Chiarella Giuseppe, Russo Diego, Monzani Fabio, Petrolo Claudio, Fattori Bruno, Pasqualetti Giuseppe, Cassandro Ettore, Costante Giuseppe
Endocr Pract. 2017 Jul;23(7):863-868. doi: 10.4158/EP161635.RA. Epub 2017 May 23.
The aim of this review was to analyze the existing literature concerning the relationship between Hashimoto thyroiditis (HT) and vestibular dysfunction.
We used electronic databases (PubMed, EMBASE, Cochrane Library) to search and collect all published articles about the association between HT and vestibular disorders.
Several observational and retrospective studies have postulated a relationship between thyroid autoimmunity and vestibular disorders. In most cases, an appropriate control group was lacking, and the impact of thyroid functional status could not precisely be established. In recent years, two well-designed prospective studies have provided convincing evidence that the association is not random. One article reported that patients with Ménière disease (MD) had a significantly higher prevalence of positive anti-thyroid autoantibody as compared to healthy controls. Moreover, more than half of MD patients had either positive anti-thyroid or non-organ-specific autoantibody titers, compared to less than 30% of both patients with unilateral vestibular paresis without cochlear involvement and healthy controls. Another study found that patients with benign paroxysmal positional vertigo (BPPV) had significantly higher serum thyroid-stimulating hormone and antithyroid autoantibody levels than healthy controls. Additionally, almost one-fifth of euthyroid patients with HT had signs of BPPV.
The published results indicate that patients with MD or BPPV are potential candidates to also develop HT. Thus, in HT patients, the presence of even slight symptoms or signs potentially related to vestibular lesions should be carefully investigated.
AITD = autoimmune thyroid disease; BPPV = benign paroxysmal positional vertigo; EH = endolymphatic hydrops; HT = Hashimoto thyroiditis; L-T = L-thyroxine; MD = Ménière disease; PS = Pendred syndrome; Tg = thyroglobulin; TPO = thyroid peroxidase; TSH = thyroid-stimulating hormone.
本综述旨在分析现有关于桥本甲状腺炎（HT）与前庭功能障碍之间关系的文献。
我们使用电子数据库（PubMed、EMBASE、Cochrane图书馆）检索并收集所有已发表的关于HT与前庭疾病关联的文章。
多项观察性和回顾性研究推测甲状腺自身免疫与前庭疾病之间存在关联。在大多数情况下，缺乏合适的对照组，且无法精确确定甲状腺功能状态的影响。近年来，两项设计良好的前瞻性研究提供了令人信服的证据，表明这种关联并非随机。一篇文章报道，与健康对照组相比，梅尼埃病（MD）患者抗甲状腺自身抗体阳性率显著更高。此外，超过一半的MD患者抗甲状腺或非器官特异性自身抗体滴度呈阳性，而单侧前庭麻痹且无耳蜗受累患者及健康对照组中这一比例均低于30%。另一项研究发现，良性阵发性位置性眩晕（BPPV）患者的血清促甲状腺激素和抗甲状腺自身抗体水平显著高于健康对照组。此外，几乎五分之一的甲状腺功能正常的HT患者有BPPV体征。
已发表的结果表明，MD或BPPV患者也有可能发展为HT。因此，在HT患者中，即使存在与前庭病变潜在相关的轻微症状或体征，也应仔细检查。
AITD = 自身免疫性甲状腺疾病；BPPV = 良性阵发性位置性眩晕；EH = 内淋巴积水；HT = 桥本甲状腺炎；L-T = 左甲状腺素；MD = 梅尼埃病；PS = 彭德莱综合征；Tg = 甲状腺球蛋白；TPO = 甲状腺过氧化物酶；TSH = 促甲状腺激素
