Article Figures & Data
Figures
- Fig 1.
Brain and ventricular changes before and after treatment in a patient with hyperthyroidism.
A, Sagittal T1-weighted image near the midline of the brain.
B, Registered subtraction image. The low-signal-intensity boundaries at the cortex (large arrow) indicate reduced brain size, and the low-signal-intensity seen more centrally (small arrow) indicates ventricular enlargement.
- Fig 2.
Correlation of changes in brain and ventricular size with changes in T4 levels (with 95% confidence limits).
A, Increases in brain size were strongly correlated with increases in T4 levels.
B, Reductions in ventricular size were strongly correlated with increases in T4 levels.
- Fig 3.
Correlation of changes in brain and ventricular size with changes in T3 levels (with 95% confidence intervals).
A, Brain size increased with increased in T3 levels, but the changes were not significant.
B, Reductions in ventricular size were strongly correlated with increases in T3 levels.
- Fig 4.
Correlation of changes in brain and ventricular size with changes in TSH levels. The data formed two distinct groups. After treatment, TSH levels in the hyperthyroid patients either increased by a small amount or not at all. Although initially very high, TSH levels in the hypothyroid patients decreased to the normal range after treatment.
A, Low levels of TSH was correlated with reductions in brain size.
B, Low levels of TSH were correlated with increases in ventricular size.
Tables
- TABLE 1:
Clinical features and serum levels of T4, free T3, and TSH before and after treatment
Patient Initial Diagnosis* Level Before Treatment Clinical Diagnosis After Treatment Clinical Assessment After Treatment‖ Level After Treatment T4 (nmol/L)† T3 (pmol/L)‡ TSH (mU/L)§ T4 (nmol/L)† T3 (pmol/L)‡ TSH (mU/L)§ 1 Hyperthyroidism 284 32.2 <0.1 Euthyroidism Symptoms remitted 116 7.8 <0.1 2 Hyperthyroidism 267 23+ <0.1 Euthyroidism Symptoms remitted 61 2.2+ <0.1 3 Hyperthyroidism 263 13.2+ <0.1 Euthyroidism Symptoms remitted 112 4.6+ <0.1 4 Hyperthyroidism 196 28.2 <0.1 Euthyroidism Symptoms remitted 73 7.2 <0.1 5 Hyperthyroidism 142 11.1 <0.1 Euthyroidism Symptoms remitted 53 2.8+ <0.1 6 Hyperthyroidism 287 39.7+ <0.1 Euthyroidism Symptoms remitted 121 6.1+ 1.4 7 Hyperthyroidism >300 55.9 <0.1 Euthyroidism Symptoms remitted 66 6.2 <0.1 8 Hyperthyroidism 307 >45 <0.1 Toxicity Symptoms remitted 229 20.4 <0.1 9 Hypothyroidism 2 2.9 43.3 Euthyroidism Symptoms remitted 81 6.9 2.5 10 Hypothyroidism <15 NA 76.5 Euthyroidism Symptoms remitted 94 NA 3.4 11 Hypothyroidism <15 NA >100 Euthyroidism Symptoms remitted 113 NA 25.9 * All patients with hyperthyroidism had neuropsychological symptoms of anxiety, agitation, restlessness, and hyperactivity. All patients with hypothyroidism had neuropsychological symptoms of tiredness, lethargy, mental slowing, and depression.
† Normal range, 60–160 nmol/L.
‡ Normal ranges, 5.4–9.3 pmol/L (assay 1) and 2.5–5.3 pmol/L (assay 2) (denoted with +).
§ Normal range, 0.4–4.0 mU/L.
‖ In all patients, symptoms remitted at clinical assessment after treatment.
Patient Initial Diagnosis Brain Size (mm3) Ventricular Size (mm3) Before Treatment After Treatment Difference Before Treatment After Treatment Difference 1 Hyperthyroidism 1,406,076 1,394,841 −11,235 10,933 12,973 +2040 2 Hyperthyroidism 1,048,747 1,024,564 −24,183 6276 6785 +509 3 Hyperthyroidism 1,081,917 1,050,734 −31,183 20,753 27,032 +6279 4 Hyperthyroidism 1,139,104 1,129,720 −9384 22,991 23,316 +325 5 Hyperthyroidism 1,453,485 1,446,143 −7342 12,941 12,691 −250 6 Hyperthyroidism 1,117,777 1,107,486 −10,291 9394 10,755 +1361 7 Hyperthyroidism 1,261,845 1,231,219 −30,626 24,503 26,729 +2226 8 Hyperthyroidism 1,209,585 1,203,256 −6329 35,018 35,371 +353 9 Hypothyroidism 1,134,086 1,136,685 +2599 9298 8220 −1078 10 Hypothyroidism 1,322,421 1,371,246 +48,825 15,159 12,783 −2376 11 Hypothyroidism 1,171,701 1,179,529 +7828 14,965 14,205 −760
