Reversible Cerebral Hypoperfusion Observed With Tc-99m HMPAO SPECT in Reversible Dementia Caused by Hypothyroidism

Kinuya, Seigo; Michigishi, Takatoshi; Tonami, Norihisa; Aburano, Tamio; Tsuji, Shiro; Hashimoto, Takuma

doi:10.1097/00003072-199909000-00005

Cited by 26 publications

(24 citation statements)

References 7 publications

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“…Impaired brain perfusion in patients with known autoimmune thyroiditis has been demonstrated and supports a hypothesis of cerebral involvement in autoimmune thyroiditis [7,8,9]. However, a recent study showed that a 6-month levothyroxine treatment reduces systemic inflammation in patients with Hashimoto's thyroiditis.…”

Section: Discussionmentioning

confidence: 90%

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT

et al. 2013

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Background: Hashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy associated with autoimmune Hashimoto's thyroiditis. Objectives and Methods: We report on a patient with HE and significant clinical improvement correlating with an increase in cerebral blood flow demonstrated by hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT).HMPAO-SPECT was performed with 740 MBq of technetium-99m-HMPAO. To demonstrate the improvement in regional cerebral blood flow, individual regions of interest were drawn around visually diminished HMPAO uptake, the lesion to reference region ratio was calculated and transverse section imagesand semi-quantitative measurements were performed. Results: We show a 5-year follow-up with significant clinical improvement, a 10-fold reduction in autoantibodies to thyroid peroxidase and an approximately 20% improvement in cerebral blood flow with HMPAO-SPECT. Conclusion: Adequate levothyroxine treatment achieving and maintaining euthyroidism should be considered as therapy to lower autoantibodies and improve clinical outcome in patients with Hashimoto's thyroiditis and encephalopathy.

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Section: Discussionmentioning

confidence: 90%

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT

et al. 2013

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“…Some have reported diffuse global hypoperfusion [87–89] while others demonstrated decreased regional cerebral blood flow [90–92]. Furthermore, variable findings regarding restoration of blood flow with treatment have been documented.…”

Section: Neuroimaging In Thyroid and Mood Disordersmentioning

confidence: 99%

The Link between Thyroid Function and Depression

Hage

Azar

2012

Journal of Thyroid Research

425

176

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The relation between thyroid function and depression has long been recognized. Patients with thyroid disorders are more prone to develop depressive symptoms and conversely depression may be accompanied by various subtle thyroid abnormalities. Traditionally, the most commonly documented abnormalities are elevated T4 levels, low T3, elevated rT3, a blunted TSH response to TRH, positive antithyroid antibodies, and elevated CSF TRH concentrations. In addition, thyroid hormone supplements appear to accelerate and enhance the clinical response to antidepressant drugs. However, the mechanisms underlying the interaction between thyroid function and depression remain to be further clarified. Recently, advances in biochemical, genetic, and neuroimaging fields have provided new insights into the thyroid-depression relationship.

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“…We note that other case reports have described white matter frontal lobe changes on MRI of the brain similar to the findings in our patient 8. In addition, positron emission tomography and single photon emission CT studies have revealed a generalised decrease in cerebral perfusion and glucose metabolism in hypothyroid subjects, which may be reversible with treatment 9 10. Meanwhile, a reversible reduction in wave activity on electroencephalogram has also been associated with hypothyroidism with psychiatric manifestations 11…”

Section: Discussionmentioning

confidence: 99%

Myxoedema madness

Azzopardi¹,

Murfin

Sharda

et al. 2010

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A 59-year-old man was referred for Mental Health Act Assessment following several months of 'odd behaviour' and self-neglect reported by his neighbours. He presented as unkempt and expressed delusional ideas with respect to age, employment and identity of family members. He was fully oriented but lacked insight into his mental state and capacity for self-care. Physical examination revealed dry skin and slow relaxing reflexes. Blood investigations revealed a raised thyroid stimulating hormone and free T4 with positive thyroid peroxidise antibodies. MRI of the brain revealed frontal lobe and cerebellar atrophy, while neuropsychological assessment identified deficit in memory processing and executive functions. Despite appropriate correction of primary hypothyroidism with levothyroxine, the patient remained delusional with respect to age and employment although he showed some improvement in memory. Capacity for self-care remained poor; thus, he was eventually transferred to sheltered housing with rehabilitation.

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Reversible Cerebral Hypoperfusion Observed With Tc-99m HMPAO SPECT in Reversible Dementia Caused by Hypothyroidism

Cited by 26 publications

References 7 publications

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT

The Link between Thyroid Function and Depression

Myxoedema madness

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Reversible Cerebral Hypoperfusion Observed With Tc-99m HMPAO SPECT in Reversible Dementia Caused by Hypothyroidism

Cited by 26 publications

References 7 publications

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by99mTc-HMPAO-SPECT

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by99mTc-HMPAO-SPECT

The Link between Thyroid Function and Depression

Myxoedema madness

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Product

Resources

About

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT

Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by^99mTc-HMPAO-SPECT