The change of cerebral blood flow in depression of hypothyroidism in induced by post-thyroidectomy

本研究利用99mTc-HMPAO SPECT和统计参数映射（SPM96）研究甲状腺切除术后短暂性甲状腺功能减退患者区域脑血流量（rCBF）分布的变化。甲状腺素治疗对rCBF变化的影响也进行了研究。测量在131I治疗前和甲状腺激素（甲状腺素）治疗后进行。我们使用调整后的rCBF图像进行相对血流再分配，并使用SPM96将这些数据与正常对照组进行比较。我们还分析了rCBF与患者抑郁严重程度之间的关系。通过甲减状态和甲亢状态的组比较试验，探讨甲状腺激素替代的效果。在统计分析方面，采用组间比较检验和千斤刀检验。组间比较研究显示，在甲状腺功能减退状态下，双侧顶叶（包括楔前叶）和部分双侧枕叶（包括楔叶）调整后的rCBF明显减少。随着抑郁程度的加重，明显低灌注区向双侧前额叶皮层延伸。在刀切试验中，66.7%的患者rCBF减少。给予甲状腺素后进行的刀切试验显示56.3%的患者有改善。基线研究中有43.7% rCBF异常的患者在随访研究中没有出现任何变化。在组间比较研究中，所有rCBF减少的区域在甲状腺素替代治疗后没有显示出显著的变化。目前的研究表明，在甲状腺切除术后和131I治疗前，短暂性甲状腺功能减退的rCBF显著降低。rcbf减少区域的异常，包括顶叶、部分枕叶，并进展到前额皮质，可能对理解短暂性甲状腺功能减退患者的认知功能障碍和抑郁很重要。基于甲状腺素治疗后rCBF变化不显著，短期随访认为在诱导甲状腺功能减退状态下rCBF的减少是长期性的或不可逆的。少

The study investigated alterations in regional cerebral blood flow (rCBF) distribution in patients with transient hypothyroidism, post-thyroidectomy, using 99mTc-HMPAO SPECT and statistical parametric mapping (SPM96). The effect of thyroxine treatment on rCBF change was also studied. The measurements were done both before 131I therapy and after thyroid hormone (thyroxin) therapy. We used the adjusted rCBF images in relative flow redistribution to compare these data with normal control groups using SPM96. We also analyzed the association between rCBF and the severity of the patients' depression. The effect of thyroid hormone replacement was investigated by a group comparison test between the hypothyroidic state and the euthyroidic state. For statistical analysis, both a group comparison test and the Jack-Knife test were done. The group comparison study showed that in the hypothyroidic state, there was a significant decrease in adjusted rCBF in the bilateral parietal lobe, including the … More precuneus and in part of the bilateral occipital lobe, including the cuneus. The areas of significantly low perfusion extended to the bilateral prefrontal cortex in accordance with the progression of the severity of depression. On the Jack-Knife test, 66.7% showed rCBF reduction. The Jack-Knife test given after thyroxine administration showed improvement in 56.3% patients. 43.7% with abnormal rCBF at the baseline study did not show any change at the follow-up study. In group comparison studies, all those areas with decreased rCBF did not show significant changes after thyroxin replacement treatment. The current study demonstrated a significant rCBF decrease in transient hypothyroidic condition after thyroidectomy and before 131I therapy. Abnormalities in this rCBF-reduced area, including the parietal lobe, part of the occipital lobe, and progressing to the prefrontal cortex, may be important in understanding cognitive dysfunction and depression in patients with transient hypothyroidism. Based on the insignificant change in rCBF after thyroxin therapy, the reduction of rCBF under the induced hypothyroidic condition was thought to be prolonged or irreversible during short-term follow up. Less