ÖZET
Amaç:
Hashimoto tiroiditi (HT), nörolojik tutulumun eşlik edebildiği otoimmün bir hastalıktır. Söz konusu tutulumun ötiroid hastalarda subklinik olarak ortaya çıkabileceği öne sürülmektedir. Bu çalışmada, objektif nörolojik bulgusu olmayan ötiroid HT hastalarında merkezi sinir sisteminin (MSS) olası tutulumunun bir göstergesi olarak, görsel uyarılmış potansiyellerdeki (VEP) değişikliklerin varlığı incelenmiştir.
Yöntemler:
Nörolojik muayenesi normal olan 30 HT ve 30 sağlıklı kontrol çalışmaya dahil edilmiştir. VEP kaydı dama taşı “patern reversal” kullanılarak yapılmış, her iki grubun, sağ ve sol göz P100, N75 ve N135 dalgalarının tepe latansları ve P100 amplitüd değerleri karşılaştırılmıştır.
Bulgular:
Gruplar arasında yaş açısından anlamlı fark bulunmamıştır. Dahil etme kriterlerine uygun erkek hasta mevcut olmadığından, kontrol grubu da sadece kadınlardan oluşturulmuştur. HT grubunun P100 (R: 108.13±4.3, L: 108.2±4.4 ms), N75 (R: 79.23±6.03, L: 80.2±5.78 ms), N135 (R: 141.8±11.2, L: 142.4±10.2 ms) tepe latansları ve P100 amplitüdü (R: 6.71± 4.16, L: 6.6±3.9 μV) ile kontrol grubunun P100 (R: 107.2±3.8, L: 107.7±4.36 ms), N75 (R: 79.9±5.5, L: 78.9±6.17 ms), N135 (R: 140.3±8.4, L: 141.9±9.7 ms) tepe latansları ve P100 amplitüdü (R: 8.20±3.32, L: 6.9±2,9 μV) arasında anlamlı fark bulunmamıştır. Tiroid spesifik antikorlar ile P100 tepe latansları arasında da anlamlı bir korelasyon saptanmamıştır.
Sonuç:
HT ve kontrol gruplarına ait VEP değerleri arasında anlamlı bir fark bulunmamasının, HT’nin optik sinir ve görsel yolakları belirgin şekilde etkilememesinden, yahut VEP tekniğinin hastalardaki olası MSS tutulumunu göstermede yeterli hassasiyete sahip olmamasından kaynaklanıyor olabileceği düşünülmüştür.
References
1
Nandi-Munshi D, Taplin CE. Thyroid-related neurological disorders and complications in children. Pediatr Neurol 2015; 52: 373-82.
2
Scolding N. The differential diagnosis of multiple sclerosis. J Neurol Neurosurg Psychiatry 2001; 71(Suppl 2): 9-15.
3
Drakulic S, Toncev G, Vrndic O, Zivancevic Simonovic S. Neurological signs and symptoms in patients with autoimmune thyroid disease. Serbian J Exp Clin Res 2011; 12: 123-6.
4
Zarković M. Autoimmune thyroid disease and brain. Srp Arh Celok Lek 2005; 133(Suppl 1): 88-91.
5
Haralur Y, Mechtler LL. Neuroimaging of multiple sclerosis mimics. Neurol Clin 2020; 38: 149-70.
6
Leyhe T, Müssig K. Cognitive and affective dysfunctions in autoimmune thyroiditis. Brain Behav Immun 2014; 41: 261-6.
7
Demir S, Duzgun E, Kafadar C, Togrol E, Senol M. G, Cakir A. Evoked potentials and other guiding factors of conversion from radiologically isolated syndrome to definite multiple sclerosis. Med Sci Disc 2017; 4: 44-50.
8
Walsh P, Kane N, Butler S. The clinical role of evoked potentials. J Neurol Neurosurg Psychiatry 2005; 76(Suppl 2): 16-22.
9
Jha MK, Thakur D, Limbu N, Badhu BP, Paudel BH. Visual evoked potentials in primary open angle glaucoma. J Neurodegener Dis 2017; 2017: 9540609.
10
Odom JV, Bach M, Brigell M, Holder GE, McCulloch DL, Mizota A, Tormene AP. ISCEV standard for clinical visual evoked potentials: (2016 update). Doc Ophthalmol 2016; 133: 1-9.
11
Gautam V, Paudel BH, Lamsal M, Agrawal K, Jha MK, Maharjan S, et al. Visual evoked potentials’ responses in hypothyroidism and hyperthyroidism. Int J Res Med Sci 2019; 7: 1589-93.
12
Pilhatsch M, Schlagenhauf F, Silverman D, Berman S, London ED, Martinez D, Whybrow PC, et al. Antibodies in autoimmune thyroiditis affect glucose metabolism of anterior cingulate. Brain Behav Immun 2014; 37: 73-7.
13
Cai YJ, Wang F, Chen ZX, Li L, Fan H, Wu ZB, et al. Hashimoto’s thyroiditis induces neuroinflammation and emotional alterations in euthyroid mice. J Neuroinflammation 2018; 15: 299.
14
Piga M, Serra A, Deiana L, Loi GL, Satta L, Di Liberto M, et al. Brain perfusion abnormalities in patients with euthyroid autoimmune thyroiditis. Eur J Nucl Med Mol Imaging 2004; 31: 1639-44.
15
Quinque EM, Karger S, Arélin K, Schroeter ML, Kratzsch J, Villringer A. A Structural and functional MRI study of the brain. Cognition and mood in long-term adequately treated Hashimoto’s thyroiditis. Psychoneuroendocrinology 2014; 42: 188-98.
16
Engler H, Doenlen R, Engler A, Riether C, Prager G, Niemi MB, et al. Acute amygdaloid response to systemic inflammation. Brain Behav Immun 2011; 25: 1384-92.
17
Wen J, Stock AD, Chalmers SA, Putterman C. The role of B cells and autoantibodies in neuropsychiatric lupus. Autoimmun Rev 2016; 15: 890-5.
18
Platt MP, Agalliu D, Cutforth T. Hello from the other side: how autoantibodies circumvent the blood-brain barrier in autoimmune encephalitis. Front Immunol 2017; 8: 442.
19
Tang Y, Xing Y, Lin MT, Zhang J, Jia J. Hashimoto’s encephalopathy cases: Chinese experience. BMC Neurol 2012; 24: 12:60.
20
Müssig K, Leyhe T, Holzmüller S, Klein R, Weinert C, Saur R, et al. Increased prevalence of antibodies to central nervous system tissue and gangliosides in Hashimoto’s thyroiditis compared to other thyroid illnesses. Psychoneuroendocrinology 2009; 34: 1252-6.
21
Mazzù I, Mosti S, Caltagirone C, Carlesimo GA. Hashimoto’s encephalopathy: Neuropsychological findings. Neurol Sci 2012; 33: 653-6.
22
Leyhe T, Müssig K, Weinert C, Laske C, Häring HU, Saur R, et al. Increased occurrence of weaknesses in attention testing in patients with Hashimoto’s thyroiditis compared to patients with thyroid illnesses. Psychoneuroendocrinology 2008; 33: 1432-6.
23
Müssig K, Künle A, Säuberlich AL, Weinert C, Ethofer T, Saur R, et al. Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto’s thyroiditis. Brain Behav Immun 2012; 26: 559-63.
24
Perga S, Martire S, Montarolo F, Giordani I, Spadaro M, Bono G, et al. The footprints of poly-autoimmunity: evidence for common biological factors ınvolved in multiple sclerosis and hashimoto’s thyroiditis. Front Immunol 2018; 20: 9:311.
25
Nandi-Munshi D, Taplin CE. Thyroid-related neurological disorders and complications in children. Pediatr Neurol 2015; 52: 373-82.
26
Yamasaki R, Kira JI. Multiple Sclerosis. Adv Exp Med Biol 2019; 1190: 217-47.
27
Kurne A, Karabudak R, Yalcin Cakmakli G, Gursoy Ozdemir Y, Aydin P, Ilksen Colpak A, et al. Recurrent optic neuritis: clues from a long-term follow up study of recurrent and bilateral optic neuritis patients. Eye Brain 2010; 5: 15-20.
28
Toyama S, Wakakura M, Chuenkongkaew W. Optic neuropathy associated with thyroid-related auto-antibodies. Neuro-Ophthalmology 2009; 25: 127-34.
29
Salvi M, Spaggiari E, Neri F, Macaluso C, Gardini E, Ferrozzi F, et al. The study of visual evoked potentials in patients with thyroid-associated ophthalmopathy identifies asymptomatic optic nerve involvement. J Clin Endocrinol Metab 1997; 82: 1027-30.
30
Nazliel B, Akbay E, Irkeç C, Yetkin I, Ersoy R, Törüner F. Pattern visual evoked potential (PVEP) evaluation in hypothyroidism. J Endocrinol Invest 2002; 25: 955-8.
31
Mitchell KW, Wood CM, Howe JW. Pattern visual evoked potentials in hyperthyroidism. Br J Ophthalmol 1988; 72: 534-7.
32
Aprajita, Sharma G, Aggarwal S. Visual evoked potentials in overt hypothyroid patients before and after achievement of euthyroidism. Indian J Endocrinol Metab 2017; 21: 419-23.
33
Iao TWU, Rong SS, Ling AN, Brelén ME, Young AL, Chong KKL. Electrophysiological studies in thyroid associated orbitopathy: a systematic review. Sci Rep 2017; 21; 7: 12108.
34
Ladenson PW, Stakes JW, Ridgway EC. Reversible alteration of the visual evoked potential in hypothyroidism. Am J Med 1984; 77: 1010-4.
35
Pawłowski P, Myśliwiec J, Mrugacz M, Bakunowicz-Łazarczyk A, Górska M. Pattern visual evoked potentials in the early diagnosis of optic neuropathy in the course of Graves’ ophthalmopathy. Endokrynol Pol 2006; 57: 122-6.
36
Pérez-Rico C, Rodríguez-González N, Arévalo-Serrano J, Blanco R. Evaluation of multifocal visual evoked potentials in patients with Graves’ orbitopathy and subclinical optic nerve involvement. Doc Ophthalmol 2012; 125: 11-9.
37
Lipski A, Eckstein A, Esser J, Loesch C, Mann K, Mohr C, et al. Course of pattern-reversed visual evoked cortical potentials in 30 eyes after bony orbital decompression in dysthyroid optic neuropathy. Br J Ophthalmol 2011; 95: 222-6.
38
Szanyi J, Kremlacek J, Kubova Z, Langrova J, Kuba M. A pilot study to monitor Graves’ ophthalmopathy with a combination of pattern-reversal and motion-onset visual evoked potentials. J Clin Apher 2012; 27: 295-301.
39
Holder GE. Electrophysiological assessment of optic nerve disease. Eye (Lond) 2004; 18: 1133-43.
40
American Clinical Neurophysiology Society. Guideline 9B: guidelines on visual evoked potentials. Am J Electroneurodiagnostic Technol 2006; 46: 254-74.
