A Longitudinal Study of Medial Temporal Lobe Volumes in Graves Disease

[helvella]

I hope some who have had Grave's read this and add some comments.

A Longitudinal Study of Medial Temporal Lobe Volumes in Graves Disease

Mats Holmberg, Helge Malmgren, Rolf A Heckemann, Birgitta Johansson, Niklas Klasson, Erik Olsson, Simon Skau, Göran Starck, Helena Filipsson Nyström

The Journal of Clinical Endocrinology & Metabolism, dgab808, doi.org/10.1210/clinem/dgab808

Published:

09 November 2021

PDF

Abstract

Context

Neuropsychiatric symptoms are common features of Graves disease (GD) in hyperthyroidism and after treatment. The mechanism behind these symptoms is unknown, but reduced hippocampal volumes have been observed in association with increased thyroid hormone levels.

Objective

This work aimed at investigating GD influence on regional medial temporal lobe (MTL) volumes.

Methods

Sixty-two women with newly diagnosed GD underwent assessment including magnetic resonance (MR) imaging in hyperthyroidism and 48 of them were followed up after a mean of 16.4 ± 4.2 SD months of treatment. Matched thyroid-healthy controls were also assessed twice at a 15-month interval. MR images were automatically segmented using multiatlas propagation with enhanced registration. Regional medial temporal lobe (MTL) volumes for amygdalae and hippocampi were compared with clinical data and data from symptom questionnaires and neuropsychological tests.

Results

Patients had smaller MTL regions than controls at inclusion. At follow-up, all 4 MTL regions had increased volumes and only the volume of the left amygdala remained reduced compared to controls. There were significant correlations between the level of thyrotropin receptor antibodies (TRAb) and MTL volumes at inclusion and also between the longitudinal difference in the levels of free 3,5,3′-triiodothyronine and TRAb and the difference in MTL volumes. There were no significant correlations between symptoms or test scores and any of the 4 MTL volumes.

Conclusion

Dynamic alterations in the amygdalae and hippocampi in GD reflect a previously unknown level of brain involvement both in the hyperthyroid state of the condition and after treatment. The clinical significance, as well as the mechanisms behind these novel findings, warrant further study of the neurological consequences of GD.

Graves disease, hippocampus, amygdala, longitudinal, cognition, depression

Full access available here:

academic.oup.com/jcem/advan...

[humanbean]

I haven't read the full paper but I wonder how they can tell whether the brain issues lead to Graves (or increase the risk of it developing) or whether Graves leads to the brain issues.

[Hennerton]

Thank you for posting this.

I know that I am not the person I used to be before raging Graves’ disease, which was not diagnosed or treated for about eight months. My problems are mostly connected with anxiety about driving to places I do not know or even some that I do know. New experiences, either good or bad, always make me anxious. I am definitely not the person I was before Graves’. Does anyone else have this problem?

[TSH110 in reply to Hennerton]

I had atropic autoimmune thyroiditis that shares similarities with graves, I presume due to the same antibodies occurring.

I am not the person I once was. My sense of humour is very dulled I take things rather literally and if the penny finally drops it takes ages. I can be very boring because of trying to do too much detail as if the ability to see the bigger picture and practice brevity has become faulty. I have terrible anxiety going anywhere, even routine journeys seem full of anxiety provoking possibilities. As for flying - not on your nelly. Any tasks involving a series of switches like on a computer using say word, excel & the internet just take me forever. I loose my place, i keep hitting the wrong buttons, I can’t remember what it is I’m trying to do or where I am in the process. I do wonder if my short term memory has gone wrong so I simply can’t hold more than one thing at a time in my head. I used to be a whizz at all that stuff. As for thinking on the spot - my mind is glacial 10 minutes later I know what I should have said.

I am optimised on NDT and all these things were a lot worse in Levothyroxine, so can only think it the disorder caused permanent problems somewhere along the line leading to this this dull wittedness and slow thought processes plus the anxiety I seem to have. To be honest it’s enough to to make you anxious knowing you aren’t firing on all cylinders anymore. Or else medication simply isn’t fine tuned enough for higher order mental activities to always run smoothly.

[tattybogle in reply to TSH110]

To be honest it’s enough to to make you anxious knowing you aren’t firing on all cylinders anymore. Totally agree with that ... i think i've always been of a cautious / potentially anxious frame of mind .. iv'e never been what you'd call 'happy go lucky' .. but when i had energy and focus to put all sort of 'checks and balances' in place i could always keep calm knowing i could cover most eventualities , so my anxiety about "what if 'x happens" was kept in control...because i knew i had put something in the back of the van that would mean i could deal with the consequences of 'x' .. (tow rope / jump leads / bit of carpet get your wheel of a bog ... jubilee clips / gaffa tape / some wire , for mending 'anything' ..... water but /gas bottle/ tea bags/pasta / and some UHT milk..... a duvet and a sheepskin rug ... Some dry kindling newspaper / a few candles / a bow saw ... great .. when all that's sorted .. i'm not remotely anxious about getting stuck on the side of a hill in December with 2 kids ..

But once i stopped being able to keep that kit sorted and together ...then i turned into a stressy mess., because i know i'm not well enough to cope with being cold and stranded without a bed and a cuppa for long before "the wheels start to come off .. and it all goes really pear shaped "

Phone calls make mea anxious now ...because i know it will be after i've put the phone down that i realise i haven't asked a necessary question .

Asking for directions in big cities makes me anxious now .. because i know i won't retain much of the directions given past the first "turn right ,then ....blank...."

[pennyannie in reply to tattybogle]

I love your description about when being well being able to cover all the eventualities as you had the ' kit ' in the van :

That pretty much sums up how I now feel not having a thyroid.

I 've no reserves, and no kit to fall back on and just have to trust nothing unforeseen happens as I 've little resilience, and yes, the anxiety is there when out and about and the pleasure of same diminished

[TSH110 in reply to tattybogle]

It’s interesting how people give you directions some are really good at giving you memorable key things to aim/look out for to get you there, others just a list of left and rights forgotten in a nanosecond! I think I were Luke keep asking as I went along. When I lived in Kenya If you needed the way to somewhere you could ask and if it was taxis they’d run round the huge taxi park till they found someone who knew the place no matter how obscure and you’d be guided to the right taxi and dropped at the right place. A lot of people are not literate and I think word of mouth is very important. If you were closer (in footing distance as they would say) and the person knew the place they’d walk with you until you we’re there. It could be 6 miles or more. I was amazed to discover people would go out of their way to get you there, once they said goodbye they’d retrace their steps 😳 - you were never lost there! I am impressed with your ruggedness.

[pennyannie]

Thank you :

I shall try and work my way through it all :

What saddens me before I start is that way back in 2004 I read it was already acknowledged that RAI led to a lower QOL and so why this treatment option wasn't included in this research paper.

Why oh why then is it still the option pushed by the mainstream medical ?

I believe I've been dealing with Graves / hypo for very many years - dyslexic as a child, singled out at school for writing with my left hand - anxiety and nervousness from a very young age, and looking back now, knowing what I do now, undiagnosed hypothyroid.

My diagnosis of Graves was at age 56 - 4 months after being physically threatened and verbally abused by a man I employed as my assistant manager. I never put the two things together and worked alongside him while I went through the company's grievance procedures.

Now 17 years post RAI my QOL is as detailed in the research papers that mainstream medical seem to deny exist.

I now self medicate, and much improved on NDT and have my life back, but it's not where I was, and though cognitive function much improved I'm easily stressed at what I see as my own short comings.

[helvella in reply to pennyannie]

And a vast proportion of those who have been hyperthyroid, for almost any reason, go through a crashing of thyroid hormone levels, often to profound hypothyroidism, before getting anywhere near to a reasonable dose of thyroid hormone - which is almost invariably just levothyroxine.

[TSH110 in reply to helvella]

That’s my story: TSH undetectable one week, 110 the next and then crashing to zero as the thyroid died - god was I ill. I was given a diagnosis of graves then it was changed to hypothyroidism, consultant said it was atropic auto immune thyroiditis when I saw him. As the thyroid had atrophied to nothing likely to have any function I suppose it has to be the latter but I was wired for some time (many years, decades even) as if it was overactive. I was given Levothyroxine, said I felt terrible -and was told I ‘d just have to get used to it as that’s as good as it was ever going to be by the thyroid nurse whom I have come to think was utterly incompetent. I did not see the consultant at that juncture despite my complaints and her admitting my levels were not correct (must have meant free T3 at rock bottom basement) I might have got a better outcome if I had seen him he was pretty good. 9 months of hell to be left feeling like that. It was perfectly possible to improve things as NDT has done and proves she spouted complete rubbish. She never even mentioned any other medications.