Research Article
BibTex RIS Cite

Balance disorders and hypothyroidism: A rare cause worth remembering

Year 2019, Volume: 9 Issue: 3, 172 - 179, 20.12.2019

Ayhan Kul Arzu Bilen Nuray Bilge Köksal Sarıhan Hülya Uzkeser Ramazan Dayanan Fatih Baygutalp

https://doi.org/10.32448/entupdates.633311

Abstract

Objectives: This study aimed to evaluate balance disorders and
potential risk factors for falling in patients with hypothyroidism, as well as
postural stability and the risk of falling.

Methods: The participants' sex, age, body mass index (BMI),
falls history in the past one year, and Falls Efficacy Scale - International
(FES-I), Neuropathic Pain Diagnostic questionnaire (DN4) and clinical symptoms
were recorded. The stability index (SI), weight distribution index (WDI) and
falls risk analysis were performed for postural stability by objective
computerised dynamic posturography.

Results: 50 patients were matched for age and sex (mean
age:41.7±11 years; age range:19-61 years) with 47 healthy (euthyroid) controls
(mean age:39±9.6 years; age range:23-60 years). All SI, HL-WDI and falls risk
scores, except FES-I, DN4 and NO-SI, were significantly higher in the patient
group. In addition, other symptoms were present at a higher rate, with the exception
of morning stiffness (p<0.05). There was no significant association between
sex, age, BMI, FES-I, DN4, serum FT4 and TSH levels, clinical symptoms and WDI
values and the risk of falls (r<0.3 and p>0.05). However, there was a
slight positive correlation between the existence of paraesthetic symptoms, a
history of falling, and the overall SI and HL-WDI values (r>0.3 and
p<0.05).







Conclusions: It was determined that, as postural stability is
affected in cases of hypothyroidism, balance becomes disordered and the risk of
falls increases.  This increase in the
risk of falls was associated with being hypothyroid, but not with FT4 or TSH
levels or the other factors evaluated.

Keywords

Hypothyroidism postural balance falling

References

  • 1. Penza P1, Lombardi R, Camozzi F, Ciano C, Lauria G. Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy. Neurol Sci 2009;30:149-51.
  • 2. Kotwal SK, Kotwal S, Gupta R, Singh JB, Mahajan A. Cerebellar ataxia as presenting feature of hypothyroidism. Arch Endocrinol Metab 2016;60:183-5.
  • 3. Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci 2009;64:896-901.
  • 4. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodignostic study. J Neurol Neurosurg Psychiatry 2000;68:750-5.
  • 5. Rybak LP. Metabolic Disorders of the Vestibular System, Otolaryngol Head Neck Surg 1995;112:128-32.
  • 6. Simmons RW, Richardson C, Pozos R. Postural stability of diabetic patients with and without cutaneous sensory deficit in the foot. Diabetes Res Clin Pract 1997;36:153-60.
  • 7. Van Deursen RWM, Simoneau GG. Foot and ankle sensory neuropathy, proprioception, and postural stability. J Orthop Sports Phys Ther 1999;29:718-26.
  • 8. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr 2012;54:429-33.
  • 9. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain 2010;11:1129-35.
  • 10. Alkan Melikoğlu M, Bağcier F. Fall Risk and Related Factors in Systemic Lupus Erythematosus. Arch Rheumatol 2017;32:216-20.
  • 11. Ozdemir O, Gokce Kutsal Y. Fall risk assessment of elderly by using posturography. Turk J Geriatr 2009;12:177-80.
  • 12. Jones G. Posture. In: Kandel E, Schwartz J, Jessel T editors. Principles of Neural Science. New York, NY: McGraw-Hill; 2000. p. 816-31.
  • 13. Mustapa A, Justine M, Mohd Mustafah N, Jamil N, Manaf H. Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review. Biomed Res Int 2016;2016:9305025.
  • 14. Lord SR. Falls. In: Halter JB, Ouslander JG, Studenski S, et al editors. Hazzard’s Geriatric Medicine and Gerontology. 7th ed. New York, NY: McGraw Hill Education; 2017. p. 1318-33.
  • 15. Ferreira AA1, Nazário JC, Pereira MJ, Azevedo NL, Barradas PC. Effects of experimental hypothyroidism on myelin function sheath structural organization. J Neurocytol 2004;33:225-31.
  • 16. Khedr EM, El Toony LF, Tarkhan MN, Abdella G. Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology 2000;41:88-94.
  • 17. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-5. 18. John SA, Solomon J, Mohan D. A Critical Review on the Normal Postural Control. POTJ 2015;8:71-5.
  • 19. Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND. Diabetic Peripheral Neuropathy Compromises Balance During Daily Activities. Diabetes Care 2015;38:1116-22.
  • 20. Akarsu EA. Acar H, Ozer F, et al. Electromyographic Findings in Overt Hypothyroidism and Subclinical Hypothyroidism. Turk J Neurol 2013;19:128-33.
  • 21. Treede RD, Apkarian AV, Bromm B, Greenspan JD, Lenz FA. Cortical representation of pain: functional characterization of nociceptive areas near the lateral sulcus. Pain 2000;87:113-9.
  • 22. Leveille SG, Jones RN, Kiely DK, et al. Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population. JAMA 2009;302:2214-21.
  • 23. Morrison S, Colberg SR, Parson HK, et al. Walking-Induced Fatigue leads to Increased Falls Risk in Older Adults. J Am Med Dir Assoc 2016;17:402-9.
  • 24. Helbostad JL, Sturnieks DL, Menant J, Delbaere K, Lord SR, Pijnappels M. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: A systematic literature review. BMC Geriatrics 2010;10:56.
  • 25. Masud T, Morris RO. Epidemiology of falls. Age Ageing 2001;30:3-7.
  • 26. Morimoto A, Sonoda N, Ugi S, et al. Association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes. Diabetol Int 2016;7:69-76.

Year 2019, Volume: 9 Issue: 3, 172 - 179, 20.12.2019

Ayhan Kul Arzu Bilen Nuray Bilge Köksal Sarıhan Hülya Uzkeser Ramazan Dayanan Fatih Baygutalp

https://doi.org/10.32448/entupdates.633311

Abstract

References

  • 1. Penza P1, Lombardi R, Camozzi F, Ciano C, Lauria G. Painful neuropathy in subclinical hypothyroidism: clinical and neuropathological recovery after hormone replacement therapy. Neurol Sci 2009;30:149-51.
  • 2. Kotwal SK, Kotwal S, Gupta R, Singh JB, Mahajan A. Cerebellar ataxia as presenting feature of hypothyroidism. Arch Endocrinol Metab 2016;60:183-5.
  • 3. Verghese J, Holtzer R, Lipton RB, Wang C. Quantitative gait markers and incident fall risk in older adults. J Gerontol A Biol Sci Med Sci 2009;64:896-901.
  • 4. Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodignostic study. J Neurol Neurosurg Psychiatry 2000;68:750-5.
  • 5. Rybak LP. Metabolic Disorders of the Vestibular System, Otolaryngol Head Neck Surg 1995;112:128-32.
  • 6. Simmons RW, Richardson C, Pozos R. Postural stability of diabetic patients with and without cutaneous sensory deficit in the foot. Diabetes Res Clin Pract 1997;36:153-60.
  • 7. Van Deursen RWM, Simoneau GG. Foot and ankle sensory neuropathy, proprioception, and postural stability. J Orthop Sports Phys Ther 1999;29:718-26.
  • 8. Ulus Y, Durmus D, Akyol Y, Terzi Y, Bilgici A, Kuru O. Reliability and validity of the Turkish version of the Falls Efficacy Scale International (FES-I) in community-dwelling older persons. Arch Gerontol Geriatr 2012;54:429-33.
  • 9. Unal-Cevik I, Sarioglu-Ay S, Evcik D. A comparison of the DN4 and LANSS questionnaires in the assessment of neuropathic pain: validity and reliability of the Turkish version of DN4. J Pain 2010;11:1129-35.
  • 10. Alkan Melikoğlu M, Bağcier F. Fall Risk and Related Factors in Systemic Lupus Erythematosus. Arch Rheumatol 2017;32:216-20.
  • 11. Ozdemir O, Gokce Kutsal Y. Fall risk assessment of elderly by using posturography. Turk J Geriatr 2009;12:177-80.
  • 12. Jones G. Posture. In: Kandel E, Schwartz J, Jessel T editors. Principles of Neural Science. New York, NY: McGraw-Hill; 2000. p. 816-31.
  • 13. Mustapa A, Justine M, Mohd Mustafah N, Jamil N, Manaf H. Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review. Biomed Res Int 2016;2016:9305025.
  • 14. Lord SR. Falls. In: Halter JB, Ouslander JG, Studenski S, et al editors. Hazzard’s Geriatric Medicine and Gerontology. 7th ed. New York, NY: McGraw Hill Education; 2017. p. 1318-33.
  • 15. Ferreira AA1, Nazário JC, Pereira MJ, Azevedo NL, Barradas PC. Effects of experimental hypothyroidism on myelin function sheath structural organization. J Neurocytol 2004;33:225-31.
  • 16. Khedr EM, El Toony LF, Tarkhan MN, Abdella G. Peripheral and central nervous system alterations in hypothyroidism: electrophysiological findings. Neuropsychobiology 2000;41:88-94.
  • 17. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-5. 18. John SA, Solomon J, Mohan D. A Critical Review on the Normal Postural Control. POTJ 2015;8:71-5.
  • 19. Brown SJ, Handsaker JC, Bowling FL, Boulton AJ, Reeves ND. Diabetic Peripheral Neuropathy Compromises Balance During Daily Activities. Diabetes Care 2015;38:1116-22.
  • 20. Akarsu EA. Acar H, Ozer F, et al. Electromyographic Findings in Overt Hypothyroidism and Subclinical Hypothyroidism. Turk J Neurol 2013;19:128-33.
  • 21. Treede RD, Apkarian AV, Bromm B, Greenspan JD, Lenz FA. Cortical representation of pain: functional characterization of nociceptive areas near the lateral sulcus. Pain 2000;87:113-9.
  • 22. Leveille SG, Jones RN, Kiely DK, et al. Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population. JAMA 2009;302:2214-21.
  • 23. Morrison S, Colberg SR, Parson HK, et al. Walking-Induced Fatigue leads to Increased Falls Risk in Older Adults. J Am Med Dir Assoc 2016;17:402-9.
  • 24. Helbostad JL, Sturnieks DL, Menant J, Delbaere K, Lord SR, Pijnappels M. Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: A systematic literature review. BMC Geriatrics 2010;10:56.
  • 25. Masud T, Morris RO. Epidemiology of falls. Age Ageing 2001;30:3-7.
  • 26. Morimoto A, Sonoda N, Ugi S, et al. Association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes. Diabetol Int 2016;7:69-76.
There are 25 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Ayhan Kul This is me 0000-0003-1313-9469

Arzu Bilen This is me 0000-0001-9017-8344

Nuray Bilge 0000-0002-9328-1678

Köksal Sarıhan This is me 0000-0002-5010-4591

Hülya Uzkeser This is me 0000-0002-1364-2657

Ramazan Dayanan This is me 0000-0003-0475-6203

Fatih Baygutalp This is me 0000-0002-7344-584X

Publication Date December 20, 2019
Submission Date June 14, 2019
Acceptance Date October 27, 2019
Published in Issue Year 2019 Volume: 9 Issue: 3

Cite

APA Kul, A., Bilen, A., Bilge, N., Sarıhan, K., et al. (2019). Balance disorders and hypothyroidism: A rare cause worth remembering. ENT Updates, 9(3), 172-179. https://doi.org/10.32448/entupdates.633311
AMA Kul A, Bilen A, Bilge N, Sarıhan K, Uzkeser H, Dayanan R, Baygutalp F. Balance disorders and hypothyroidism: A rare cause worth remembering. ENT Updates. December 2019;9(3):172-179. doi:10.32448/entupdates.633311
Chicago Kul, Ayhan, Arzu Bilen, Nuray Bilge, Köksal Sarıhan, Hülya Uzkeser, Ramazan Dayanan, and Fatih Baygutalp. “Balance Disorders and Hypothyroidism: A Rare Cause Worth Remembering”. ENT Updates 9, no. 3 (December 2019): 172-79. https://doi.org/10.32448/entupdates.633311.
EndNote Kul A, Bilen A, Bilge N, Sarıhan K, Uzkeser H, Dayanan R, Baygutalp F (December 1, 2019) Balance disorders and hypothyroidism: A rare cause worth remembering. ENT Updates 9 3 172–179.
IEEE A. Kul, “Balance disorders and hypothyroidism: A rare cause worth remembering”, ENT Updates, vol. 9, no. 3, pp. 172–179, 2019, doi: 10.32448/entupdates.633311.
ISNAD Kul, Ayhan et al. “Balance Disorders and Hypothyroidism: A Rare Cause Worth Remembering”. ENT Updates 9/3 (December 2019), 172-179. https://doi.org/10.32448/entupdates.633311.
JAMA Kul A, Bilen A, Bilge N, Sarıhan K, Uzkeser H, Dayanan R, Baygutalp F. Balance disorders and hypothyroidism: A rare cause worth remembering. ENT Updates. 2019;9:172–179.
MLA Kul, Ayhan et al. “Balance Disorders and Hypothyroidism: A Rare Cause Worth Remembering”. ENT Updates, vol. 9, no. 3, 2019, pp. 172-9, doi:10.32448/entupdates.633311.
Vancouver Kul A, Bilen A, Bilge N, Sarıhan K, Uzkeser H, Dayanan R, Baygutalp F. Balance disorders and hypothyroidism: A rare cause worth remembering. ENT Updates. 2019;9(3):172-9.
 Download Cover Image