of Lübeck, 23538, Lübeck, Germany
| | - Georg Brabant
- Department of Internal Medicine I, University of Lübeck, 23538, Lübeck, Germany
| | - Thomas F. Münte
- Department of Neurology, University of Lübeck, 23538, Lübeck, Germany
- * E-mail:
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Yuan L, Tian Y, Zhang F, Ma H, Chen X, Dai F, Wang K. Decision-Making in Patients with Hyperthyroidism: A Neuropsychological Study. PLoS One 2015; 10:e0129773. [PMID: 26090955 PMCID: PMC4474662 DOI: 10.1371/journal.pone.0129773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 05/13/2015] [Indexed: 02/08/2023] Open
Abstract
Introduction Cognitive and behavioral impairments are common in patients with abnormal thyroid function; these impairments cause a reduction in their quality of life. The current study investigates the decision making performance in patients with hyperthyroidism to explore the possible mechanism of their cognitive and behavioral impairments. Methods Thirty-eight patients with hyperthyroidism and forty healthy control subjects were recruited to perform the Iowa Gambling Task (IGT), which assessed decision making under ambiguous conditions. Results Patients with hyperthyroidism had a higher score on the Zung Self-Rating Anxiety Scale (Z-SAS), and exhibited poorer executive function and IGT performance than did healthy control subjects. The patients preferred to choose decks with a high immediate reward, despite a higher future punishment, and were not capable of effectively using feedback information from previous choices. No clinical characteristics were associated with the total net score of the IGT in the current study. Conclusions Patients with hyperthyroidism had decision-making impairment under ambiguous conditions. The deficits may result from frontal cortex and limbic system metabolic disorders and dopamine dysfunction.
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Affiliation(s)
- Lili Yuan
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Yanghua Tian
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Fangfang Zhang
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Huijuan Ma
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Xingui Chen
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
| | - Fang Dai
- Department of Endocrinology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
- * E-mail: (FD); (KW)
| | - Kai Wang
- Department of Neurology, First Hospital of Anhui Medical University, Hefei, Anhui Province, PR China
- * E-mail: (FD); (KW)
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Göttlich M, Heldmann M, Göbel A, Dirk AL, Brabant G, Münte TF. Experimentally induced thyrotoxicosis leads to increased connectivity in temporal lobe structures: a resting state fMRI study. Psychoneuroendocrinology 2015; 56:100-9. [PMID: 25808701 DOI: 10.1016/j.psyneuen.2015.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/20/2015] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
Adult onset hyperthyroidism may impact on different cognitive domains, including attention and concentration, memory, perceptual function, language and executive function. Previous PET studies implicated changed functionality of limbic regions, the temporal and frontal lobes in hyperthyroidism, whereas it is unknown whether cognitive effects of hyperthyroidism may be due to changed brain connectivity. This study aimed to investigate the effect of experimentally induced short-term hyperthyroidism thyrotoxicosis on resting-state functional connectivity using functional magnetic resonance imaging. Twenty-nine healthy male right-handed subjects were examined twice, once prior and once after 8 weeks of oral administration of 250 μg levothyroxine per day. Resting-state fMRI was subjected to graph-theory based analysis methods to investigate whole-brain intrinsic functional connectivity. Despite a lack of subjective changes noticed by the subjects significant thyrotoxicosis was confirmed in all subjects. This induced a significant increase in resting-state functional connectivity specifically in the rostral temporal lobes (0.05 FDR corrected at the cluster level), which is caused by an increased connectivity to the cognitive control network. The increased connectivity between temporal poles and the cognitive control network shown here under experimental conditions supports an important function of thyroid hormones in the regulation of paralimbic structures.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Anna Göbel
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Anna-Luise Dirk
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Georg Brabant
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany.
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Zhang W, Liu X, Zhang Y, Song L, Hou J, Chen B, He M, Cai P, Lii H. Disrupted functional connectivity of the hippocampus in patients with hyperthyroidism: evidence from resting-state fMRI. Eur J Radiol 2014; 83:1907-13. [PMID: 25082476 DOI: 10.1016/j.ejrad.2014.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 06/29/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The hippocampus expresses high levels of thyroid hormone receptors, suggesting that hippocampal functions, including cognition and regulation of mood, can be disrupted by thyroid pathology. Indeed, structural and functional alterations within the hippocampus have been observed in hyperthyroid patients. In addition to internal circuitry, hippocampal processing is dependent on extensive connections with other limbic and neocortical structures, but the effects of hyperthyroidism on functional connectivity (FC) with these areas have not been studied. The purpose of this study was to investigate possible abnormalities in the FC between the hippocampus and other neural structures in hyperthyroid patients using resting-state fMRI. METHODS Seed-based correlation analysis was performed on resting-state fMRI data to reveal possible differences in hippocampal FC between hyperthyroid patients and healthy controls. Correlation analysis was used to investigate the relationships between the strength of FC in regions showing significant group differences and clinical variables. RESULTS Compared to controls, hyperthyroid patients showed weaker FC between the bilateral hippocampus and both the bilateral anterior cingulate cortex (ACC) and bilateral posterior cingulate cortex (PCC), as well as between the right hippocampus and right medial orbitofrontal cortex (mOFC). Disease duration was negatively correlated with FC strength between the bilateral hippocampus and bilateral ACC and PCC. Levels of depression and anxiety were negatively correlated with FC strength between the bilateral hippocampus and bilateral ACC. CONCLUSION Decreased functional connectivity between the hippocampus and bilateral ACC, PCC, and right mOFC may contribute to the emotional and cognitive dysfunction associated with hyperthyroidism.
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Affiliation(s)
- Wei Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China; Department of Radiology, Sichuan Provincial Corps Hospital, Chinese People's Armed Police Forces, Leshan 614000, China.
| | - Xianjun Liu
- Department of Radiology, Sichuan Provincial Corps Hospital, Chinese People's Armed Police Forces, Leshan 614000, China.
| | - Yi Zhang
- Department of Radiology, Sichuan Provincial Corps Hospital, Chinese People's Armed Police Forces, Leshan 614000, China.
| | - Lingheng Song
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Jingming Hou
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Mei He
- Department of Clinical Psychology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
| | - Haitao Lii
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
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Andersen SL, Laurberg P, Wu CS, Olsen J. Attention deficit hyperactivity disorder and autism spectrum disorder in children born to mothers with thyroid dysfunction: a Danish nationwide cohort study. BJOG 2014; 121:1365-74. [PMID: 24605987 DOI: 10.1111/1471-0528.12681] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the association between maternal hyper- and hypothyroidism and the risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in the child. DESIGN A population-based cohort study. SETTING Singletons liveborn in Denmark between 1991 and 2004. POPULATION A total of 857 014 singletons alive and living in Denmark at the age of 3 years. METHODS Information on the diagnosis and/or treatment of maternal thyroid disease and the neurodevelopmental disorders ADHD and ASD in the child was obtained from Danish nationwide registers. The Cox proportional hazards model was used to estimate the hazard ratio (HR) with 95% confidence interval (95% CI) for risk of ADHD and ASD in children born to mothers with thyroid dysfunction, adjusting for potential confounding factors. MAIN OUTCOME MEASURES ADHD and ASD in the child. RESULTS Altogether, 30,295 singletons (3.5%) were born to mothers with thyroid dysfunction. Maternal hyperthyroidism diagnosed and treated for the first time after the birth of the child increased the risk of ADHD in the child (adjusted HR 1.23; 95% CI 1.05-1.44), whereas hypothyroidism increased the risk of ASD (adjusted HR 1.34; 95% CI 1.14-1.59). No significant association was seen for maternal diagnosis and treatment prior to the birth of the child. CONCLUSIONS Children born to mothers diagnosed and treated for the first time for thyroid dysfunction after their birth may have been exposed to abnormal levels of maternal thyroid hormone already present during the pregnancy, and this untreated condition could increase the risk of specific neurodevelopmental disorders in the child.
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Affiliation(s)
- S L Andersen
- Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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Grey matter abnormalities in untreated hyperthyroidism: A voxel-based morphometry study using the DARTEL approach. Eur J Radiol 2014; 83:e43-8. [PMID: 24161779 DOI: 10.1016/j.ejrad.2013.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 09/15/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022]
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Yeap BB, Alfonso H, Chubb SAP, Puri G, Hankey GJ, Flicker L, Almeida OP. Higher free thyroxine levels predict increased incidence of dementia in older men: the Health in Men Study. J Clin Endocrinol Metab 2012; 97:E2230-7. [PMID: 22977271 DOI: 10.1210/jc.2012-2108] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Both hypothyroidism and subclinical hyperthyroidism hinder cognitive function. OBJECTIVE We aimed to determine whether more subtle alterations of thyroid hormone levels predict increased incidence of dementia in aging men. PARTICIPANTS AND DESIGN Community-dwelling men aged 70-89 yr participated in this prospective longitudinal study. MAIN OUTCOME MEASURES The Standardized Mini-Mental State Examination was performed at baseline (2001-2004), and circulating TSH and free T(4) (FT(4)) were assayed. Men with known thyroid disease or dementia, or Standardized Mini-Mental State Examination scores below 24 were excluded from follow-up. New-onset dementia, defined by International Classification of Disease (ICD) codes, was ascertained using data linkage (2001-2009). RESULTS During follow-up, 145 of 3401 men (4.3%) were diagnosed for the first time with dementia. Men who developed dementia had higher baseline FT(4) (16.5 ± 2.2 vs. 15.9 ± 2.2 pmol/liter, P = 0.004) but similar TSH (2.2 ± 1.4 vs. 2.3 ± 1.6 mU/liter, P = 0.23) compared with men who did not receive this diagnosis. After adjusting for covariates, higher FT(4) predicted new-onset dementia (11% increased risk per 1 pmol/liter increase in FT(4), P = 0.005; quartiles Q2-4 vs. Q1: adjusted hazard ratio = 1.76, 95% confidence interval = 1.03-3.00, P = 0.04). There was no association between TSH quartiles and incident dementia. When the analysis was restricted to euthyroid men (excluding those with subclinical hyper- or hypothyroidism), higher FT(4) remained associated with incident dementia (11% increase per unit increment, P = 0.03; Q2-4 vs. Q1: adjusted hazard ratio = 2.02, 95% confidence interval = 1.10-3.71, P = 0.024). CONCLUSIONS Higher FT(4) levels predict new-onset dementia in older men, independently of conventional risk factors for cognitive decline. Additional studies are needed to explore potential underlying mechanisms and to clarify the utility of thyroid function testing in older men at risk of dementia.
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Affiliation(s)
- Bu B Yeap
- School of Medicine and Pharmacology, Centre for Medical Research, University of Western Australia, Crawley, Western Australia 6009, Australia.
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Jahagirdar V, McNay EC. Thyroid hormone's role in regulating brain glucose metabolism and potentially modulating hippocampal cognitive processes. Metab Brain Dis 2012; 27:101-11. [PMID: 22437199 PMCID: PMC3348399 DOI: 10.1007/s11011-012-9291-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/08/2012] [Indexed: 12/25/2022]
Abstract
Cognitive performance is dependent on adequate glucose supply to the brain. Insulin, which regulates systemic glucose metabolism, has been recently shown both to regulate hippocampal metabolism and to be a mandatory component of hippocampally-mediated cognitive performance. Thyroid hormones (TH) regulate systemic glucose metabolism and may also be involved in regulation of brain glucose metabolism. Here we review potential mechanisms for such regulation. Importantly, TH imbalance is often encountered in combination with metabolic disorders such as diabetes, and may cause additional metabolic dysregulation and hence worsening of disease states. TH's potential as a regulator of brain glucose metabolism is heightened by interactions with insulin signaling, but there have been relatively few studies on this topic or on the actions of TH in a mature brain. This review discusses evidence for mechanistic links between TH, insulin, cognitive function, and brain glucose metabolism, and reaches the conclusion that TH may modulate memory processes, likely at least in part by modulation of central insulin signaling and glucose metabolism.
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Affiliation(s)
- V Jahagirdar
- Office of Outcomes Assessment and Institutional Research, Excelsior College, Albany, NY 12203, USA.
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