Cognitive and White Matter Microstructure Development in Congenital Hypothyroidism and Familial Thyroid Disorders.

CONTEXT: Children with congenital hypothyroidism (CH) are at risk for suboptimal neurodevelopment. OBJECTIVES: To evaluate neurocognitive function and white matter microstructure in children with permanent or transient CH and to correlate these findings with disease severity. DESIGN, PARTICIPANTS AND METHODS: A retrospective and prospective observational study was conducted in 39 children with permanent or transient CH, and in 39 healthy children. Cognitive function was assessed by Wechsler Intelligence Scale, Fourth Edition, and by other tests; the white matter microstructure was investigated by 3 Tesla magnetic resonance imaging. RESULTS: Children with permanent CH have lower cognitive scores at a median age of 9.5 years than those with transient CH and controls. An IQ score between 71 and 84 was found in 28.6% of permanent CH and of <70 (P = 0.06) in 10.7%. The Processing Speed Index (PSI; P = 0.004), sustained visual attention (P = 0.02), reading speed (P = 0.0001), written calculations (P = 0.002), and numerical knowledge (P = 0.0001) were significantly lower than controls. Children born to mothers with Hashimoto's thyroiditis have significantly lower IQ values (P = 0.02), Working Memory Index (P = 0.03), and PSI (P = 0.02). Significantly lower IQ and Verbal Comprehension Index values were found in children with a family history of thyroid disorders (P = 0.004 and P = 0.009, respectively). In children with permanent CH, significant correlations between abnormalities in white matter microstructural, clinical, and cognitive measures were documented. CONCLUSIONS: These findings indicate that children with CH are at risk of neurocognitive impairment and white matter abnormalities despite timely and adequate treatment. The association between offspring cognitive vulnerability and maternal thyroid disorders requires careful consideration.

Role of thyroid hormone therapy in depressive disorders.

PURPOSE: The close association among thyroid metabolism, mood disorders and behavior has long been known. The old and modern uses of thyroid hormones to modulate the expression of depression and bipolar disorder and to improve clinical outcome when used in conjunction with psychotropic medications. METHODS: A literature search was performed to identify studies investigating the effects of thyroid hormone treatment in patient s with mood disorders. RESULTS: The successful modification of mood disorders with thyroid hormone underscores the association between endocrine and cerebral systems in these disorders. Thyroid hormones have a profound influence on behavior and appear to be capable of modulating the phenotypic expression of major mood disorders. In fact, there is evidence that triiodothyronine (LT3) may accelerate the antidepressant response to antidepressants, and studies suggest that LT3 also may augment the response to antidepressants in refractory depression. Add-on treatment with supraphysiologic doses of levothyroxine (LT4) has shown efficacy in open-label and in placebo-controlled studies, including in rapid cycling and prophylaxis-resistant bipolar disorder, and with acute refractory uni- or bipolar depression. Functional brain-imaging studies (PET) demonstrated that administration of supraphysiologic LT4 improves depressive symptoms in patients with bipolar depression by modulating cerebral activity in the anterior limbic network. CONCLUSION: The add-on administration of supraphysiologic doses of LT4 is a promising strategy in patients with refractory bipolar and depressive mood disorders.

The relation between thyroid dysregulation and impaired cognition/behaviour: An integrative review.

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.

The role of coping strategies, depression and anxiety in thyroid disease / A megküzdési stratégiák, a depresszió és a szorongás szerepe a pajzsmirigybetegségekben.

Összefoglaló. Bevezetés: A tudományos szakirodalomban számos kérdés fogalmazódik meg a pajzsmirigybetegségeket befolyásoló pszichológiai tényezokrol. Kevés tanulmány készült a pajzsmirigybetegségek és a megküzdési stratégiák kapcsolatáról. Célkituzés: Jelen tanulmányunk célja felmérni a megküzdési stratégiák, a depresszió és a szorongás szintjének változásait a pajzsmirigybetegek (hyperthyreosis és hypothyreosis) esetében a gyógyszeres kezelés (Thyrozol és Euthyrox) hatására. Módszer: A betegeket a szakorvos diagnózisa, illetve a TSH- és fT4-szint alapján hyperthyreosis- (n = 10) és hypothyreosis- (n = 21) csoportba soroltuk. Mindkét csoport tagjait az endokrinológiai kezelés elott és után pszichológiai felmérésnek vetettük alá. A felmérés során a megküzdési stratégiák felméréséhez a következo skálákat alkalmaztuk: Kognitív Érzelem Szabályozás Kérdoív (Cognitive Emotion Regulation Questionnaire - CERQ), Hobfoll-féle Megküzdési Stratégia Kérdoív (Strategic Approach to Coping Scale - SACS). A Beck Depresszió Kérdoívet (Beck Depression Inventory - BDI-II) alkalmaztuk a depresszió felmérésére, az Állapot- és Vonásszorongás Kérdoívet (State-Trait Anxiety Inventory, Form Y - STAI-Y) a szorongás szintjének felmérésére. Eredmények: A két csoport pszichológiai és laboreredményeit összehasonlítottuk a gyógyszeres kezelés elott és után. Mind a hyperthyreosisban, mind a hypothyreosisban szenvedo betegeknél magas volt a depresszió és a szorongás szintje. A hyperthyreosisban szenvedo betegeknél a depresszió magasabb. A gyógyszeres kezelés után a depresszió és a szorongás szintje csökkent mindkét csoportban, a megküzdési stratégiák többnyire változatlanok maradtak. Következtetések: Pajzsmirigybetegeknél a kognitív viselkedésbeli pszichoterápiás beavatkozás a gyógyszeres kezelés kiegészíto alternatívája lehet a szorongás és a depresszió szintjének csökkentése és a diszfunkcionális megküzdési stratégiák módosítása szempontjából. Orv Hetil. 2021; 162(7): 262-268. INTRODUCTION: There is a high interest in the scientific literature in psychological factors that influence the course of thyroid disease. There are a few studies on the link between thyroid disease and coping strategies. OBJECTIVE: In the present study, we aimed to evaluate the manifestation of depression, anxiety and coping strategies in people with thyroid disease and the impact of endocrinological medication on these psychologic items. METHOD: The patients were grouped into two groups, hyperthyroid (n = 10) and hypothyroid (n = 21), according to the diagnosis established by the attending physician, TSH and fT4 level. Patients with hyperthyroidism and hypothyroidism were evaluated before and after endocrinological treatment with the Cognitive Emotion Regulation Questionnaire (CERQ), Strategic Approach to Coping Scale (SACS) for the evaluation of coping strategies, Beck Depression Inventory (BDI-II) for assessing the level of depression, State-Trait Anxiety Inventory, Form Y (STAI-Y) for assessing anxiety. These two groups have been compared. RESULTS: The psychological and laboratory results of the two groups were compared before and after drug treatment. Both patients with hyperthyroidism and with hypothyroidism had high levels of depression and anxiety. In hyperthyroidism, depression is more severe. Following treatment with Thyrozol and Euthyrox, the level of depression and anxiety decreases in patients with hyper- and hypothyroidism; the coping strategies remained almost unchanged. CONCLUSION: Cognitive-behavioral psychotherapeutic intervention could be supplementary to drug treatment in terms of reducing anxiety, depression, and modifying dysfunctional coping strategies for patients with thyroid diseases. Orv Hetil. 2021; 162(7): 262-268.

Neuropsychologic changes in primary hyperparathyroidism after parathyroidectomy from a dual-institution prospective study.

BACKGROUND: The impact of parathyroidectomy on neuropsychiatric symptoms in primary hyperparathyroidism remains poorly defined. The validated scales Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 can be used to assess depression and anxiety, respectively. Our aim was to prospectively characterize the changes in neuropsychiatric symptoms after parathyroidectomy. METHODS: Patients undergoing parathyroidectomy and thyroidectomy (control) from two institutions between 2014 and 2019 were prospectively administered a questionnaire assessing neuropsychiatric symptoms before and after surgery. Paired t tests compared preoperative with postoperative neuropsychiatric symptoms and t tests compared differences in neuropsychiatric symptoms between parathyroidectomy and thyroidectomy. RESULTS: A total of 244 patients underwent parathyroidectomy and 161 underwent thyroidectomy. We observed improvement in neuropsychiatric symptoms after parathyroidectomy (6.2 [5.0-7.4], P < .01). Preoperatively, neuropsychiatric symptoms were more prevalent in patients undergoing parathyroidectomy when compared with thyroidectomy (11.2 ± 11.5 vs 7.5 ± 8.2, P < .01); however, after surgery there was no difference between the two groups (5.1 ± 7.1 vs 5.4 ± 7.2, P = .59). Preoperatively, 27.5% and 18.0% of patients endorsed moderate to severe depression and anxiety, which fell to 8.2% and 5.3%, respectively, (P < .01) after surgery. CONCLUSION: Patients undergoing parathyroidectomy showed significant improvement in neuropsychiatric symptoms after surgery. Neuropsychiatric symptoms are more prevalent in patients with primary hyperparathyroidism. Neuropsychiatric symptoms should be assessed in all patients with primary hyperparathyroidism and should be considered a relative indication for parathyroidectomy.

Evaluation of anxiety and depression in patients with thyroid function disorder.

OBJECTIVES We aim to determine the anxiety and depression levels of patients treated for hypothyroidism who assumed euthyroid status. These patients also frequently attend family medicine outpatient clinics. METHODS This study was conducted on 76 euthyroid volunteer participants (patient groups) who were treated for hypothyroidism and followed-up and 22 healthy volunteers (control group). Questionnaires were administered to all participants to assess anxiety and depression levels. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all the groups. In addition, BAI sub-parameters were evaluated in detail. RESULTS At least mild depression was detected in 54.5% of the first group, 41.7% of the second group, and 33.3% of the third group. When the BDI and BAI total scores of the participants in different groups were compared, statistically significant differences were determined. Statistically significant results were detected related to different BAI sub-parameters between the patient groups and in comparison to the fourth group. CONCLUSIONS We found that patients were predisposed to anxiety and depression even if they were euthyroid. When the sub-parameters of BAI were evaluated in detail, we observed that the duration of the disease significantly affected some anxiety-related symptoms.

On maternal Post-Partum/Natal depression. A global underrecognized problem and the need for better Treatment strategies.

BACKGROUND: Maternal Postpartum (PPD) or Postnatal Depression (PND) is believed to be the commonest medical complication postpartum. Evidence suggests a significantly higher prevalence of the disease compared to the often reported 10-15%. METHOD: Studies were identified by accessing several databases including PubMed/Medline, PubMed Central, EBSCO, and PsycINFO. RESULTS: Vitamin D (VD) deficiency, hormonal levels alteration (estrogen, progesterone, testosterone, oxytocin, and prolactin), thyroid dysfunction, and increased oxidative stress, play a critical role in PPD etiopathogenesis and pathophysiology. CONCLUSIONS: Treatment strategies should include an integrated approach of antidepressants and psychotherapy, melatonin, diet, sleep improvement, exercise, VD and antioxidants supplementation, and economic and social support.

Disfunción tiroidea y trastornos del ánimo: revisión del estado del arte / Thyroid dysfunction and mood disorders: review of the state of the art

La relación entre función tiroidea y trastornos del ánimo se ha observado desde hace más de 50 años. Las hormonas tiroideas, actúan en el cerebro modulando génicamente proteínas asociadas a la fisiopatología de los trastornos del ánimo y potenciando los sistemas de neurotransmisión serotoninérgica y noradrenérgica. En el tratamiento de un episodio depresivo, la normalización de hormonas tiroideas es fundamental, y debe realizarse en todo paciente con sintomatología anímica, especialmente en aquellos con respuestas insuficientes a tratamiento, que requieren niveles de hormonas más estrictos que lo recomendado para población general. En pacientes eutiroideos, la potenciación con triyodotironina ha sido probada, pero también se ha utilizado T4 en altas dosis en casos resistentes, en que se postula que pudiese existir un estado de resistencia a hormonas tiroideas, no reflejado en los niveles hormonales periféricos evaluados rutinariamente. Las enzimas deiodasas, el receptor de hormona tiroidea, y el transportador de hormona tiroidea en la barrera hematoencefálica son blancos a investigar. Los objetivos de la presente revisión son ofrecer orientaciones respecto del uso de hormonas tiroideas en pacientes con trastornos del ánimo, una puesta al día sobre la relación entre hormonas tiroídeas y sistema nervioso central, y las interacciones entre psicofármacos y función tiroidea.

The relationship between thyroid function and mood disorders has been observed for more than 50 years. Thyroid hormones act in the brain genetically modulating proteins associated with the pathophysiology of mood disorders and potentiating the serotonergic and noradrenergic neurotransmission systems. In the treatment of a depressive episode, the normalization of thyroid hormones is essential, and should be performed in all patients with mood symptoms, especially in those with insufficient responses to treatment, which require more stringent hormone levels than recommended for the general population. In euthyroid patients, potentiation with triiodothyronine has been proven, but T4 has also been used in high doses in resistant cases, in which it is postulated that there might be a state of resistance to thyroid hormones, not reflected in the peripheral hormonal levels evaluated routinely. The enzymes deiodasas, the thyroid hormone receptor, and the thyroid hormone transporter in the blood brain barrier are white to investigate. The objectives of this review are to provide guidance regarding the use of thyroid hormones in patients with mood disorders, an update on the relationship between thyroid hormones and central nervous system, and the interactions between psychoactive drugs and thyroid function.

Altered attention networks in patients with thyroid dysfunction: A neuropsychological study.

Patients with thyroid dysfunction (31 hypothyroid, 32 subclinical hypothyroidism, 34 hyperthyroid, and 30 subclinical hyperthyroidism) and 37 euthyroid control subjects were recruited and performed the attention network test (ANT), which can simultaneously examine the alertness, orientation and execution control of the participants. Patients with hypothyroidism had abnormalities in the alerting network, and those with hyperthyroidism had impairments of the alerting and executive control networks. No attention networks deficit existed in patients with subclinical hyperthyroidism and subclinical hypothyroidism. The anxiety and depression scores of patients with thyroid dysfunction were significantly higher than those of the healthy control group. Covariance analysis demonstrated that interactions between group and Hamilton Anxiety Scale scores, group and HAMD score were not significant, but there was a significant main effect for group when analyzing the difference in values of the alerting network between groups. Further, the efficiency of the executive control network was negatively correlated with the T4 level in the hypothyroidism group, and positively correlated with the T4 level in the hyperthyroidism group. T4 or T3 level and efficiencies of the executive control network had a significant quadratic U-shaped relationship in all participants. In summary, the patients with four kinds of thyroid dysfunction exhibited different characteristics of ANT performance. Patients with thyroid dysfunction had various degrees of anxiety and depression disorders, but anxiety and depression disorders had no effect on the differences in the executive control network between the groups.

Evaluation of anxiety and depression in patients with thyroid function disorder

SUMMARY OBJECTIVES We aim to determine the anxiety and depression levels of patients treated for hypothyroidism who assumed euthyroid status. These patients also frequently attend family medicine outpatient clinics. METHODS This study was conducted on 76 euthyroid volunteer participants (patient groups) who were treated for hypothyroidism and followed-up and 22 healthy volunteers (control group). Questionnaires were administered to all participants to assess anxiety and depression levels. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all the groups. In addition, BAI sub-parameters were evaluated in detail. RESULTS At least mild depression was detected in 54.5% of the first group, 41.7% of the second group, and 33.3% of the third group. When the BDI and BAI total scores of the participants in different groups were compared, statistically significant differences were determined. Statistically significant results were detected related to different BAI sub-parameters between the patient groups and in comparison to the fourth group. CONCLUSIONS We found that patients were predisposed to anxiety and depression even if they were euthyroid. When the sub-parameters of BAI were evaluated in detail, we observed that the duration of the disease significantly affected some anxiety-related symptoms.

RESUMO OBJETIVOS Nosso objetivo é determinar os níveis de ansiedade e depressão de pacientes tratados por hipotireoidismo que passaram a um estado eutireoideo. Esses pacientes frequentemente se consultam em clínicas de medicina da família. METODOLOGIA Este estudo foi realizado em 76 voluntários em estado eutireoideo (grupos de pacientes) que foram tratados por hipotireoidismo e passaram por acompanhamento e 22 voluntários saudáveis (grupo de controle). Foram aplicados questionários a todos os participantes para avaliar os níveis de ansiedade e depressão. O Beck Depression Inventory (BDI) e o Beck Anxiety Inventory (BAI) foram aplicados a todos os grupos. Além disso, os subparâmetros do BAI foram avaliados em detalhe. RESULTADOS Pelo menos depressão leve foi detectada em 54,5% do primeiro grupo, 41,7% do segundo grupo, e 33,3% do terceiro grupo. Quando comparadas as pontuações totais do BDI e do BAI dos participantes de diferentes grupos, diferenças estatisticamente significativas foram encontradas. Resultados estatisticamente significantes foram observados em relação a diferentes subparâmetros do BAI entre os grupos de pacientes e em comparação ao quarto grupo. CONCLUSÃO Observamos que os pacientes estavam predispostos a ansiedade e depressão, mesmo em estado eutireoideo. Quando os subparâmetros do BAI foram avaliados em detalhe, observou-se que a duração da doença afetou significativamente alguns sintomas relacionados à ansiedade.

The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women.

BACKGROUND: Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an increased prevalence of sexual dysfunction among patients with thyroid disorders. As such, it is important for sexual medicine physicians to be primed on the presentation of patients with overlying sexual and thyroid dysfunction to allow for proper management. AIM: To review the available literature exploring the relationship between thyroid disease and sexual dysfunction in men and women. METHODS: A PubMed review of existing clinical and pre-clinical studies from 1978 through 2018 was performed. MAIN OUTCOME MEASURES: The prevalence, symptomatology, pathophysiology, diagnosis and management of patients with sexual dysfunction in the setting of thyroid disease were reviewed. RESULTS: The prevalence of sexual dysfunction in patients with hypothyroid (59-63% and 22-46% in men and women, respectively) and hyperthyroidism (48-77% and 44-60% in men and women, respectively) has been estimated in select populations. Both hypothyroidism and hyperthyroidism were strongly associated with erectile and ejaculatory dysfunction: hypothyroidism with delayed ejaculation, hyperthyroidism with pre-mature ejaculation. Hypothyroidism and hyperthyroidism have been reported to impair libido in men and women; however, evidence of hypothyroidism's impact on male libido is mixed. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Mechanistically, hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways and can indirectly provoke psychiatric and autonomic dysregulation that can impair sexual function. Correction to euthyroid state was associated with dramatic resolution of sexual dysfunction in both male and female patients with hypothyroidism or hyperthyroidism. CONCLUSION: By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms may be remedied by treating an underlying thyroid disorder. Gabrielson AT, Sartor RA, Hellstrom WJG. The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sex Med Rev 2019;7:57-70.

How Should Thyroid-Related Quality of Life Be Assessed? Recalled Patient-Reported Outcomes Compared to Here-and-Now Measures.

BACKGROUND: The impact of thyroid disease on quality of life is an important disease aspect that is best investigated by patient-reported outcomes. Recent patient-reported outcomes research has raised concern about the validity of traditional retrospective questionnaires. Therefore, ecological momentary assessments of patients' subjective well-being have been introduced to avoid recall bias and improve contextual validity. Despite theoretical advantages, the measurement properties remain unsubstantiated. This study examines the relationship between the retrospective thyroid-related quality of life patient-reported outcome measure (ThyPRO) and a momentary (here-and-now) version of ThyPRO. METHODS: Eighty-three newly diagnosed hyperthyroid patients expected to undergo treatment completed questions on their thyroid-related quality of life. Head-to-head comparison was performed between 12 momentary items from four multi-item ThyPRO scales administered three times daily via a smartphone application during 28 days and the original retrospective ThyPRO on day 28. The measurement difference between recalled and momentary ratings was quantified for all four scales. Furthermore, correlations between the measures were investigated, and their agreement was explored using Bland-Altman plots. Finally, the study examined whether retrospective ratings were influenced by two forms of recall bias (the peak effect and the end effect). RESULTS: Retrospective and mean momentary ThyPRO ratings were highly correlated (Pearson's correlations: 0.74-0.88). However, retrospective ratings provided significantly higher scores (i.e., worse quality of life) on all scales. Bland-Altman plots showed a skewed distribution, indicating low levels of agreement. Results supported a peak effect for retrospective ratings on tiredness but not for the remaining scales. Further, results supported end effects for retrospective ratings of emotional susceptibility and anxiety. CONCLUSIONS: Retrospective and mean momentary ThyPRO ratings correlated strongly, but retrospective ratings were higher, indicating more disease impact. The differences were of magnitudes normally deemed clinically relevant. Limited evidence supported peak and end effect bias for retrospective assessments. The two measurement modalities did not appear congruent and thus cannot be used interchangeably. When designing clinical studies, whether to use a momentary or retrospective measurement method may depend on the aim of measurement. Further prospective analyses are needed to compare any beneficial effects, for example in terms of higher precision or sensitivity to clinical change, of momentary assessments.

The role of illness burden in theory of mind performance among older adults.

Background/Study Context: Theory of Mind (ToM) reflects the ability to reason about mental states in order to understand and predict behavior. Research has identified links between increased pulse pressure, a measure of vascular health, and reduced cognitive ToM in older adults. However, the relationships between other vascular and nonvascular conditions and reduced ToM are unknown. We examined (1) illnesses as predictors of cognitive and affective ToM and (2) neurocognitive mediators of illness burden and ToM. METHODS: We used hierarchical regression and mediation to investigate the effects of vascular illness burden (hypertension, Type 2 diabetes, high cholesterol, and high pulse pressure) and nonvascular illness burden (osteoporosis, osteoarthritis, rheumatoid arthritis, and thyroid dysfunction) on cognitive and affective ToM in N = 86 community-dwelling older adults (59 females; 27 males, M age = 71.74 years). RESULTS: Vascular illness burden emerged as a significant predictor of older adults' cognitive ToM (R2 = .43, p < .001), and this relationship was mediated by executive functioning. Nonvascular illness burden did not predict cognitive nor affective ToM in this sample. CONCLUSION: Our findings highlight the specific importance of considering vascular health as a risk factor for declines in ToM in later life. Further elucidation of the associations between health, neurocognition, and ToM will be valuable in developing effective interventions for older adults given the high prevalence of vascular illness in later life.

Patients with Benign Thyroid Diseases Experience an Impaired Sex Life.

BACKGROUND: This study aimed to characterize the frequency of self-reported thyroid-related impaired sex life in patients with thyroid diseases, to examine its clinical correlates and relationship with overall quality of life (QOL), and to investigate the effect of treatment. PATIENTS AND METHODS: Two separate patient samples with benign thyroid diseases were investigated: a cross-sectional sample (759 women and 118 men) treated at two Danish university hospital outpatient clinics, in 2007-2008, and a longitudinal sample (358 women and 74 men) undergoing treatment at the abovementioned centers, during 2008-2012, evaluated before and 6 months after therapy. The thyroid-specific QOL questionnaire ThyPRO was used to measure patient-evaluated thyroid-related sex life impairment. Biochemical and clinical variables were analyzed (i.e., age, education, degree of thyroid dysfunction, comorbidity, serum thyrotropin, total thyroxine, and triiodothyronine, as well as thyroperoxidase and thyrotropin receptor antibody concentrations). The SF-36 Health Survey was used to analyze the effect of impaired sex life on overall QOL. RESULTS: In the cross-sectional sample, 36% of women and 31% of men reported what they perceived to be thyroid-attributable impaired sex life. Women with autoimmune thyroid diseases reported more impairment than those with non-autoimmune thyroid diseases. In patients with Graves' disease lower levels of educational attainment and in patients with toxic nodular goiter comorbidities were associated with impaired sex life. Overall QOL was lower in patients with thyroid-related sex life impairment. In the longitudinal sample, 42% of women and 33% of men had impaired sex life at baseline, which improved at 6 months follow-up only in women and, when analyzing individual diagnoses separately, statistically significantly among those with autoimmune hypothyroidism. Sexual impairment was associated with low education in patients with toxic nodular goiter and with high plasma triiodothyronine concentrations in patients with Graves' disease. In autoimmune hypothyroidism, a younger age was associated with sex life impairment. CONCLUSION: We found a high frequency of self-reported, thyroid-related sex life impairment in patients with benign thyroid diseases, especially in young women with autoimmune thyroid diseases. Self-perceived impaired sex life persisted in women treated for Graves' disease, suggesting that normalization of thyroid function was not sufficient to restore sexual function.

Measurement properties of ThyPRO short-form (ThyPRO-39) for use in Chinese patients with benign thyroid diseases.

PURPOSE: To evaluate the validity and reliability of a newly-translated Thyroid-specific Patient-Reported Outcome short-form (ThyPRO-39) instrument for ethnic-Chinese patients suffering from benign thyroid diseases. METHODS: The translation and cross-cultural adaptation of the English ThyPRO-39 were performed using the double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Cross-sectional data of 308 patients with benign thyroid diseases were utilized for this psychometric evaluation of ThyPRO-39 instrument. Convergent validity between similar construct in the ThyPRO-39, SF-6D, and SF-12v2 was assessed using Spearman correlations. The internal construct validity was assessed by corrected item-total correlations. Sensitivity of the ThyPRO-39 domain scores was determined by performing known group comparisons by independent t test. The internal consistency reliability was assessed by Cronbach's alpha coefficient. RESULTS: Significant floor effects were observed in 9 out of 13 domains of the ThyPRO-39. The hypothesized correlations between similar constructs in the ThyPRO-39 and the SF-12v2 and SF-6D were generally observed, supporting convergent validity. The internal construct validity was supported in most items, except eight items in six scales. Scale score of hyperthyroid symptoms of the ThyPRO-39 was significantly higher in the group with Graves' disease or hyperthyroid disease than the group without Graves' disease nor hyperthyroid disease. Scale scores of eye symptoms and impaired daily life were significantly higher in the incidental group than the non-incidental group. For six domains (hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, depressivity, and emotional susceptibility), Cronbach's alpha did not reach the recommended standard of 0.7. CONCLUSIONS: This was the first psychometric study to translate and adapt the ThyPRO-39 instrument for non-Caucasian patients, and report its validity and reliability for use in Chinese patients with benign thyroid diseases. Given the low item-total correlations in eight items and low internal consistency reliability in respective scales of the ThyPRO-39, we suggest that the improvement of those eight items should produce a more valid and reliable ThyPRO-39 instrument.

Intellectual performance of children of mothers with an untreated thyroid disorder in the first trimester of pregnancy.

INTRODUCTION: The focus of the present study was the importance of the mother's thyroid function for foetal development in the first trimester, when the baby is totally dependent on the mother for thyroid hormones. MATERIAL AND METHODS: The study consisted in testing the intellectual performance of children with both euthyroid and thyroid-dysfunction mothers. The experimental group comprised 60 children of mothers with an untreated thyroid disorder in the first trimester of their pregnancy (TSH≥3.5 and/or TPO-Ab≥20). The control group contained 132 children whose mothers showed no symptoms of a thyroid disorder either before or during pregnancy/postpartum. Both groups of children were administered the WISC-III, whereby the intellectual performance of the experimental-group children was compared with that of the control-group children. The comparison included the percentage of children with IQ≤ 85 and SLD and/or ADD risks. Our research is a follow-up to a blanket thyroid screening of 1 649 pregnant women conducted during 2004-2006 in the region around Havlíckuv Brod. RESULTS: The research found no significant difference between the two groups of children with respect to their intellectual abilities, either regarding their overall IQ (p=0.67), verbal IQ (p=0.81), performance IQ (p=0.41), or the individual scores (ISP: p=0.85; IPU: p=0.54, IKO: p=0.57; IRZ: p=0.13), nor did the experimental group show a significantly higher occurrence of children with IQ≤85 than the control group (p=0.66). However, the experimental group did exhibit a statistically significant increase in the percentage of children with a suspected SLD or clinically significant attention issues (p =0.05). CONCLUSION: Untreated thyroid disorders in the first trimester of pregnancy can increase the risk of the child developing attention or learning issues. < p > < /p >.

Globus Symptoms in Patients Undergoing Thyroidectomy: Relationships with Psychogenic Factors, Thyroid Disease, and Surgical Procedure.

BACKGROUND: The number of patients who need thyroid surgery has increased worldwide in recent decades. Patients with thyroid disease experience globus pharyngeus as a result of direct compression and edema of the surrounding organs. Thyroid surgery is needed to improve these symptoms or as treatment for thyroid cancer. After thyroid surgery, globus symptoms may become worse and may affect the daily life of the patient for a long time. Psychogenic problems have also been thought to cause the globus sensation. A prospective analysis of globus symptoms and psychogenic factors following thyroidectomy was performed. MATERIAL AND METHODS: Patients scheduled to undergo thyroid surgery between February and September 2016 completed the foreign-body sensation in the throat score (FBST; range 0-8.2) and the self-rating depression scale (SDS; range 0-100) preoperatively and three days, one month, three months, six months, and 12 months postoperatively. RESULTS: Long-term follow-up was completed in 616 patients (491 females). A total of 365 patients had thyroid cancer, 169 had benign tumors, and 82 had diffuse goiters with Graves' disease. The percentage of patients who complained about neck discomfort (FBST >2) was 29.4% before surgery. A preoperative high FBST showed a significant direct correlation with a high SDS, but thyroid volume did not. A postoperative high FBST was seen in 75.3% of patients at two days and 78.9% at one month after surgery, and it then gradually decreased to 49.3% at 12 months after surgery. At three days after the operation, the median FBST was significantly higher in patients who had total thyroidectomy with lateral neck dissection or total thyroidectomy only compared to those who had lobectomy only (p < 0.05). These differences were still present 12 months after surgery. A higher preoperative SDS score was also identified as an independent predictor for a high FBST at 12 months after surgery, but not at one or three months postoperatively, on multivariate analyses. CONCLUSION: Preoperative globus symptoms appear directly related to psychological factors. The area of the surgical procedure and preoperative psychological factors were related to persistent neck discomfort.

Psychiatric and physical comorbidities and their impact on the course of bipolar disorder: A prospective, naturalistic 4-year follow-up study.

OBJECTIVES: The aim of the present study was to increase the available evidence on how physical and psychiatric comorbidities influence the long-term outcome in bipolar I and II disorder. METHODS: We examined the prevalence of comorbid physical (metabolic, cardiovascular, thyroid, and neurological) diseases and psychiatric (neurotic, stress-related, somatoform, and personality) disorders and their impact on the risk of relapse in bipolar disorder. A total of 284 consecutively admitted patients with ICD-10 bipolar I (n=161) and II (n=123) disorder were followed up naturalistically over a period of 4 years. RESULTS: Globally, 22.0% patients had metabolic, 18.8% cardiovascular, 18.8% thyroid, and 7.6% neurological diseases; 15.5% had neurotic, stress-related, and somatoform disorders; 12.0% had personality disorders; and 52.9% had nicotine dependence. We did not find any effect of comorbid metabolic, cardiovascular or neurological diseases or psychiatric disorders on the relapse risk. However, the presence of thyroid diseases, and especially hypothyroidism, was associated with an increased risk of manic relapse in bipolar disorder I (thyroid disease: hazard ratio [HR]=2.7; P=.003; hypothyroidism: HR=3.7;, P<.001). Among patients with hypothyroidism, higher blood levels of baseline thyroid-stimulating hormone (bTSH) were also associated with an increased risk of manic relapse (HR=1.07 per milli-international units per liter; P=.011), whereas blood levels of free triiodothyronine (fT3 ) or free thyroxine (fT4 ) were not found to have an influence. CONCLUSIONS: Our data underline the negative long-term impact of thyroid diseases, and especially hypothyroidism with high blood levels of bTSH, on bipolar disorder with more manic episodes, and the importance of its detection and treatment.

Prevalence of thyroid dysfunction and its impact on cognition in older mexican adults: (SADEM study).

INTRODUCTION: Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. METHODS: We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0 IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3 IU/l and FT4 >23 pmol/l; (3) Overt hypothyroidism: TSH >4.8 IU/l, FT4 <13 pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3 IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8 IU/l, FT4: 13-23 pmol/l. RESULTS: The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). CONCLUSIONS: The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.