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Obsekov V, Ghassabian A, Mukhopadhyay S, Trasande L. Manganese and thyroid function in the national health and nutrition examination survey, 2011-2012. ENVIRONMENTAL RESEARCH 2023; 222:115371. [PMID: 36709872 DOI: 10.1016/j.envres.2023.115371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Manganese (Mn) exposure is prevalent, as it is found naturally as ionized trace elements and released into the environment as a byproduct of manufacturing and waste disposal. Animal and human studies have suggested variable effects on thyroid function, but the association of Mn exposure with thyroid function has not been evaluated in a national sample. OBJECTIVE To investigate the associations between serum and urinary Mn levels and serum thyroid hormone concentrations in a nationally representative sample. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION This was a cross-sectional analysis of data from the 2011-2012 National Health and Nutrition Examination Survey among 1360 participants. MAIN OUTCOME MEASURES Serum thyroid stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), free T3, and free T4. RESULTS Serum Mn levels were positively associated with increasing total T4, free T3, and total T3 in the whole cohort (p < 0.01). Urinary Mn levels were not associated with thyroid hormone levels. When subgroup analyses were performed by gender, only males had total T4 associated with serum Mn [β = 0.01, p < 0.01, confidence interval (CI): 0.004-0.018]. In individuals under 22 years old, serum Mn was significantly associated with total T4 (β = 0.02, p = 0.002, CI: 0.008-0.029). Serum Mn was positively associated with Free T3 in both genders (β = 0.07, p < 0.001). CONCLUSION While our findings do not suggest clinical thyroid dysfunction, there is an association between serum Mn and subclinical changes in thyroid function that warrant further studies. Regulatory action should be considered as Mn-based organometallic compounds are being considered as replacements for lead in gasoline and may pose future risks to human health.
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Affiliation(s)
- Vladislav Obsekov
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Akhgar Ghassabian
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Leonardo Trasande
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Departments of Population Health and Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA; NYU Wagner School of Public Service, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA
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Kocaaslan Atli S, Olgaç Dündar N, Erdoğan U, Evirgen Esin N, Bayazit O, Kahya MC, Çatli G, Gençpinar P, Nuri Dündar B, Dundar BN. Resting Electroencephalography Differences Between Eyes-Closed and Eyes-Open Conditions in Children with Subclinical Hypothyroidism. Turk Arch Pediatr 2023; 58:34-41. [PMID: 36598209 PMCID: PMC9885780 DOI: 10.5152/turkarchpediatr.2022.22144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Electroencephalography changes that occur during the transition from eyes-closed to the eyes-open state in resting condition are related to the early phase of sensory processing and are defined as activation. The present study aimed to reveal the potential deteriorations that may occur in the initial period of sensory processing in resting electroencephalography between children with subclinical hypothyroidism and a control group. MATERIALS AND METHODS Electroencephalographies of 15 children with subclinical hypothyroidism and 15 healthy children aged 10 to 17 years were recorded for 2 minutes for EC and 2 minutes for eyes-open conditions in resting state. Absolute electroencephalography band powers (μV2 ) within the delta, theta, alpha, and beta frequency bands were calculated in Fz, Cz, Pz, and Oz electrodes, respectively, for eyes-closed and eyes-open conditions. RESULTS The results show that, although there was no noteworthy difference between the powers of the electroencephalography frequency bands of children with subclinical hypothyroidism and healthy children during the eyes-open condition, the alpha powers of the control group were significantly higher in all electrodes during the eyes-closed condition. Furthermore, the powers of all frequency bands were observed to decrease in the eyes-open condition in the control group. However, the same net decrease was not observed in the frequency powers of children with subclinical hypothyroidism. CONCLUSION According to the results of this study, children with subclinical hypothyroidism may experience information processing impairments starting in the early stages of sensory processing.
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Affiliation(s)
- Sibel Kocaaslan Atli
- Department of Biophysics, İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey,Corresponding author:Sibel Kocaaslan Atli ✉
| | - Nihal Olgaç Dündar
- Department of Pediatric Neurology, İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | - Uğraş Erdoğan
- Department of Electrical – Electronics, İzmir Institute of Technology, Faculty of Engineering, İzmir, Turkey
| | | | - Onur Bayazit
- Department of Biophysics, ydın University, Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Cemal Kahya
- Department of Biophysics, İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | - Gönül Çatli
- Department of Pediatric Endocrinology, İzmir Katip Celebi University, Faculty of Medicine, İzmir, Turkey
| | - Pınar Gençpinar
- Department of Pediatric Neurology, İzmir Katip Çelebi University, Faculty of Medicine, İzmir, Turkey
| | - Bumin Nuri Dündar
- Department of Pediatric Endocrinology, İzmir Katip Celebi University, Faculty of Medicine, İzmir, Turkey
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Surya ND, Widjanarko ND, Permatasari TK, Yosephine Y, Wijaya E. Subclinical hypothyroidism and digit span test performance in children: a systematic review and meta-analysis. PAEDIATRICA INDONESIANA 2022. [DOI: 10.14238/pi62.5.2022.324-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The digit span (DS) test is one of the most commonly used neuropsychological tests to assess certain cognitive domains, i.e., short-term verbal memory, working memory, and attention. Subclinical hypothyroidism (SH) may be associated with a risk of cognitive impairment in children and adolescents.
Objective To evaluate the association between SH and DS test performance in children.
Methods Eligible studies evaluating SH and DS test performance were included in this systematic review and further assessed for risk of bias using the Newcastle Ottawa Scale. We carried out a meta-analysis using the random effects model to determine mean difference with 95% confidence interval (95%CI) for continuous data. This systematic review was conducted according to the Preview Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
Results Out of 1,511 participants in the five included studies, 129 had SH and 1,382 were euthyroid. The quality of all studies were fair to good. Three studies were extracted for meta-analysis, with results showing a trend toward a poorer DS test performance in the SH group compared to controls, although this difference was statistically insignificant (IV -0.57; 95%CI -1.61 to 0.46; P=0.28). There was no significant heterogeneity among the included studies (I2=0%; P=0.69).
Conclusion No significant association was noted between SH and the domains of cognitive function assessed using the DS test. Several intrinsic and extrinsic factors and inability of the DS test to detect subtle impairment may limit its usefulness in children.
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Mishra J, Vishwakarma J, Malik R, Gupta K, Pandey R, Maurya SK, Garg A, Shukla M, Chattopadhyay N, Bandyopadhyay S. Hypothyroidism Induces Interleukin-1-Dependent Autophagy Mechanism as a Key Mediator of Hippocampal Neuronal Apoptosis and Cognitive Decline in Postnatal Rats. Mol Neurobiol 2021; 58:1196-1211. [PMID: 33106949 DOI: 10.1007/s12035-020-02178-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
Abstract
Thyroid hormone (TH) is essential for brain development, and hypothyroidism induces cognitive deficits in children and young adults. However, the participating mechanisms remain less explored. Here, we examined the molecular mechanism, hypothesizing the involvement of a deregulated autophagy and apoptosis pathway in hippocampal neurons that regulate cognitive functions. Therefore, we used a rat model of developmental hypothyroidism, generated through methimazole treatment from gestation until young adulthood. We detected that methimazole stimulated the autophagy mechanism, characterized by increased LC3B-II, Beclin-1, ATG7, and ATG5-12 conjugate and decreased p-mTOR/mTOR and p-ULK1/ULK1 autophagy regulators in the hippocampus of developing and young adult rats. This methimazole-induced hippocampal autophagy could be inhibited by thyroxine treatment. Subsequently, probing the upstream mediators of autophagy revealed an increased hippocampal neuroinflammation, marked by upregulated interleukin (IL)-1alpha and beta and activated microglial marker, Iba1, promoting neuronal IL-1 receptor-1 expression. Hence, IL-1R-antagonist (IL-1Ra), which reduced hippocampal neuronal IL-1R1, also inhibited the enhanced autophagy in hypothyroid rats. We then linked these events with hypothyroidism-induced apoptosis and loss of hippocampal neurons, where we observed that like thyroxine, IL-1Ra and autophagy inhibitor, 3-methyladenine, reduced the cleaved caspase-3 and TUNEL-stained apoptotic neurons and enhanced Nissl-stained neuronal count in methimazole-treated rats. We further related these molecular results with cognition through Y-maze and passive avoidance tests, demonstrating an IL-1Ra and 3-methyladenine-mediated improvement in learning-memory performances of the hypothyroid rats. Taken together, our study enlightens the critical role of neuroinflammation-dependent autophagy mechanism in TH-regulated hippocampal functions, disrupted in developmental hypothyroidism.
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Affiliation(s)
- Juhi Mishra
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
- Department of Biochemistry, Babu Banarasi Das University, Faizabad Road, Lucknow, Uttar Pradesh, India
| | - Jitendra Vishwakarma
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rafat Malik
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
| | - Keerti Gupta
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rukmani Pandey
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
- Department of Psychiatry, Center for Molecular Biology and Genetics of Neurodegeneration, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shailendra Kumar Maurya
- Division of Endocrinology, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, Uttar Pradesh, India
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Asmita Garg
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Manoj Shukla
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, Uttar Pradesh, India
| | - Sanghamitra Bandyopadhyay
- Developmental Toxicology Laboratory, Systems Toxicology & Health Risk Assessment Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Vishvigyan Bhavan, Lucknow, Uttar Pradesh, 226001, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India.
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Kalra P, Kumaraswamy DR, Dharmalingam M, Saini J, Yadav R. Neuropsychological Impairments in Young Patients With Subclinical Hypothyroidism: A Case Control Study. Ann Neurosci 2020; 27:169-174. [PMID: 34556956 PMCID: PMC8455001 DOI: 10.1177/0972753121990177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is a lack of clarity about the cognitive dysfunction in young patients with subclinical hypothyroidism (SCH). This study was done to explore the neuropsychological impairments in young patients with SCH and compare them with euthyroid controls. Methods: Patients between 18 and 45 years of age and diagnosed with SCH were recruited. Controls were euthyroid age, gender, and education matched. All the cases and controls underwent a detailed neuropsychological assessment with a battery of tests validated for use in the age groups of 18 to 65 years. Results: Thirty-nine patients with a mean age of 30.3 ± 7.7 years (female:male ratio 12:1) and 23 controls (female:male ratio 21:2) with a mean age of 33.4 ± 7.1 years (P = .24) were included in the study. The mean TSH value was 6.36 ± 1.3 mIU/L and 2.49 ± 1.03 mIU/L in cases and controls, respectively (P < .001). The visual memory delayed recall was impaired, in 48.71% (n = 19) and 21.7% (n = 5) cases and controls, respectively (P = .03). The category fluency test showed impairment in a greater number of cases (35.9%, n = 14) as compared to controls (13%, n = 3; P = .04). Conclusion: This study shows that younger patients with SCH have delayed visual memory recall and category fluency deficits, which are suggestive of dysfunction of the prefrontal cortex and temporal lobe in young SCH patients. These impairments may justify the treatment of young SCH patients with replacement therapy.
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Affiliation(s)
- Pramila Kalra
- Department of Endocrinology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - D R Kumaraswamy
- Department of Neuropsychology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Mala Dharmalingam
- Department of Endocrinology, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Capalbo D, Alfano S, Polizzi M, Di Mase R, Improda N, Esposito A, Bravaccio C, Salerno M. Cognitive Function in Children With Idiopathic Subclinical Hypothyroidism: Effects of 2 Years of Levothyroxine Therapy. J Clin Endocrinol Metab 2020; 105:5718305. [PMID: 32002552 DOI: 10.1210/clinem/dgaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/28/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term consequences of mild subclinical hypothyroidism (SH) in children are still unclear, and the need for levothyroxine (L-T4) supplementation remains controversial. We designed a 2-year, case-control, prospective study of a cohort of children with SH to evaluate the effects of L-T4 therapy on neurocognitive outcome. METHODS Thirty-four children, age 9.1 ± 2.6 years, with long-lasting, idiopathic, and mild SH, and 34 healthy matched controls, were enrolled. Twenty SH children underwent a 2-year L-T4 treatment (group A), whereas 14 refused treatment and were reevaluated after a 2-year-follow-up (group B). IQ and specific cognitive domains were evaluated in all children at study entry and after 2 years of therapy (group A) or observation (group B) in SH individuals. RESULTS In SH children baseline IQ scores were normal and comparable to controls (full-scale IQ [FSIQ] 100.4 ± 11.3 vs 101.8 ± 14.2, verbal IQ [VIQ] 99.7 ± 13.7 vs 98.3 ± 14.9 and performance IQ [PIQ] 101.2 ± 10.4 vs 105 ± 10.4).In group A, L-T4 treatment was associated with normalization of thyrotropin (6.3 ± 1.0 mIU/L at baseline vs 2.8 ± 1.4 mIU/L at 2 years, P < .001). However, 2-year L-T4 therapy was not associated with a change in IQ scores (FSIQ 104.4 ± 13.8 vs 102.7 ± 11.0; VIQ 101.8 ± 14.9 vs 102.3 ± 11.9; and PIQ 106.5 ± 13.9 vs 102.7 ± 10.7) or in verbal or performance subtest scores. No significant differences were found in IQ scores after 2 years of treatment in group A compared to group B after a 2-year follow-up. CONCLUSIONS Our data suggest neurocognitive function in children is not impaired by persistent, mild, untreated SH and is not significantly modified by 2-year L-T4 supplementation.
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Affiliation(s)
- Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Sara Alfano
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Miriam Polizzi
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Mother and Child, University Hospital Federico II, Naples, Italy
| | - Nicola Improda
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carmela Bravaccio
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University Federico II, Naples, Italy
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Tooze A, Sheehan JP. Neurocognitive changes in pituitary adenoma patients after Gamma Knife radiosurgery. J Neurosurg 2019; 129:55-62. [PMID: 30544290 DOI: 10.3171/2018.7.gks181595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPituitary adenomas and the treatment required for the underlying neuropathology have frequently been associated with cognitive dysfunction. However, the mechanisms for these impairments remain the subject of much debate. The authors evaluated cognitive outcomes in patients treated with or without Gamma Knife radiosurgery (GKRS) for an underlying pituitary adenoma.METHODSThis was a retrospective, institutional review board-approved, single-institution study. A total of 51 patients (23 male, 28 female) treated for pituitary adenoma were included in this neurocognitive study. Twenty-one patients underwent GKRS following transsphenoidal surgery, 22 patients were treated with transsphenoidal surgery alone, and eight patients were conservatively managed or were treated with medical management alone. Comparisons using psychometric tests of general intellectual abilities, memory, and executive functions were made between the treatment groups, between male and female patients, and between patients with Cushing's disease and those with nonfunctioning adenoma (NFA).RESULTSThe entire patient sample, the NFA group, and the GKRS group scored significantly below expected on measures of both immediate and delayed memory, particularly for visually presented information (p ≤ 0.05); however, there were no significant differences between the patients with Cushing's disease and those with NFA (t ≤ 0.56, p ≥ 0.52). In those who underwent GKRS, memory scores were not significantly different from those in the patients who did not undergo GKRS (t ≤ 1.32, p ≥ 0.19). Male patients across the sample were more likely to demonstrate impairments in both immediate memory (t = -3.41, p = 0.003) and delayed memory (t = -3.80, p = 0.001) than were female patients (t ≤ 1.09, p ≥ 0.29). There were no impairments on measures of general intellectual functioning or executive functions in any patient group. The potential contributions of tumor size and hormone levels are discussed.CONCLUSIONSOverall, pituitary adenoma patients demonstrated relative impairment in anterograde memory. However, GKRS did not lead to adverse effects for immediate or delayed memory in pituitary adenoma patients. Cognitive assessment of pituitary adenoma patients is important in their longitudinal care.
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Affiliation(s)
- Alana Tooze
- 1Sussex Rehabilitation Centre, Princess Royal Hospital, Haywards Heath, Sussex, United Kingdom; and
| | - Jason P Sheehan
- 2Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Kocaaslan Atli S, Olgaç Dündar N, Bayazit O, Evirgen Esin N, Erdoğan U, Çatli G, Kahya MC, Dündar BN. Auditory event-related potentials demonstrate early cognitive impairment in children with subclinical hypothyroidism. J Pediatr Endocrinol Metab 2019; 32:689-697. [PMID: 31194683 DOI: 10.1515/jpem-2018-0463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/15/2019] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to examine the cognitive functions of children with subclinical hypothyroidism (SH) and healthy children with the use of auditory event-related potentials (AERPs) and neuropsychological tests. Methods Twenty children aged between 8 and 17 years, diagnosed with SH, and 20 age-matched healthy controls were included in this study. A classical auditory oddball paradigm was applied during the electroencephalography (EEG) recordings, and event-related potentials (ERPs) were evaluated between the 0.5- and 20-Hz frequency intervals. P1, N1, P2, N2 and P3 amplitudes and latencies were measured in Fz, FCz, Cz, CPz, Pz and Oz electrodes. Additionally, a number of neuropsychological tests evaluating the reaction time and various cognitive functions were carried out. Results In children with SH, P3 amplitudes in FCz, Cz and CPz electrodes were significantly lower than those in controls (p < 0.05). In addition to this, the P1N1 and N1P2 peak-to-peak amplitude values were also found to be smaller for children with SH than controls (p < 0.05). With regard to the neuropsychological tests, no significant difference was observed between the SH and control groups on any of the cognitive test parameters, reaction time or correct response rates. Conclusions In the present study, while children with SH did not differ from controls with respect to their cognitive functions evaluated via neuropsychological tests, cognitive differences were detected via electrophysiological investigations. This result implies that implicit changes in cognition which are not yet overtly reflected on neuropsychological tests may be detected at an early stage in children with SH.
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Affiliation(s)
- Sibel Kocaaslan Atli
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Nihal Olgaç Dündar
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Onur Bayazit
- Aydın University, Faculty of Medicine, Biophysics Department, Istanbul, Turkey
| | | | - Uğraş Erdoğan
- Izmir Institute of Technology, Faculty of Engineering, Department of Electrical - Electronics, Izmir, Turkey
| | - Gönül Çatli
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
| | - Mehmet Cemal Kahya
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Biophysics, İzmir, Turkey
| | - Bumin Nuri Dündar
- Izmir Katip Celebi University, Faculty of Medicine, Department of Pediatric Endocrinology, Izmir, Turkey
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9
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Önsesveren I, Barjaktarovic M, Chaker L, de Rijke YB, Jaddoe VWV, van Santen HM, Visser TJ, Peeters RP, Korevaar TIM. Childhood Thyroid Function Reference Ranges and Determinants: A Literature Overview and a Prospective Cohort Study. Thyroid 2017; 27:1360-1369. [PMID: 28942709 DOI: 10.1089/thy.2017.0262] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Reported cutoffs for childhood thyrotropin (TSH) and free thyroxine (fT4) reference ranges vary widely, and knowledge on the determinants of childhood thyroid function is sparse. This study aimed to summarize the existing studies on thyroid function reference ranges in children. Furthermore, the objective was to investigate the determinants of childhood TSH and fT4 concentration in a population based-prospective cohort. METHODS First, to identify studies on childhood thyroid reference ranges, The National Library of Medicine's PubMed, Embase, Ovid Medline, Web of Science, and Google Scholar databases were systematically searched. Second, in a non-selected sample of 4273 children (median age 6.0 years, range 4.9-9.1 years) from the cohort, the associations of age, sex, anthropometric characteristics, ethnicity, maternal education, and time and season at venipuncture were studied with TSH and fT4 concentrations. The study also investigated to what extent between-individual variations in the determinants of TSH and fT4 could influence the calculation of reference ranges. RESULTS Published reference ranges for TSH and fT4 differ per age range and within age ranges (cutoffs low TSH: 0.13 to >1 mIU/L; high TSH: 2.36 to >10 mIU/L; low fT4: 7.0 to >10 pmol/L; high fT4: 15.5 to >30 pmol/L). In the present cohort, weight, sex, and ethnicity were determinants of TSH (p ≤ 0.03) and fT4 concentrations (p ≤ 0.01), and height and time at venipuncture were determinants of TSH only (p < 0.0001). The between-individual variation depending on clinical determinants for TSH ranged between 0.64 and 0.96 mIU/L (total population 0.87 mIU/L) for the lower limit and 4.30 and 5.62 mIU/L (total population 5.20 mIU/L) for the upper limit, whereas for fT4, the lower limit ranged between 13.6 and 14.2 pmol/L (total population 13.8 pmol/L) and the upper limit ranged between 20.2 and 23.0 pmol/L (total population 20.8 pmol/L). CONCLUSIONS Considerable differences exist in the reported reference ranges for childhood TSH and fT4 across and within age ranges and assays. The present cohort shows only a minimal association between TSH and fT4, suggesting that the hypothalamus-pituitary-thyroid axis remains unaffected by thyroid interfering factors. Various determinants of TSH and fT4 in children were identified, which accounted for a considerable variation of reference range cutoffs.
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Affiliation(s)
- Ibrahim Önsesveren
- 1 The Generation R Study Group, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Mirjana Barjaktarovic
- 1 The Generation R Study Group, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Layal Chaker
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 4 Department of Clinical Chemistry, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- 1 The Generation R Study Group, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 5 Department of Epidemiology, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 6 Pediatrics, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Hanneke M van Santen
- 7 Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center , Utrecht, The Netherlands
| | - Theo J Visser
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Robin P Peeters
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
| | - Tim I M Korevaar
- 1 The Generation R Study Group, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 2 Department of Internal Medicine, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
- 3 Academic Center for Thyroid Diseases, Erasmus Medical Center-Sophia Children's Hospital , Rotterdam, The Netherlands
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10
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McMullen J, Ghassabian A, Kohn B, Trasande L. Identifying Subpopulations Vulnerable to the Thyroid-Blocking Effects of Perchlorate and Thiocyanate. J Clin Endocrinol Metab 2017; 102:2637-2645. [PMID: 28430972 DOI: 10.1210/jc.2017-00046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/06/2017] [Indexed: 12/17/2022]
Abstract
CONTEXT Common environmental contaminants can disrupt normal thyroid function, which plays essential but varying roles at different ages. OBJECTIVE To evaluate the relationship of perchlorate, thiocyanate, and nitrate, three sodium-iodide symporter (NIS) inhibitors, and thyroid function in different age-sex-stratified populations. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION This was a cross-sectional analysis of data from the 2009 to 2012 National Health and Nutrition Examination Survey evaluating the exposure to perchlorate, thiocyanate, and nitrate in 3151 participants aged 12 to 80. MAIN OUTCOME MEASURE Blood serum free thyroxine (FT4) as both a continuous and categorical variable. We also assessed blood serum thyroid stimulating hormone. RESULTS Controlling for serum cotinine, body mass index, total daily energy consumption, race/ethnicity, and poverty-to-income ratio, for each log unit increase in perchlorate, FT4 decreased by 0.03 ng/dL in both the general population (P = 0.004) and in all women (P = 0.005), and by 0.06 ng/dL in adolescent girls (P = 0.029), corresponding to 4% and 8% decreases relative to median FT4, respectively. For each log unit increase thiocyanate, FT4 decreased by 0.07 ng/dL in adolescent boys (P = 0.003), corresponding to a 9% decrease relative to median FT4, respectively. CONCLUSIONS Our results indicate that adolescent boys and girls represent vulnerable subpopulations to the thyroid-blocking effects of NIS symporter inhibitors. These results suggest a valuable screening and intervention opportunity.
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Affiliation(s)
- Jenica McMullen
- School of Medicine, New York University, New York, New York 10003
| | - Akhgar Ghassabian
- School of Medicine, New York University, New York, New York 10003
- Department of Pediatrics, School of Medicine, New York University, New York, New York 10003
| | - Brenda Kohn
- School of Medicine, New York University, New York, New York 10003
- Department of Pediatrics, School of Medicine, New York University, New York, New York 10003
| | - Leonardo Trasande
- School of Medicine, New York University, New York, New York 10003
- Department of Pediatrics, School of Medicine, New York University, New York, New York 10003
- Wagner School of Public Service, New York University, New York, New York 10003
- College of Global Public Health, New York University, New York, New York 10003
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