Abstract
Purpose
To investigate the functional integrity of visual pathway in hypothyroid patients by pattern visual evoked potential (PVEP).
Methods
We enrolled 36 female patients with history of hypothyroidism (18 overt and 18 subclinical) aged 20 to 60 years and 36 healthy women of similar age (control group). All subjects had a complete ophthalmic examination. For VEP testing, subjects were exposed to checks subtending a visual angle of 15 and 60 min of arc.
Results
For the 15 min of arc check size, the mean P100 latency was significantly delayed (113 milliseconds (ms)) and amplitude significantly reduced (9.2 microvolts (µv)) in the hypothyroidism group compared with controls (109.6 ms and 11.6 µv, respectively). For this 15′ check size, the group differences were related to significantly increased latency and reduced amplitude of responses in the group with overt hypothyroidism compared with controls. There was no difference between the groups (hypothyroid vs control) with 60 min of arc check size. There was a significant correlation between severity of the disease and PVEP component.
Conclusions
In conclusion, low levels of circulating hypothyroid hormone are associated with delay in the pattern VEP to small check sizes. This CNS involvement worsens in patients with greater severity and duration of hypothyroidism.
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References
Ladenson PW, Stakes JW, Ridgway EC (1984) Reversible alteration of the visual evoked potential in hypothyroidism. Am J Med 77(6):1010–1014
Surks MI et al (2004) Subclinical thyroid disease. JAMA J Am Med Assoc 291(2):228
Cooper DS (2001) Subclinical hypothyroidism. N Engl J Med 345(4):260–265
Versura P, Campos EC (2010) The ocular surface in thyroid diseases. Curr Opin Allergy Clin Immunol 10(5):486–492
Avramides A et al (1992) Visual evoked potentials in hypothyroid and hyperthyroid patients before and after achievement of euthyroidism. J Endocrinol Invest 15(10):749–753
Khedr EM, El Toony LF, Tarkhan MN, Abdella G (2000) Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology 41(2):88–94
Tamburini G et al (1998) Visual evoked potentials in hypothyroidism: a long-term evaluation. Electromyogr Clin Neurophysiol 38(4):201–205
Misra S, Sinha RS, Jain DC, Chakravorty B (1996) Visual evoked potential (VEP)–dependable marker for CNS affection in thyroid diseases. J Assoc Phys India 44(2):123–126
Nazliel B, Akbay E, Irkec C, Yetkin I, Ersoy R, Toruner F (2002) Pattern visual evoked potential (PVEP) evaluation in hypothyroidism. J Endocrinol Invest 25(11):955–958
Holder GE, Condon JR (1989) Pattern visual evoked potentials and pattern electroretinograms in hypothyroidism. Doc Ophthalmol 73(2):127–131
Osterweil D, Syndulko K, Cohen SN, Pettler-Jennings PD (1992) Cognitive function in non-demented older adults with hypothyroidism. J Am Geriatr Soc 40:325–335
American Clinical Neurophysiology (2006) Guideline 5: guidelines for standard electrode position nomenclature. J Clin Neurophysiol 23:107–110
Mastaglia FL, Black JL, Collins DW, Gutteridge DH, Yuen RW (1978) Slowing of conduction in visual pathway in hypothyroidism. Lancet 1(8060):387–388
Huang TS, Chang YC, Lee SH, Chen FW, Chopra IJ (1989) Visual, brainstem auditory and somatosensory evoked potential abnormalities in thyroid disease. Thyroidology 1(3):137–142
Abbott RJ, O’Malley BP, Barnett DB, Timson L, Rosenthal FD (1983) Central and peripheral nerve conduction in thyroid dysfunction: the influence of L-thyroxine therapy compared with warming upon the conduction abnormalities of primary hypothyroidism. Clin Sci 64(6):617–622
Caturegli P, Kimura H, Rocchi R, Rose NR (2007) Autoimmune thyroid diseases. Curr Opin Rheumatol 19(1):44–48
Fairweather D, Frisancho-Kiss S, Rose NR (2008) Sex differences in autoimmune disease from a pathological perspective. Am J Pathol 173(3):600–609
Flynn RWV, MacDonald TM, Morris AD, Jung RT, Leese GP (2004) The thyroid epidemiology, audit, and research study: thyroid dysfunction in the general population. J Clin Endocrinol Metab 89(8):3879–3884
Odom JV et al (2016) ISCEV standard for clinical visual evoked potentials: (2016 update). Doc Ophthalmol 133(1):1–9. https://doi.org/10.1007/s10633-016-9553-y
Nemni R et al (1987) Polyneuropathy in hypothyroidism: clinical, electrophysiological and morphological findings in four cases. J Neurol Neurosurg Psychiatry 50(11):1454–1460
Acknowledgements
We thank the research vice-chancellor of Mashhad University of Medical Sciences for supporting this study. The results described in this paper were of a MSc Optometry thesis.
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Azimi, A., Bonakdaran, S., Heravian, J. et al. Pattern visual evoked potential in hypothyroid patients. Doc Ophthalmol 138, 77–84 (2019). https://doi.org/10.1007/s10633-019-09670-1
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DOI: https://doi.org/10.1007/s10633-019-09670-1