Szakirodalom

Thyroid hormones regulate embryonic and fetal neurodevelopment, with the maternal thyroid gland exclusively producing these hormones for the first half of gestation and then a combination of maternal and fetal production occurring during the second half of gestation. Hypothyroidism during pregnancy is common in humans, particularly due to the additional demand put on the thyroid gland as pregnancy proceeds. Epidemiological studies have linked maternal hypothyroidism to an increased risk of attention-deficit/hyperactivity disorder and autism spectrum disorder diagnosis in these children, as well as cognitive deficits and delays. Rodent models have been extensively used to model developmental hypothyroidism and study the long-term effects on offspring. Increases in activity, reductions in anxiety, cognitive impairments, and social alterations have been observed. In this review, I discuss the current understanding of the organizational impacts of hypothyroidism on activity, affective behaviors, cognition, and social behaviors in humans and animal models, paying special attention to critical periods that may underlie these effects. I also review potential interactions between thyroid hormones and steroid hormones known to be important for organization of the brain and behavior during perinatal and adolescent development. Understanding the effects of developmental hypothyroidism is critical, as early developmental exposure to many endocrine-disrupting chemicals may alter behavior through reducing thyroid hormone signaling, and the final section of the paper reviews these interactions. Understanding the organizational effects of thyroid hormones is important for decisions related to screening and interventions during pregnancy.

This study aimed to explore associations between social isolation, loneliness, and hypothyroidism risk, and whether genetic susceptibility modifies these links. It enrolled 434,628 hypothyroidism-free participants from the UK Biobank. Social isolation was assessed via 3 dichotomous questions, loneliness via 2 revised UCLA Loneliness Scale questions, and hypothyroidism cases via hospital/death records. Hypothyroidism polygenic risk scores (PRSs) were calculated using related genetic loci, with Cox proportional hazards models for analysis. Over a median 12.3-year follow-up, 9,873 hypothyroidism cases occurred. Demographically adjusted models showed social isolation (HR = 1.25, 95% CI 1.17-1.33) and loneliness (HR = 1.38, 95% CI 1.27-1.50) linked to higher risk. After full adjustment, only loneliness remained significant (HR = 1.12, 95% CI 1.02-1.24), while social isolation’s association became insignificant. No significant interactions between loneliness/social isolation or loneliness/PRS were found. Joint analysis revealed highest risk in those with high PRS and loneliness. Findings indicate loneliness, not social isolation, is an independent hypothyroidism risk factor, regardless of genetic susceptibility and other factors.

Hypothyroidism is linked to depression and several metabolic alterations, including insulin resistance, dyslipidemia, and oxidative stress. This study investigates the impact of hormones, autoimmunity, metabolic, and antioxidant indicators on the severity of depression in patients with hypothyroidism.

Patients with hypothyroidism admitted to the intensive care unit (ICU) frequently develop hypothyroidism-associated delirium (HAD), a condition strongly linked to adverse prognostic outcomes. The primary objective of this study was to develop a machine learning (ML) -based predictive model for the early identification of HAD.

To identify pre-treatment determinants of hypothyroidism and decision regret (DR) following radioiodine (RAI) therapy in Graves’ disease (GD), and to assess their longitudinal impact on health-related quality of life (QoL).

BACKGROUND AND OBJECTIVE: The relationship between quality of life (QoL) and thyroid stimulating hormone (TSH) levels in patients receiving levothyroxine (LT4) therapy is unclear. Our aim was to determine the efficacy of replacement therapy and the relationship between TSH concentration and QoL in patients diagnosed with primary hypothyroidism and receiving LT4 replacement therapy. METHODS: This is a national retrospective cross-sectional study. Demographic information, a questionnaire for diagnosis and management of thyroid diseases and Thyroid related Patient Reported Outcome (ThyPRO ) and EQ-5D questionnaires to assess quality of life were used to collect data. The study included retrospective 3 year follow up data. RESULTS: Our study included 1750 patients (90.3% female, 9.7% male) from 26 centers with a mean age of 47.8 ± 12.6 years (18–88) and a body mass index of 28.84 ± 5.89 kg/m2. Patients had been receiving levothyroxine replacement for 10.23 ± 7.03 (3–55) years. The mean number of visits during the three-year follow-up period was 6.34 ± 2.78 [1–22]. A total of 188 patients (10.7%) had never reached the specific TSH target. The target TSH value was reached < 3 times (n = 715; 40.8%), 3–5 times (n = 775; 44.2%), and ≥ 6 times (n = 260; 14.8%). According to the ThyPRO questionnaire, patients who achieved their treatment target fewer than 3 times had higher (worse thyroid related quality of life) scores in several domains, including goiter symptoms, hyper-/hypothyroid symptoms, fatigue, cognitive complaints, anxiety, depression, and impairments in social, sexual, and daily functioning. In contrast, these patients had lower EQ-5D scores, indicating poorer overall health-related quality of life. CONCLUSION: In hypothyroidism replacement therapy, it is crucial to establish an individualized TSH target, and the patient’s cognitive functions and quality of life are positively impacted by the attainment of euthyroidism.

Overweight/obesity and subclinical hypothyroidism (SCH) are common in major depressive disorder (MDD). This study investigates the prevalence of overweight/obesity and its clinical correlates in Chinese first-episode, drug-naïve (FEDN) MDD patients with comorbid SCH, stratified by sex.

This study aimed to investigate the prevalence of anxiety and depression symptoms and analyse the associated risk factors in postmenopausal women with type 2 diabetes mellitus (T2DM) and comorbid hypothyroidism.

This study examined the knowledge, attitudes and practices of pregnant women regarding hypothyroidism during pregnancy.

Physicians demonstrate differing attitudes about the management of hypothyroid patients on optimal replacement with thyroxine (T4) who have persisting symptoms. The use of liothyronine (T3) as combination therapy (T4+T3) has been promoted, and some patients demonstrate a compelling benefit. They can be identified by delayed relaxation of tendon reflexes, that is, a positive Woltman’s sign. This is specific for T3 responders. A generation of Endocrinologists has neglected this useful clinical sign. Patients with autoimmune symptoms and elevated anti-thyroid peroxidase (anti-TPO) antibodies show improvement after total thyroidectomy, but with the risk of significant postoperative complications. This discrete subgroup tends to be disregarded by authorities in the literature. There is a compelling need for further research on the nonsurgical treatment of this subgroup. Many dissatisfied patients have psychosomatic symptoms because of the burden of having a chronic disease, the need to take regular medication, and other psychosocial concerns. They have medically not yet explained symptoms (MNYES) and require support, counselling, and sometimes cognitive behaviour therapy. True thyroxine allergy and/or sensitivity does occur but is extremely rare. These four subgroups could be designated as – (1) T3-hypothyroidism; (2) Anti-TPO-toxic hypothyroidism; (3) Hypothyroidism-in-denial; and (4) Thyroxine- sensitivity. Recognition of these individual categories is necessary to achieve agreement among physicians and to promote further targeted research.