Changes of event related potential and cognitive processes in patients with subclinical hypothyroidism after thyroxine treatment.

OBJECTIVE: Recently, it has been repeatedly shown that patients with subclinical hypothyroidism (SH) formerly considered as completely symptom free, may have numerous minimal, often non-specific subjective complaints, and that in those patients it is possible to prove many subtle but objective deviations. We decided to quantify whether there are event related potential (ERP) deviations as electrophysiological markers of cognitive activity in patients with SH and whether ERP could be influenced by thyroxine treatment leading to normalization of TSH level in serum. SUBJECTS AND DESIGN: Event related potential (ERP) was examined in thirty one patients (mean age 52 +/- 12.5 years) with SH and without any other endocrine or metabolic diseases and in 29 subjects of the control group. From 31 patients 20 women (mean age 61.8 +/-6.8 years) were selected and divided into a group of 10 women treated six months with L-thyroxine until the normalization of TSH and remaining 10 women receiving placebo. ERP examination was repeated and all such patients also underwent neuropsychological examination consisting of the Wechsler Memory Scale and the MMPI/100 (Minnesota Multiphasic Personality Inventory). The interval between the diagnosis of SH and final evaluation of treatment was 16 months. RESULTS: In SH thyroxine treated patients the average P3 wave latency was 374 ms (SD 40.6), while in placebo group it was 340 ms (SD 32.3. P<0.01). In addition, the treatment with thyroxine normalized the TSH level resulted in a decrease of P3 wave latency from 374 +/- 36.3 ms to 343 +/- 16.3 ms (P<0.01). However, in the placebo group such changes were not observed, the latency of P3 being 387 +/- 24.3 ms at the beginning and 379 +/- 36.5 ms at the end of observation period. No significant correlations between P3 wave latency and thyroid parameters were found. In thyroxine treated group a significant improvement in verbal memory (P<0.01), visual memory (P<0.01) and total memory scores (P<0.01) was found, while no changes in these parameters were observed in the placebo group. No significant differences were found in the MMPI test evaluation. CONCLUSION: SH patients had significantly longer P3 wave latency in ERP examination as compared to healthy individuals which gives evidence for impaired cognitive functions in SH patients. In these patients the normalization of TSH level by thyroxine treatment resulted also in the normalization of P3 wave latency. In addition, also verbal, visual and total memory scores improved significantly with the TSH normalization.

[Effect of normalization of an isolated increase in TSH on the neuropsychological profile of patients]. / Vliv normalizace izolovane zvýseného TSH na neuropsychologický profil pacientu.

BACKGROUND: Isolated TSH increase--"subclinical hypothyreosis" (SH) appears to be comparatively common. Its incidence among women over sixty has been estimated up to 17%. Though SH was assumed to be entirely asymptomatic, recent findings revealed various fine subjective and objective symptoms of the disease. METHODS AND RESULTS: Twenty otherwise healthy female patients with SH diagnosis were examined. Using personality questionnaire MMPI/100 eight different clinical scales and two control scales were evaluated, using Wechsler's memory scale WM-R 5 memory quotients were tested. The group was randomised into a subgroup treated for six month with placebo and a subgroup where thyroxin was administrated and thyroidal test normalised. Psychological testing repeated before and after the treatment, results evaluated using paired t-test. Results indicate that: 1. Patients with SH did not differ in personality features, they only had a higher tendency to the depressive mood, which could be positively influenced by thyroxin (significance at 5% level). 2. Thyroxin treatment brought about improvement of some cognitive parameters of the verbal (p < 0.01), visual (p < 0.05), and general memory (p < 0.01). 3. Results of psychological and cognitive tests correlate better with FT4 than TSH level. CONCLUSIONS: Though SH cannot be associated with changes in personality features, TSH normalisation results in statistically significant improvement of cognitive function--verbal, visual and general memory.

Unusual complication of total thyroidectomy: arteriovenous fistula.

We describe the case of a 29-year-old woman from the Chernobyl area, who moved to the Czech Republic 10 years after the Chernobyl nuclear disaster. She was evaluated for a large goiter. Fine-needle aspiration cytology indicated a diagnosis of a typical degenerated Hurthle cell adenoma. She underwent total thyroidectomy but a continual loud murmur was found 1 month after surgery. An arteriovenous (AV) fistula between the right thyrocervical trunk and the right jugular vein was proven angiographically. This fistula was successfully closed by artificial embolization performed by detachable Gianturco-Anderson-Wallace (GAW) coil. This is the first description of using such a procedure in order to close an AV fistula after thyroidectomy.

[Use of captopril in diabetics]. / Vyuzití captoprilu u diabetiku.

The author describes in his brief review the pathophysiological effects of the inhibitor of the angiotensin converting enzyme (ACEI) and its favourable properties in the treatment of hypertension in diabetics, in the treatment of diabetic nephropathy and its metabolic effects on insulin resistance, improvement of cognitive functions and thus a better quality of life of the patients.

[Endothelial dysfunction in diabetes mellitus]. / Endoteliální dysfunkce u diabetes mellitus.

Impairment of the vascular endothelium and its functions is a common sign of several serious diseases (atherosclerosis, hypertension, vascular spasms, thromboses) and is the initial stage of vascular affection in diabetes mellitus. The endothelium plays an important role in the transformation of some substances with a cardiovascular action and it secretes itself vasoactive substances. Vascular affections in diabetes are characterized by impaired homeostasis of vasoactive substances of endothelial origin--raised levels of vasoconstrictor factors (endothelins, thromboxanes) and reduction of vasodilatating factors (prostacyclin, EDRF--endothelin derived relaxing factor) as well as disorders of their interrelations. Vasoactive agents lead at the same time also to alteration of the growth and proliferation potential of smooth muscle cells of the vascular wall and thus to remodelling of the vascular structure in diabetes. At present possible ways how to influence these processes in a favourable way are intensely studied and discussed.

[Endothelins. I. Physiology]. / Endoteliny. I. Fyziologické údaje.

At the beginning of 1988 in Japan in a unique manner a new peptide substance derived form the endothelium was described, so far the most powerful vasoconstrictor substance-endothelin. This started an information boom which soon led to evidence of other substances of this group, naturally related substances; the detailed structure of all endothelins was established, gradually these substances were synthetized, very sensitive radioassays for their estimation were developed. Experimental and clinical work on endothelins and their effects penetrate at present all spheres of medicine and intensive work is under way, focused on their use in the treatment of diseases as widespread as hypertension, vasospastic disorders, atherosclerosis, bronchial asthma, renal failure, etc. These findings are becoming the basis of a medical sub-discipline which can be described by the term of vascular wall endocrinology. In the first part of the review the author submits information on the chemical structure, synthesis and secretion of endothelins, on their plasma levels, mechanism of intracellular action and experimental effects. In the second part the author reviews findings on the participation of endothelins in the pathogenesis of cardiovascular and renal diseases. Their role in the control of volume homeostasis and in the genesis of the preeclamptic syndrome is discussed, as well as effects on the CNS and other organs, and the author reflects on the general impact of contemporary findings on endothelins in medicine and on possibilities of their perspective practical use.

[Actinomycosis of the ovary as a cause of cachexia in a young patient]. / Aktinomykóza ovaria jako prícina kachektizace u mladé pacientky.

The authors describe the case of a 40-year-old female patient treated for prolonged periods unsuccessfully with several antibiotics on account of a febrile condition of obscure aetiology and subsequently repeatedly subjected to laparotomy on account of intra-abdominal abscesses. The cause of the fever, abdominal pain and gradual cachectization was an abdominal form of actinomycosis. After establishment of the diagnosis the patient was successfully treated by long-term penicillin administration and recovered completely. The authors discuss experience reported in the literature and therapeutic possibilities in actinomycosis.

[Is the measurement of the pulse wave rate useful in the diagnosis of the early stages of arterial atherosclerosis of the lower extremities in type I diabetics?]. / Je merení rychlosti pulsové vlny prínosem pro diagnostiku casných stadií aterosklerózy tepen dolních koncetin u diabetiku I. typu?

The authors examined the rate of the pulse wave (RPW) on the arteries of the lower extremities in a group of 60 type I diabetics and in a control group of 60 subjects without diabetes. The aim of the examination was to find out whether in diabetes threatened by early development of atherosclerosis preclinical signs of stiffening of the arteries with a fast spread of the pulse wave are present. The authors found in diabetics significantly higher values of RPW, as compared with non-diabetics, starting from the fourth decade. In subjects under 30 years the RPW in the two groups did not differ. In diabetics significant linear correlations were revealed between RPW values and age and RPW values and the duration of diabetes--i.e. with advancing age and longer duration of diabetes RPW rises. In diabetics with peripheral neuropathy significantly higher RPW values were recorded, as compared with diabetics without this complication. Assessment of the RPW by ultrasound is a non-invasive useful examination which makes it possible to detect among type I diabetics subjects with preclinical signs of stiffening of the arteries of the lower extremities which is considered an initial stage of atherosclerosis.