Let's face it, the only reason this is worth writing and reading is that so much has been ignored for so long.
If it doesn't resolve with levothyroxine, it must be something other than thyroid...
Thank you, Johannes W. Dietrich
Open access
Published: 29 May 2024
Impaired autonomic function and somatosensory disturbance in patients with treated autoimmune thyroiditis
Bojana Bazika-Gerasch, Nina Kumowski, Elena Enax-Krumova, Miriam Kaisler, Lynn Bernadette Eitner, Christoph Maier & Johannes W. Dietrich
Scientific Reports volume 14, Article number: 12358 (2024)
Abstract
Despite treatment with levothyroxine, hypothyroidism and autoimmune thyroiditis (AIT) may be associated with reduced quality of life (QoL), an enigmatic condition referred to as "syndrome T". Peripheral neuropathy, described in untreated thyroid disease, could be a contributing mechanism. We analysed autonomic and somatosensory function in 29 patients with AIT and treated hypothyroidism and 27 healthy volunteers. They underwent heart rate variability (HRV) analysis and quantitative sensory testing (n = 28), comprising 13 parameters of small and large nerve fibre function and pain thresholds. Autonomic cardiovascular function was assessed in rest, deep respiration and orthostasis. Additionally, biomarkers for autoimmunity and thyroid function were measured. Anxiety, depression and QoL were assessed using validated questionnaires. 36% of the patients showed at least one sign of somatosensory small or large fibre dysfunction. 57% presented with mild hyperalgesia to at least one stimulus. Several markers of autonomic function and some detection thresholds were related to the antibody titres. Anxiety, depression scores and QoL correlated to antibody titres and HRV measures. Autonomic and somatosensory dysfunction indicate that in treated hypothyroidism and AIT a subgroup of patients suffers from neuropathic symptoms leading to impaired QoL. Additionally, mild hyperalgesia as a possible sensitisation phenomenon should be considered a target for symptomatic treatment.
[ rest of paper ]
Conclusion
Autoimmune thyroiditis may involve autonomic dysfunction, even in subjects receiving adequate substitutive therapy with levothyroxine. In treated hypothyroidism, cardiovascular autonomic function is predicted by thyroid autoimmunity rather than thyroid function. One-third of the examined AIT patients exhibit at least one abnormal decreased detection threshold, mostly in the form of paradoxical heat sensation as a sign of small fibre dysfunction. In half of the patients, at least one pain threshold (mostly for heat) was mildly decreased indicating peripheral sensitization.
Full open access paper here:
nature.com/articles/s41598-...
Bazika-Gerasch, B., Kumowski, N., Enax-Krumova, E. et al. Impaired autonomic function and somatosensory disturbance in patients with treated autoimmune thyroiditis. Sci Rep 14, 12358 (2024). doi.org/10.1038/s41598-024-...
