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Genç B, Aslan K, Avcı U, İncesu L, Günbey HP. Opposing effects of thyroid hormones on hypothalamic subunits and limbic structures in hyperthyroidism patients: A comprehensive volumetric study. J Neuroendocrinol 2024; 36:e13369. [PMID: 38326952 DOI: 10.1111/jne.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/25/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
Thyroid hormones play a critical role in brain development, but paradoxically, patients with hyperthyroidism often exhibit cognitive decline and irritability. This study aims to explore the pattern of atrophy in hyperthyroid patients, changes in specific areas of the brain, including hypothalamic subfields and limbic structures, and their relationships with hormonal levels and psychometric tests. This prospective cross-sectional study involves 19 newly diagnosed, untreated hyperthyroid patients, and 15 age and gender-matched control subjects. The participants underwent psychometric and cognitive tests and volumetric MRI. The hypothalamic subfield (anterior-inferior, anterior-superior, superior-tubular, inferior-tubular, and posterior hypothalamus) and limbic structures (fornix, basal forebrain, nucleus accumbens, and septal nucleus) were segmented using voxel-based morphometry, surface-based morphometry, and deep learning algorithms. The groups were compared using the t-test, and correlation analyses were performed between clinical parameters and volumetric measurements. The correlation between hormonal parameters and volumetric measurements in patient and control groups was assessed with the Meng test. Hyperthyroid patients displayed widespread grey matter loss and sulcal shallowing in the left hemisphere. However, no local gyrification index changes or cortical thickness variations were detected. The limbic structures and hypothalamic subunits did not show any volume discrepancies. Free thyroxine in the patient group negatively correlated with bilateral anterior-inferior and right septal nucleus, but positively correlated with left anterior-inferior in the control group. Thyroid stimulating hormone in the patient group showed a positive correlation with bilateral fornix volume, a correlation absent in the control group. Disease duration negatively correlated with right anterior-inferior, right tubular inferior, and right septal nucleus. Changes in cognitive and psychometric test scores in the patient group correlated with the bilateral septal nucleus volume. Hyperthyroidism primarily leads to a reduction in grey matter volume and sulcal shallowing. Thyroid hormones have differing volumetric effects in limbic structures and hypothalamic subunits under physiological and hyperthyroid conditions.
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Affiliation(s)
- Barış Genç
- Department of Radiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Kerim Aslan
- Department of Neuroradiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Uğur Avcı
- Department of Endocrinology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Lütfi İncesu
- Department of Neuroradiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hediye Pınar Günbey
- Department Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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Goldberg H, Malik AI. Teprotumumab in thyroid eye disease. Saudi J Ophthalmol 2024; 38:29-33. [PMID: 38628412 PMCID: PMC11017013 DOI: 10.4103/sjopt.sjopt_179_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 04/19/2024] Open
Abstract
Thyroid eye disease (TED) is an inflammatory condition involving the periocular and orbital soft tissues, affecting most commonly patients with hyperthyroid disorders. Traditional treatments used for the active phase of the disease range from conservative lubrication for mild symptoms to systemic immunomodulating drugs for moderate-to-severe symptoms. Teprotumumab (Tepezza) is a monoclonal antibody with an inhibitory effect on insulin-like growth factor 1 and is the first Food and Drug Administration (FDA) approved targeted medical therapy for reducing the inflammatory signs and symptoms associated with TED. Two large multicenter, randomized, double-masked, placebo-controlled trials have confirmed the efficacy and safety of teprotumumab in patients with active, moderate-to-severe TED. Recent reports and publications have also demonstrated the efficacy of teprotumumab in a wider range of patients. In this review, we summarize the clinical features and pathophysiology of TED, disease course, and traditional management methods. We further detail the development of teprotumumab, the founding studies that brought it to its FDA approval, adverse events profile, and ongoing as well as future investigations.
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Affiliation(s)
- Hila Goldberg
- Department of Ophthalmology, Blanton Eye institute, Houston Methodist Hospital, Houston, Texas, USA
- Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Amina I. Malik
- Department of Ophthalmology, Blanton Eye institute, Houston Methodist Hospital, Houston, Texas, USA
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Bilichodu Rangappa S, Sharma A, Avula S, Chandramohan D, Sharma V. The Intertwined Relationship Between an Overactive Thyroid and an Overactive Mind: A Case Report and Review of Literature. Cureus 2023; 15:e50748. [PMID: 38239533 PMCID: PMC10794160 DOI: 10.7759/cureus.50748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
This case report presents the clinical scenario of a 45-year-old male patient who exhibited acute psychiatric symptoms as the initial manifestation of Graves' disease, a common etiology of hyperthyroidism. The patient presented with severe agitation, persecutory delusions, and auditory hallucinations, raising concerns about his mental health. Detailed diagnostic evaluations revealed thyroid dysfunction characterized by markedly low thyroid-stimulating hormone (TSH) levels, elevated free T4 levels, and increased total T3 levels, indicative of thyrotoxicosis. Elevated thyroid-stimulating immunoglobulin (TSI) levels further confirmed the diagnosis of Graves' disease. The patient received treatment with methimazole and propranolol to manage the hyperthyroidism, leading to the resolution of psychiatric symptoms. This case emphasizes the importance of considering thyroid function in patients presenting with acute psychiatric disturbances. This literature review explores the intricate relationship between hyperthyroidism, a condition characterized by the excessive production of thyroid hormones, and its impact on psychological and cognitive processes. Understanding the connection between an overactive thyroid and an overactive mind is crucial for clinicians and researchers to provide comprehensive care and treatment for affected individuals.
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Affiliation(s)
| | - Aditi Sharma
- Psychiatry, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Sreekant Avula
- Diabetes, Endocrinology, and Metabolism, University of Minnesota, Minneapolis, USA
| | - Deepak Chandramohan
- Internal Medicine and Nephrology, University of Alabama at Birmingham, Birmingham, USA
| | - Vinod Sharma
- Psychiatry, The Wright Center for Graduate Medical Education, Scranton, USA
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Mohan S, Koo Lin L, Ho TC, Zhang-Nunes S, Patel V, Chang JR. Lateral orbital wall anomaly in a patient with thyroid eye disease. Orbit 2023; 42:94-97. [PMID: 34404314 DOI: 10.1080/01676830.2021.1966812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
An isolated defect in the lateral orbital wall is an uncommon occurrence, although cases of orbital floor, roof, and medial wall spontaneous dehiscence have been described in the literature. Here, we describe a lateral orbital wall defect in a patient with thyroid eye disease - which may be related to bony remodeling or may represent a rare congenital anomaly. Computed tomography (CT) prior to decompression surgery revealed a defect in the left lateral orbital wall. At the time of orbital decompression, prolapse of buccal fat into the orbit was noted once the subperiosteal plane was entered along the lateral orbital wall in the area of this bony defect. Literature review revealed only a few previous reports of lateral wall abnormalities, including two involving the inferior orbital fissure; one other case was associated with Down syndrome, and other reports consist of sphenoid hypoplasia associated with neurofibromatosis.
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Affiliation(s)
- Sukriti Mohan
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California, USA
| | - Tiffany C Ho
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sandy Zhang-Nunes
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jessica R Chang
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Delcorte O, Degosserie J, Pierreux CE. Role of Extracellular Vesicles in Thyroid Physiology and Diseases: Implications for Diagnosis and Treatment. Biomedicines 2022; 10:biomedicines10102585. [PMID: 36289847 PMCID: PMC9599682 DOI: 10.3390/biomedicines10102585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Extracellular vesicles are spherical subcellular structures delimited by a lipid bilayer and released by most cells in the human body. They are loaded with a myriad of molecules (i.e., nucleic acids and proteins) depending on their cell of origin and provide the ability to transmit a message to surrounding or distant target cells. In several organs, including the thyroid, abundant recent literature reports that extracellular vesicles are responsible for intercellular communication in physiological and pathological processes, and that their utilization as a potential biomarker of pathological states (i.e., cancer, autoimmune diseases) or as therapeutic delivery vehicles promise clinical options. In this review, we present the current knowledge and understanding regarding the role of extracellular vesicles in developing thyroid diseases and diagnosis.
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Affiliation(s)
- Ophélie Delcorte
- CELL Unit, de Duve Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
- Correspondence:
| | - Jonathan Degosserie
- Department of Laboratory Medicine, Molecular Diagnostic Center, CHU UCL Namur, 5530 Yvoir, Belgium
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Wagner LH, Bradley EA, Tooley AA, Ren Y, Rachmasari KN, Stan MN. Thyroid eye disease or Graves' orbitopathy: What name to use, and why it matters. Front Endocrinol (Lausanne) 2022; 13:1083886. [PMID: 36518254 PMCID: PMC9742525 DOI: 10.3389/fendo.2022.1083886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
There is currently no universally accepted name for inflammatory disease of the eye and orbit associated with thyroid autoimmune disease. Variability in terminology impedes the evaluation of scientific literature and clinical collaboration and can affect patients' understanding of a disease process. The goals of this perspective article are 1. To compare the frequency of different terms used for eye disease associated with autoimmune thyroid disease in the scientific literature between 2000, 2010 and 2020 publications; 2. To investigate potential associations of terminology with author and journal specialty, and multidisciplinary vs. mono-disciplinary author teams; 3. To determine preferential terms used by professional societies; and 4. To propose standardized terminology based on our data analysis. The methods for this study included review of all English language articles listed in PubMed, with publication dates in the years 2000, 2010 and 2020, that included one of 6 terms currently used to describe eye disease associated with autoimmune thyroid disease. Characteristics pertaining to authors, journals, and article type were recorded. Results showed that the most used term in the 2000 literature was Graves' Ophthalmopathy (61%). In the 2010 literature, Graves' Orbitopathy (31%) became most common, followed by Graves' Ophthalmopathy (30%). Between 2010 and 2020, thyroid eye disease (37%) became the most common term, followed by Graves' Orbitopathy (35%). This perspective article proposes "thyroid eye disease" (TED) as the preferred name for this entity and discusses supporting terminology patterns and trends over time in scientific literature and in professional societies.
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Affiliation(s)
- Lilly H. Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Lilly H. Wagner,
| | | | - Andrea A. Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Yanhan Ren
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | | | - Marius N. Stan
- Division of Endocrinology, Mayo Clinic, Rochester, MI, United States
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Molina CM, Wisniewski K, Heaton V, Pringle JK, Avila EF, Herrera LA, Guerrero J, Saumett M, Echeverry R, Duarte M, Baena A. Monitoring of simulated clandestine graves of dismembered victims using UAVs, electrical tomography, and GPR over one year to aid investigations of human rights violations in Colombia, South America. J Forensic Sci 2021; 67:1060-1071. [PMID: 34927732 DOI: 10.1111/1556-4029.14962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/17/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
In most Latin American countries, there are significant numbers of missing people and forced disappearances, over 120,000 in Colombia alone. Successful detection of shallow buried human remains by forensic search teams is difficult in varying terrain and climates. Previous research has created controlled simulated clandestine graves of murder victims to optimize search techniques and methodologies. This paper reports on a study on controlled test site results over four simulated dismembered victims' clandestine graves as this is sadly a common scenario encountered in Latin America. Multispectral images were collected once post-burial, electrical resistivity surveys were collected 4 times, and ground penetrating radar (GPR) surveys were collected three times up to the end of the 371 day survey monitoring period. After data processing, results showed that the multispectral data set could detect the simulated clandestine and control graves, with electrical resistivity imaging relative high resistances over some of the simulated graves but not over the empty control graves. GPR results showed good imaging on the Day 8 surveys, medium imaging on the Day 294 surveys, and medium to good imaging on the Day 371 surveys. Study implications suggest that, while clandestine graves of dismembered homicide victims would likely result in smaller-sized graves when compared to graves containing intact bodies, these graves can still potentially be detected using remote sensing and geophysical methods.
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Affiliation(s)
- Carlos Martín Molina
- Facultad de Ingeniería Ambiental y Civil, Universidad Antonio Nariño, Bogotá, Colombia
| | | | - Vivienne Heaton
- School of Chemical and Physical Sciences, Keele University, Keele, UK
| | - Jamie K Pringle
- School of Geography, Geology and Environment, Keele University, Keele, UK
| | - Edier Fernando Avila
- Facultad de Ciencias Agropecuarias, Universidad de Cundinamarca, Fusagasugá, Colombia
| | - Luis Alberto Herrera
- Facultad de Ciencias Agropecuarias, Universidad de Cundinamarca, Fusagasugá, Colombia
| | - Jorge Guerrero
- Facultad de Ciencias Agropecuarias, Universidad de Cundinamarca, Fusagasugá, Colombia
| | | | - Raúl Echeverry
- Facultad de Ingeniería Ambiental y Civil, Universidad Antonio Nariño, Bogotá, Colombia
| | - Mario Duarte
- Facultad de Ingeniería Mecánica, Electrónica y Biomédica, Universidad Antonio Nariño, Bogotá, Colombia
| | - Alejandra Baena
- Facultad de Ciencias, Sede Circunvalar, Universidad Antonio Nariño, Bogotá, Colombia
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Abstract
BACKGROUND A thyroid storm (TS) is a rare, but life-threatening condition in hyperthyroid patients. Mortality in adult TS patients may be as high as 10%. Typically, a trigger precipitates the storm in hyperthyroid patients. CASE PRESENTATION We report the case of an adolescent girl with untreated hyperthyroidism who developed fulminant TS after a significant choking episode. Initially, she was found to have neck swelling and tachycardia leading providers to suspect infection. She deteriorated after a CAT Scan (CT) was performed with iodine contrast, potentially worsening storm symptoms. Here, we describe the case, the treatment strategy and propose a treatment modification for pediatric patients. CONCLUSIONS While many children are found to have minor abnormalities in thyroid studies, this case highlights the critical importance of prompt medical attention for any child with significantly elevated free thyroxine (FT4) levels as morbidity can occur when left untreated.
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Affiliation(s)
- Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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Ogun OA, Adeleye JO. Severe Ophthalmological Complications of Thyroid Disease are Rare in Ibadan, Southwestern Nigeria: Results of a Pilot Study. Ophthalmol Eye Dis 2016; 8:5-9. [PMID: 27042149 PMCID: PMC4811264 DOI: 10.4137/oed.s32169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ocular manifestations of thyroid dysfunction constitute a wide clinical spectrum ranging from minor ocular discomfort, lid retraction, lid lag and ocular injection, to sight threatening eyeball protusion and optic nerve compression. Thyroid-related eye disorders are most commonly associated with Graves’ disease, and this most frequently occurs in the setting of hyperthyroidism. However, in 10% of cases, typical eye signs have also been reported in euthyroid and hypothyroid states. The severity of thyroid eye disease has been linked to cigarette smoking. There is very little data specifically reporting the ocular manifestations of thyroid disease among black African patients and there is no known report from Nigeria. This pilot study therefore focused on documenting the ocular signs accompanying thyroid dysfunction in a black African population. AIM To evaluate the pattern of ocular complications, among patients treated for thyroid disorders, in a major Nigerian teaching hospital. RESULTS A total of 75 patients with thyroid dysfunction, were evaluated, comprising 63 females and 12 males. There was a very low prevalence of smoking among patients (<5%). Graves’ disease was the commonest thyroid disorder, representing 70% of cases. Seventy-eight percent of patients were hyperthyroid, 11.8% were euthyroid and only 9.8% of patients were hypothyroid. Commonest systemic symptoms were neck swelling (68.6%), weight loss (63.8%), tremors (60.9%) and palpitations (59.4%). Two-thirds of patients reported ocular symptoms consisting mainly of painless eye swelling (66.7%) and ocular irritation (58%). Conjunctival injection, lid lag and lid retraction were the commonest ocular signs. Chemosis, severe proptosis and ocular motility disorder were very rare. Optic neuropathy was found in 4 patients but was related to pre-existing glaucoma. Majority of patients required only ocular emollients and tear supplements. CONCLUSION Severe ocular complications of thyroid disorders were uncommon in this cross-section of Nigerian patients. This may be linked to the very low prevalence of cigarette smoking among Nigerians or genetic and environmental factors linked to their African heritage.
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Affiliation(s)
- Olufunmilola A Ogun
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Jokotade O Adeleye
- Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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