Zarković Milos
Institute of Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Serbia, Belgrade.
Srp Arh Celok Lek. 2005 Oct;133 Suppl 1:88-91. doi: 10.2298/sarh05s1088z.
Changes of the affective and cognitive function are usually associated with thyroid gland dysfunction. In autoimmune thyroid disease, these changes can be caused by thyroid dysfunction (hypo- or hyperthyroidism) or associated with the presence of antithyroid antibodies. Even a small change in thyroid hormone concentration is associated with change of cognitive function. In euthyroid older males, variation of total and free thyroxin accounts for about 10% of Wechsler adult intelligence test variance. In euthyroid females, lower cognitive function, measured by Mini Mental test, also correlates with blood thyroxin. Short-term (4 weeks) hypothyroidism induces clinically significant cognitivedysfunction, which is reversible by thyroid hormone substitution. Mild hypothyroidism (TSH less than 10) also induces reversible cognitive dysfunction. In hypothyroidism, PET scanning shows global reduction of brain blood flow and glucose metabolism. Hashimoto's encephalopathy is characterized by corticosteroid reversible encephalopathy associated with the presence of antithyroid antibodies. Encephalopathy can be manifested as multiple stroke-like episodes (vasculitis like), or as diffuse, progressive type characterized by dementia and psychiatric symptoms. In euthyroid patients with Hashimoto's thyroiditis and no evidence of neurological disease, SPECT showed brain perfusion abnormalities. Post mortem and brain biopsy findings can be normal or show perivascular lymphocytic infiltration. Recently, presence of antineuronal antibodies has been found in patients with Hashimoto's thyroiditis. Specific high reactivity against human alpha-enolase was high in patients with Hashimoto's encephalopathy, but absent in patients with other neurological disorders and healthy subjects. Specific antineural antibodies were found in another group of Hashimoto's encephalopathy patients. Furthermore, Ferracci et al, found antithyroid antibodies in the CSF of patients with Hashimoto's encephalopathy.
情感和认知功能的变化通常与甲状腺功能障碍有关。在自身免疫性甲状腺疾病中，这些变化可能由甲状腺功能障碍（甲状腺功能减退或亢进）引起，或与抗甲状腺抗体的存在有关。即使甲状腺激素浓度的微小变化也与认知功能的改变有关。在甲状腺功能正常的老年男性中，总甲状腺素和游离甲状腺素的变化约占韦氏成人智力测验方差的10%。在甲状腺功能正常的女性中，通过简易精神状态检查测量的较低认知功能也与血液甲状腺素相关。短期（4周）甲状腺功能减退会导致临床上显著的认知功能障碍，甲状腺激素替代治疗可使其逆转。轻度甲状腺功能减退（促甲状腺激素小于10）也会导致可逆的认知功能障碍。在甲状腺功能减退时，正电子发射断层扫描显示脑血流量和葡萄糖代谢整体减少。桥本脑病的特征是与抗甲状腺抗体的存在相关的皮质类固醇可逆性脑病。脑病可表现为多次类似中风的发作（类似血管炎），或表现为以痴呆和精神症状为特征的弥漫性、进行性类型。在没有神经疾病证据的桥本甲状腺炎甲状腺功能正常的患者中，单光子发射计算机断层扫描显示脑灌注异常。尸检和脑活检结果可能正常，或显示血管周围淋巴细胞浸润。最近，在桥本甲状腺炎患者中发现了抗神经元抗体。桥本脑病患者对人α-烯醇化酶的特异性高反应性较高，但在其他神经疾病患者和健康受试者中不存在。在另一组桥本脑病患者中发现了特异性抗神经抗体。此外，费拉奇等人在桥本脑病患者的脑脊液中发现了抗甲状腺抗体。
