Shin Yong-Wook, Choi Yun Mi, Kim Ho Sung, Kim Dae-Jin, Jo Hang Joon, O'Donnell Brian F, Jang Eun Kyung, Kim Tae Yong, Shong Young Kee, Hong Jin Pyo, Kim Won Bae
1 Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea .
2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, South Korea .
Thyroid. 2016 May;26(5):641-9. doi: 10.1089/thy.2015.0452. Epub 2016 Apr 11.
Acute hypothyroidism induced by thyroid hormone withdrawal (THW) in patients with thyroid cancer after total thyroidectomy can affect mood and quality of life (QoL). While loss or dysregulation of thyroid hormone (TH) has these well-known behavioral consequences, the effects of TH alterations on brain function are not well understood. Resting state functional connectivity (FC) measured by functional magnetic resonance imaging (fMRI) allows non-invasive evaluation of human brain function. This study therefore examined whether THW affects resting state FC and whether changes in FC correlate with the mood or QoL of the patients with THW status.
Twenty-one patients who had undergone total thyroidectomy for thyroid cancer were recruited. Resting state fMRI scanning of the brain, thyroid function tests, and administration of the 12-Item Short Form Health Survey (SF-12) and the Patient Health Questionnaire-9 (PHQ-9) were performed before and after two weeks of THW. Regional homogeneity (ReHo), one of the measures of resting state FC, was calculated, and each voxel was compared between before and after THW in 19 patients. The ReHo values were extracted from the regions of interest showing within-group differences in ReHo values after THW, and correlations of ReHo values with thyrotropin (TSH) levels, total score of the PHQ-9, and composite scores of the SF-12 were statistically evaluated.
Higher ReHo was observed after THW in the brain cortical regions across primary motor and sensory, visual, and association cortices. Among the regions, the ReHo values in the bilateral pre- and postcentral gyri, bilateral middle occipito-temporal cortices, the left precuneus, and the left lingual gyrus showed positive correlations with serum TSH levels after THW. Higher ReHo values in the bilateral pre- and postcentral gyri, the left middle temporo-occipital cortices, and the left ligual gyrus correlated with the lower mental component summary score from the SF-12, while higher ReHo values in the bilateral pre- and postcentral gyri correlated with higher total scores in the PHQ-9.
Local brain FC is increased in the acute hypothyroid state. Higher FC correlates with a poorer mental QoL and increased depression in the hypothyroid state.
甲状腺癌患者全甲状腺切除术后因甲状腺激素撤减（THW）诱发的急性甲状腺功能减退可影响情绪和生活质量（QoL）。虽然甲状腺激素（TH）的丧失或失调会产生这些众所周知的行为后果，但TH改变对脑功能的影响尚不清楚。通过功能磁共振成像（fMRI）测量的静息态功能连接（FC）可对人类脑功能进行无创评估。因此，本研究探讨了THW是否会影响静息态FC，以及FC的变化是否与处于THW状态患者的情绪或生活质量相关。
招募了21例因甲状腺癌接受全甲状腺切除术的患者。在THW两周前后进行脑部静息态fMRI扫描、甲状腺功能测试，并发放12项简明健康调查问卷（SF - 12）和患者健康问卷 - 9（PHQ - 9）。计算静息态FC的测量指标之一区域一致性（ReHo），并对19例患者THW前后的每个体素进行比较。从THW后ReHo值显示组内差异的感兴趣区域提取ReHo值，并对ReHo值与促甲状腺激素（TSH）水平、PHQ - 9总分和SF - 12综合评分的相关性进行统计学评估。
THW后，在初级运动和感觉、视觉及联合皮层的脑皮质区域观察到更高的ReHo。在这些区域中，双侧中央前回和中央后回、双侧枕颞中皮质、左侧楔前叶和左侧舌回的ReHo值与THW后的血清TSH水平呈正相关。双侧中央前回和中央后回、左侧颞枕中皮质和左侧舌回较高的ReHo值与SF - 12较低的心理成分总分相关，而双侧中央前回和中央后回较高的ReHo值与PHQ - 9较高的总分相关。
急性甲状腺功能减退状态下局部脑FC增加。较高的FC与甲状腺功能减退状态下较差的心理生活质量和抑郁增加相关。
