A Longitudinal Study of Medial Temporal Lobe Volumes in Graves Disease

Abstract

Background Neuropsychiatric symptoms are common features of Graves' disease (GD), in hyperthyroidism and after treatment. The mechanism behind these symptoms is unknown, but reduced hippocampal volumes have been observed in association with increased thyroid hormone levels. Methods Sixty-two women with newly diagnosed GD underwent assessment including magnetic resonance (MR) imaging in hyperthyroidism and 48 of them were followed up after a mean of 16.4 ± 4.2 SD months of treatment. Matched thyroid-healthy controls were also assessed twice at a 15-month interval. MR images were automatically segmented using multi-atlas propagation with enhanced registration. Regional medial temporal lobe (MTL) volumes for amygdalae and hippocampi were compared with clinical data and data from symptom questionnaires and neuropsychological tests. Results Patients had smaller MTL regions than controls at inclusion. At follow-up, all four MTL regions had increased volumes and only the volume of the left amygdala remained reduced compared to controls. There were significant correlations between the level of TSH receptor antibodies (TRAb) and MTL volumes at inclusion and also between the longitudinal difference in the levels of fT3 and TRAb and the difference in MTL volumes. There were no significant correlations between symptom or test scores and any of the four MTL volumes. Conclusion Dynamic alterations in the amygdalae and hippocampi in GD reflect a previously unknown level of brain involvement both in the hyperthyroid state of the condition and after treatment. The clinical significance, as well as the mechanisms behind these novel findings, warrant further study of neurological consequences of GD.

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