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6SYMPTOMS OF ORGANIC BRAIN DAMAGE IN PRIMARY
HYPOTHYROIDISM
Bilous I.I.
Pavlovych L.B.
MD, PhD;
Department of Nervous Diseases, Psychiatry and Medical Psychology «Higher State Educational Establishment» Bukovinian State Medical University ", Chernivtsi, Ukraine
ABSTRACT
The purpose of the work is to identify the clinical features of organic brain damage in patients with subclinical and clinically expressed hypothyroidism against the background of autoimmune thyroiditis and postoperative hypothyroidism. The study involved 56 patients with hypothyroidism as a result of AIT (autoimmune thyroiditis) and 20 patients with postoperative hypothyroidism. 18 patients had subclinical hypothyroidism. We used clinical-neurological and electrophysiological examination of patients. In order to determine the peculiarities of cognitive functions, we used the MMSE test (Mini Mental State Examination), methods of evaluation of attention on the Schultz tables modified by Horbova F.D. and memory was tested by "Memorizing 10 words" (by Luria A.R.). To assess the personal and reactive anxiety, the Spielberger State-Trait Anxiety Inventory scale, adapted by Hanin Yu.L., and the degree of depressive disorders was determined by the Beck A.T. scale. The organic syndromes in the structure of the central nervous system damage mainly had a mild degree of severity and reflected the simultaneous involvement of several structures of the brain in the pathological process. Symptoms of damage of the cranial nerves and vestibular-cerebellar disorders occurred most often in patients with primary hypothyroidism. It should be noted that extrapyramidal syndrome was more frequently detected in patients with more severe hormonal deficiency.
Neurosis-like syndrome in patients with primary hypothyroidism was practically obligatory. Patients in most cases complained of mild irritability, tearfulness, emotional lability. In the majority of patients with primary hypothyroidism, regardless of its cause and severity, there was a high personal anxiety, and the reactive one was moderate. One of the features of neurosis-like syndrome in primary hypothyroidism is the prevalence of its manifestations in patients with autoimmune thyroiditis and in patients with subclinical hypothyroidism.
Keywords: autoimmune thyroiditis, subclinical hypothyroidism
Introduction.
The prevalence of hypothyroidism in the population can reach 21% [1, 2, 8, 10]. This allows to consider hypothyroidism one of the most common endocrine diseases. Its high prevalence, involvement in the pathological process of all systems and organs with no exception, the polymorphism of the clinical picture along with sufficiently nonspecific symptoms stipulate the great medical and social importance of the problem of early diagnostics and elimination of hypothyroidism [3, 4, 6, 9].
Hormones of the thyroid gland regulate all types of metabolism in the body, affect the cells, and stimulate tissue respiration. Consequently, even a small deficiency of thyroid hormones in the body causes serious, sometimes irreversible disorders. In recent years, the frequency of thyroid abnormalities has increased throughout the world. Psychoneurological disorders, which are the result of hypothyroid encephalopathy, are the most common disorders of the nervous system in adult patients with hypothyroidism. Acute suppression of energetic and anabolic processes in the brain contributes to the formation of organic damage to the nervous system. Slowness of thinking, retardation, drowsiness, memory loss is found in many patients, and the degree of these disorders depends on the reduction of thyroid gland function [5, 12, 15]. The development of cretinism in children, which manifests itself as a delay in psychoneurological and physical growth is the most severe complication of hypothyroidism. Psychoneurological disorders in children suffering
from congenital hypothyroidism are far from having a constant tendency to reverse development, even with the early administration of the substitution therapy. This is due to the significant influence of thyroid hormones during the period of the prenatal development of the nervous system and to the inability to eliminate the defect in newborn infants.
Chronic hypothyroid encephalopathy is most often manifested by emotional disturbances. The brain is very sensitive to a deficiency of thyroid hormones in the body. It manifests itself in a depressed mood, a feeling of sorrow and severe depression [7, 11, 14, 15].
Asthenia, neurosis-like states, insomnia are frequent companions of hypothyroidism as well. So-called "sleep apnea", associated with soft tissue edema of the neck and vocal cords is common, manifesting itself by numerous episodes of respiratory arrest for more than 10 seconds, which is often accompanied by snoring.
The aim of the study. To identify the clinical features of the central nervous system in patients with sub-clinical and clinically expressed hypothyroidism against the background of autoimmune thyroiditis and postoperative hypothyroidism. Materials and methods. Patients with neurological disorders secondary to endocrine pathology. Methods: clinical-neurological and psychodiagnostic ones. In order to determine the peculiarities of cognitive functions, we used the MMSE test (Mini Mental State Examination), methods of evaluation of attention on the Schultz tables modified by Horbova F.D. and memory was tested by "Memorizing 10 words" (by Luria A.R.). To assess the personal and
reactive anxiety, the Spielberger State-Trait Anxiety Inventory scale, adapted by Hanin Yu.L., and the degree of depressive disorders was determined by the Beck A.T. scale.
The study involved 56 patients with hypothyroidism as a result of AIT (autoimmune thyroiditis) and 20 patients with postoperative hypothyroidism. The control group consisted of 20 practically healthy persons. 58 (76,3%) of patients were on substitution therapy using synthetic derivatives of L-thyroxin, and 18 (23,7%) patients had subclinical hypothyroidism. We used clinical-neurological and electrophysiological examination of patients.
Research results discussion
The symptoms of hypothyroidism were detected in all patients during the clinical examination: memory impairment, decreased ability to work, fast fatigability, sleep disturbances, swelling of the face and extremities, recurrent pain in the region of the heart. Patients with hypothyroidism complained of headache, dizziness, instability while walking, noise and tinnitus in the ears and head, periodic loss of vision and hearing, increased blood pressure, emotional instability, decreased emotional background.
In the structure of the damage of the central nervous system, there have been identified and studied the symptoms of pyramidal syndrome, vestibular-cerebel-lar and extrapyramidal disorders, syndrome of the cranial nerves damage. Pyramidal syndrome was evaluated by the presence of changes in deep and superficial reflexes, the presence of pathological reflexes, increased muscle tone for spasticity type and decreased muscle strength. Vestibular-cerebellar syndrome was evaluated by the presence and degree of vertigo severity, the presence and severity of nystagmus and the accuracy of the implementation of coordinating samples. Extrapyramidal syndrome was evaluated by the presence and degree of severity of changes in muscle tone, as well as by characteristic disorders of motor actions.
The evaluation of the syndrome of cranial nerves damage was carried out by the presence and severity of pseudobulbar syndrome, oculomotor disorders and symptoms of central damage of the facial nerve.
Symptoms of damage of the cranial nerves and vestibular-cerebellar syndrome were most often detected in patients with primary hypothyroidism. Pseu-dobulbar disorders were found in 38% of patients with autoimmune thyroiditis and in 36% of patients with postoperative hypothyroidism. Neurological examination of patients showed oculomotor disturbances in 64% of patients with autoimmune thyroiditis and in 67% of those with postoperative hypothyroidism. Extrapyramidal syndrome was the least frequent.
The significant difference in the frequency of the studied syndromes in patients with autoimmune thy-roiditis and in those with postoperative hypothyroidism was not detected. It should be noted that all the studied syndromes were of a mild severity.
The picture of organic brain damage depended on the severity of the primary hypothyroidism. Extrapyramidal disorders were more likely to occur in patients with more severe hormonal deficiency, whereas pyramidal syndrome, cranial nerve damage syndrome, and
vestibular-cerebellar disorders were found to be approximately the same in patients with subclinical and clinically pronounced hypothyroidism. Pseudobulbar disorders were observed in 34% of patients with sub-clinical hypothyroidism and in 42% of patients with clinical hypothyroidism, oculomotor disorders were observed in 63% and 58% respectively. However, the degree of severity of all the considered syndromes did not depend on the severity of hypothyroidism.
Cognitive impairment was noted in 74.8% of the patients. No one of these patients had severe cognitive impairments leading to a violation of social adaptation. In most patients (64.9%) cognitive impairments were mild. Patients complained of a slight decrease in memory, absent-mindedness, which did not reduce their working capacity and did not lead to a social maladaptation. Among patients with hypothyroidism secondary to AIT and with hypothyroidism without AIT, the incidence of cognitive impairments was practically the same. For instance, in patients with AIT, impaired attention and memory were noted in 75.7% of cases, and in patients with hypothyroidism without AIT in 72.4% of individuals. There were no significant differences in the severity of cognitive impairment in patients of both groups either. Among patients with subclinical and clinical hypothyroidism, there were no significant differences in the incidence or the severity of cognitive impairment. Disturbances in memory and attention were noted in 75.9% of patients with subclinical hypo-thyroidism. Among patients with clinical hypothyroid-ism, these disorders were found in 75%.
Neurosis-like syndrome was observed in 93% of the patients under study. Patients complained of slight irritation and emotional lability. In patients with hypothyroidism secondary to AIT neurosis-like syndrome occurred in 91% of cases, in patients with hypothyroidism without AIT - in 97%. The same number of patients with subclinical and those with clinical hypothyroidism complained of high irritability and tearfulness, but it was the patients with subclinical hypothyroidism whose neurosis-like syndrome was more pronounced. The incidence in them was 90%, and in those with clinical hypothyroidism - 94%.
The level of personal anxiety that characterizes it as a character trait on the Spielberg and Hanin scale of anxiety self-esteem had no probable differences in the studied groups and was high in patients both with and without AIT, as well as in patients with varying degrees of severity of hypothyroidism. The average index of personal anxiety in patients with hypothyroidism of the thyroid gland secondary to AIT was 55.13 ± 9.62 points, and in patients with hypothyroidism without AIT - 53.09 ± 8.24 points. In subclinical hypothyroidism, it was 54.90 ± 9.10 points, and in clinical hypothyroidism - 55.30 ± 9.02 points.
The reactive anxiety allows evaluating anxiety as a transient clinical condition. It was moderate in most patients with primary hypothyroidism, regardless of its cause and severity. However, the average index of reactive anxiety was higher in patients with AIT and amounted to 45.13 ± 9.20 points, and in patients with hypothyroidism without AIT - 32.72 ± 9.20 points. The reactive anxiety was also more pronounced in patients
with subclinical hypothyroidism and amounted to 45,95 ± 8,10 points, and in patients with clinical hypothyroidism - 33,80 ± 8,20 points.
Conclusions.
1. The organic syndromes in the structure of the central nervous system damage mainly had a mild degree of severity and reflected the simultaneous involvement of several structures of the brain in the pathological process. Symptoms of damage of the cranial nerves and vestibular-cerebellar disorders occurred most often in patients with primary hypothyroidism. It should be noted that extrapyramidal syndrome was more frequently detected in patients with more severe hormonal deficiency.
2. Neurosis-like syndrome in patients with primary hypothyroidism was practically obligatory. Patients in most cases complained of mild irritability, tearfulness, emotional lability. In the majority of patients with primary hypothyroidism, regardless of its cause and severity, there was a high personal anxiety, and the reactive one was moderate. One of the features of neurosis-like syndrome in primary hypothyroidism is the prevalence of its manifestations in patients with autoimmune thyroiditis and in patients with subclinical hypothyroidism.
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К ВОПРОСУ О ВЗАИМОСВЯЗИ ОТКРЫТОГО АРТЕРИАЛЬНОГО ПРОТОКА И ВЕНТИЛЯТОР-АССОЦИИРОВАННЫХ ПНЕВМОНИЙ У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ, ПОЛУЧАЮЩИХ РЕСПИРАТОРНУЮ ТЕРАПИЮ
Брыксина Е.Ю.
Федеральное государственное бюджетное образовательное учреждение высшего образования Ростовский государственный медицинский университет Министерства здравоохранения
Российской Федерации, кафедра акушерства, гинекологии, перинатологии и репродуктивной медицины №4, доктор медицинских наук, врач-неонатолог
