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13MEDICAL SCIENCES
THE CHANGES IN MRI OF THE BRAIN IN PATIENTS WITH 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 changes in MRI and clinical features of organic brain damage in patients with primary hypothyroidism. We used clinical-neurological and MRI examination of patients. For the MRI of the brain, the magnetic resonance scanner produced by "Siemens" company with a voltage of magnetic field of 1.0 Tesla, with a thickness of sections of 2.0 mm. Magnetic resonance tomography of the brain in patients with primary hypothyroidism. MRI of the brain was performed in 22 patients aged 28-65 years with primary hypothyroidism. The changes in MRI in patients with primary hypothyroidism were nonspecific. In part, the changes in the MRI scan can be explained by the presence of concomitant pathology. However, in patients without changes in MRI, neurological syndromes were observed, which were no less pronounced than in patients with concomitant pathology. Finding "empty Turkish saddle" syndrome and calcification of basal ganglia in MRI scanning is interesting. 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.
Keywords: hypothyroidism
Introduction.
Magnetic resonance imaging (MRI) has become a leading method of neuroimaging in recent years. The method is based on the phenomenon of nuclear magnetic resonance that is on the registration of electromagnetic radiation coming from protons after their excitation by radio-frequency pulses in a constant magnetic field. Radiation of energy by protons in the form of electromagnetic oscillations with different frequency occurs simultaneously with the process of proton returning to the initial state (relaxation) with the loss of excess energy in the form of radiation of the same frequency. Registration of these oscillations; The digitization allows you to form layered images and reproduce them.
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].
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.
For the MRI of the brain, the magnetic resonance scanner produced by "Siemens" company with a voltage of magnetic field of 1.0 Tesla, with a thickness of
sections of 2.0 mm. Magnetic resonance tomography of the brain in patients with primary hypothyroidism. MRI of the brain was performed in 22 patients aged 28-65 years with primary hypothyroidism.
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.
Having external and internal hydrocephalus, focal changes in the vascular nature, cystic changes in the shells, "empty Turkish saddle" syndrome, calcification of basal ganglia were considered. The severity of internal hydrocephalus was assessed according to the size of the anterior horns of the lateral ventricles. The degree of severity of external hydrocephalus was assessed by the presence and severity of enlargement of the subdu-ral spaces, lateral sulci, the fissure between the hemispheres of the brain, the bases of the brain. The assessment of the severity of vascular changes was based on the calculation of the number of vascular foci and the presence of leukoaraiosis. Changes in MRI scan were observed in 68,1% of the experimental patients (15 patients). Hydrocephalus was the most common finding and was diagnosed in 73,3% (11 patients). Of these, 81,8% (9 patients) had mixed hydrocephalus. In 18,2% (2 patients) only external hydrocephalus was detected. Only hydrocephalus was found in 54,5% (6 patients),
in the remaining 45,5% (5 patients) hydrocephalus was combined with other MRI findings. External and internal hydrocephalus was observed in patients of all age groups. There was a positive correlation between the severity of hydrocephalus and that of organic pathology of the brain during the examination of patients (p = 0.05). There was no reliable difference between the severity of organic syndromes in patients with changes in MRI and those without pathological changes in MRI. Signs of organic brain damage in patients with unchanged MRI scans were found in 3 patients (42,8%), in patients with changes in MRI scans this figure was 93,3% (14 patients). Vascular changes (5-6 foci) were detected in 1 patient (6,7%) in combination with mixed hydrocephalus. This patient experienced a periodic increase in blood pressure and rare pain in the area of the heart that occurs during physical activity. In the neurological status of this patient, mild oculomotor and ves-tibulocerebellar disorders were observed. External and internal hydrocephalus were predominantly mild. Cystic changes in the shells of the brain were observed in 2 patients (13,3%) and they were focal. In both cases there was a deformation of the liquor spaces of the con-vexital area of the frontal lobes. These patients indicated a history of craniocerebral trauma. In the neurological status of these patients there were slight oculomotor and moderate vestibulocerebellar disorders. "Empty Turkish Saddle" syndrome was observed in 3 (20%) patients. Objectively, they were found to have mild pyramidal, vestibulocerebellar and oculomotor disorders. Calcification of basal ganglia was found in one patient. This pathology was combined with empty Turkish saddle syndrome and mixed hydrocephaly. In the neurological status, moderate pyramidal, vestibulo-cerebellar syndromes were observed. The patient had cerebral contusion in his history. Therefore, the changes in MRI in patients with primary hypothyroid-ism were nonspecific. In part, the changes in the MRI scan can be explained by the presence of concomitant pathology. However, in patients without changes in MRI, neurological syndromes were observed, which were no less pronounced than in patients with concomitant pathology. Finding "empty Turkish saddle" syndrome and calcification of basal ganglia in MRI scanning is interesting.
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. The changes in MRI in patients with primary hypothyroidism were nonspecific. In part, the changes in the MRI scan can be explained by the presence of concomitant pathology. However, in patients without changes in MRI, neurological syndromes were observed, which were no less pronounced than in patients with concomitant pathology. Finding "empty Turkish
saddle" syndrome and calcification of basal ganglia in MRI scanning is interesting.
References
1. Lee KW, Kim SH, Kim KJ, Kim SH, Kim HY, Kim BJ, et al. A Rare Manifestation of Hypothyroid Myopathy: Hoffmann's Syndrome. Endocrinol Metab (Seoul). 2015;30(4):626-30. doi: 10.3803/EnM.2015.30.4.626
2. Chung J, Ahn KS, Kang CH, Hong SJ, Kim BH. Hoffmann's disease: MR imaging of hypothyroid myopathy. Skeletal Radiol. 2015;44(11):1701-4. doi: 10.1007/s00256-015-2226-1
3. Samy DM, Ismail CA, Nassra RA. Circulating irisin concentrations in rat models of thyroid dysfunction - effect of exercise. Metabolism. 2015;64(7):804-13. doi: 10.1016/j.metabol.2015.01.001
4. Jbara Y, Bricker D. Rhabdomyolysis in the setting of induced hypothyroidism and statin therapy: a case report. Eur Thyroid J. 2015;4(1):62-4. doi: 10.1159/000371548
5. Villar J, Finol HJ, Torres SH, Roschman-Gonzalez A. Myopathy in patients with Hashimoto's disease. Invest Clin. 2015;56(1):33-46..
6. Mangaraj S, Sethy G. Hoffman's syndrome - A rare facet of hypothyroid myopathy. J Neurosci Rural Pract. 2014;5(4):447-8. doi: 10.4103/09763147.140025
7. Sharma V, Borah P, Basumatary LJ, Das M, Goswami M, Kayal AK. Myopathies of endocrine disorders: A prospective clinical and biochemical study. Ann Indian Acad Neurol. 2014;17(3):298-302. doi: 10.4103/0972-2327.138505
8. Nalini A, Govindaraju C, Kalra P, Kadukar P. Hoffmann's syndrome with unusually long duration:
Report on clinical, laboratory and muscle imaging findings in two cases. Ann Indian Acad Neurol. 2014;17(2):217-21. doi: 10.4103/0972-2327.132643
9. Kvetny J, Ellervik C, Bech P. Is suppressed thyroid-stimulating hormone (TSH) associated with subclinical depression in the Danish General Suburban Population Study? Nord J Psychiatry. 2015;69(4):282-6. doi: 10.3109/08039488.2014.972454
10. Esfahanian F, Ghelich R, Rashidian H, Jadali Z. Increased Levels of Serum Interleukin-17 in Patients with Hashimoto's Thyroiditis. Indian J Endocrinol Metab. 2017;21(4):551-4. doi: 10.4103/ijem.IJEM_412_16
11. Menon V, Subramanian K, Thamizh JS. Psychiatric Presentations Heralding Hashimoto's Encepha-lopathy: A Systematic Review and Analysis of Cases Reported in Literature. J Neurosci Rural Pract. 2017;8(2):261-7. doi: 10.4103/jnrp.jnrp_440_16
12. Kirim S, Keskek SO, Köksal F, Haydardedeoglu FE, Bozkirli E, Toledano Y. Depression in patients with euthyroid chronic autoimmune thyroiditis. Endocr J. 2012;59(8):705-8.
13. Brown BT, Graham PL, Bonello R, Pollard H. A biopsychosocial approach to primary hypothyroid-ism: Treatment and harms data from a randomized controlled trial. Chiropr Man Therap. 2015;23:24. doi: https://doi.org/10.1186/s12998-015-0068-5
14. Yan N, Meng S, Song RH, Qin Q, Wang X, Yao Q, et al. Polymorphism of IL37 gene as a protective factor for autoimmune thyroid disease. J Molec En-docrinol. 2015;55(3):209-18. doi: https://doi.org/10.1530/jme-15-0144
15. Wong-Anuchit C. Clinical management of an-tipsychotic-induced hyperprolactinemia. Perspect Psy-chiatr Care. 2016;52(2):145-52. doi: 10.1111/ppc. 12111
THE IMPORTANCE OF SCLEROTHERAPY IN THE TREATMENT OF CHRONIC
VENOUS INSUFFICIENCY
Musayev V.A.
Department of Invasive Radiology of Medical Faculty of the University of Gazi, Ankara, Turkey
ABSTRACT
Chronic venous insufficiency (XVI) and associated varicose veins are the cause of major diseases and are very common among the population. Venous insufficiency covers about 10-35% of the population. On average 25% of women and 15% of men suffer from severe pathological conditions. In addition, the spread of venous system diseases is rising as the average life expectancy of the population increases. In advanced age, varicose veins, telangiectomy and venous insufficiency hyperpigmentation, lipodermatosclerosis, other skin changes, especially acute or trophic ulcers, increase in frequency. Factors such as gender and ethnicity play an important role. The frequency of inheritance in women is twice as high as men. However, traumatic events such as trophic changes in men and edema are more common in women than in women.
Keywords: Chronic venous insufficiency, varicose veins, thrombophlebitis, associated, superficial,perfo-rated venules,
Chronic venous insufficiency (CVi) is a common problem associated with varicose veins, which is usually asymptomatic but can cause pain, itching, edema, color changes and open ulcers [1]. Over 15 years varicose vein formation is observed in 20-25% of women and 10-15% of men [2]. Varicose veins may be asymptomatic or may cause severe symptoms. Standing for a
long time may cause pain, itching, burning, tingling, night cramps, edema, skin changes and venous ulcers in chronic cases. Preventing daily activities of people can cause work and time loss [3]. Thrombophlebitis and associated pulmonary emboli may rarely develop
