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The odds ratios (95% confidence interval) of levothyroxine medication, goiter, hypothyroidism, thyroiditis, hyperthyroidism, and autoimmune thyroiditis for benign paroxysmal positional vertigo according to age and sex.
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Background:
This study investigated relationship between multiple thyroid disorders and benign paroxysmal positional vertigo (BPPV), adjusting for levothyroxine medication.
Methods:
The Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 were used. A total of 19,071 patients with BPPV were matched with 76,284...
Context in source publication
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Citations
... They suggested a possible overlap between autoimmune diseases and BPPV, either through a cross-reaction mechanism (the inner ear may share common antigens with certain organisms such as viruses or bacteria) or, like Papi, mechanical stimulation by immune complexes in the context of a multi-visceral autoimmune disease. In the same year, Choi, Kim et al. [13] carried out the first large study with a control group on the rate of various thyroid diseases in BPPV patients. The result was that hypothyroidism was linked to BPPV in all women and men over the age of 65. ...
The association between vestibular pathologies and thyroid hormone disorders has been known for several decades. However, very little information is available on the types of vestibular symptoms that may be affected by altered thyroid hormone levels. The aim of this study was to provide patient data in order to identify statistical associations between vestibular pathologies and thyroid hormone disorders. A retrospective review of the records of 422 patients seen for physiotherapy treatment of vertigo was carried out. Statistical analysis of the data was performed using logistic regression, providing Chi2 and Odds Ratio statistics. Our results show that hypothyroidism statistically significantly increases the expression of certain symptoms, such as vestibular instability and gait disorders, in vestibular pathologies such as Menière’s disease or central vertigo. By analyzing patient data, our study provides new evidence of dependence between altered thyroid status and the expression of vestibular pathologies.
... Our results indicate a possible association between Hashimoto thyroiditis and BPPV. This relationship was demonstrated through the significance of the OR obtained in the meta-analysis, which, in turn, is in line with the conclusions of Modugno et al., 12 Papi et al., 10 Papi et al 11 ., and Choi et al. 22 According to these authors, a high serum level of antithyroid antibodies, TPOAb and TGAb, increases the risk of developing BPPV, thus supporting the theory that thyroid autoimmunity may favor the development of vestibular diseases, regardless of thyroid function. Chiarella et al. 23 emphasize that changes in TPOAb levels represent a greater risk of developing vestibular dysfunction than in TGAb, besides confirming the importance of antithyroid antibodies. ...
... It was the only study in the present systematic review with conflicting data with the others. [10][11][12]22 Four studies analyzed the association between hypothyroidism and BPPV. Two of them, Turgay Yildirim et al. 24 and Hsu et al., 25 found no causal relationship. ...
... Two of them, Turgay Yildirim et al. 24 and Hsu et al., 25 found no causal relationship. Nonetheless, the results obtained by Papi et al. 10 and Choi et al. 22 suggested a positive relationship between hypothyroidism and BPPV. One of the strands that explain this relationship stems from studies that suggest an association between low levels of thyroid hormones and changes in the cardiovascular system, sufficient to cause a decrease in body blood flow and, consequently, promote a decrease in microcirculation in the inner ear, thus explaining a higher rate of BPPV in people with thyroid disease. ...
Introduction Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular dysfunction that most affects people worldwide, but its etiopathogenesis is still not fully understood. Considering the etiological diversity, some studies highlight the association between BPPV and thyroid diseases.
Objective To investigate the association between thyroid diseases and BPPV.
Data Synthesis Systematic review and meta-analysis of epidemiological studies searched in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases. Studies that were fully available and investigated the association between BPPV and thyroid diseases were selected. The articles that composed the meta-analysis were analyzed using the dichotomous model, the Mantel-Haenszel statistical test, odds ratio (OR), and a 95% confidence interval (CI). Of the 67 articles retrieved from the databases, 7 met the eligibility criteria of the systematic review, and 4 had data necessary to perform the meta-analysis. Qualitative analysis revealed that the studies were conducted in the European and Asian continents. The predominant methodological design was the case-control type, and thyroid dysfunctions, hypothyroidism, and Hashimoto thyroiditis occurred more frequently. The meta-analysis showed no association between hypothyroidism and BPPV; however, there was a statistically significant relationship between Hashimoto thyroiditis and BPPV.
Conclusion The meta-analysis results suggest a possible association between BPPV and Hashimoto thyroiditis. Nevertheless, we emphasize the need for further studies to elucidate the evidence obtained.
... However, a recent metaanalysis found no significant association between migraine and the recurrence of BPPV, probably due to significant heterogeneity and the small number of included studies 25,34 . Recently, the association between hypothyroidism and BPPV has been investigated 43,44 . Another study demonstrated that patients with hypothyroidism treated with hormone replacement therapy have an increased risk of BPPV recurrence, which is particularly strong for patients with Hashimoto's thyroiditis and positive thyroid antibodies, suggesting an association between autoimmunity and recurrent BPPV, and thus the importance of investigating thyroid dysfunction 45 . ...
Benign baroxysmal positional vertigo (BPPV) represents the most common peripheral vestibular dysfunction encountered in clinical practice. Although canalith repositioning procedures (CRPs) are a relatively successful treatment for BPPV, many patients suffer from recurrences. Several studies have demonstrated that various pathological conditions (diabetes, hypertension, endolymphatic hydrops, low vitamin D levels) as well as delayed BPPV treatment using CRP, multiple canal involvement may be associated with recurrence of BPPV. We evaluated the history of 1,428 patients (558 males and 870 females, age range 10-92 years) suffering from BPPV. Of 1,428 cases, 820 (77%) did not relapse in the following 20 years. Mean age and gender did not differ significantly between groups with and without recurrence. Regarding risk factors for BPPV recurrence, age, female gender, migraine, hypertension, diabetes mellitus, hyperlipidaemia, osteoporosis, vascular diseases, and vitamin D deficiency may be associated with recurrent BPPV and should be kept in mind. Osteoporosis, vitamin D deficiency as well as thyroid dysfunction should be evaluated in postmenopausal women. Treatment of these comorbidities may help to reduce the risk of BPPV recurrence.
... This is the case, for example, with the strong preponderance of benign paroxysmal positional vertigo (BPPV) in postmenopausal women [34][35][36][37][38][39][40][41][42][43][44]. This is also the case for thyroid pathologies [45][46][47][48], diabetes [49][50][51][52][53], and vestibular migraines [54,55]. We also know that vestibular stimulation activates the sympathetic system [56] and the hypothalamicpituitary axis with modulation of the secretions of CRH, ACTH, LHRH, and LH [57]. ...
... Fourteen papers were devoted to patients with BPPV, among which 11 investigated the impact of menopause and sexual hormonal changes in these patients [34][35][36][37][38][39][40][41][42][43][44]. Two papers addressed the combination of thyroid disease and BPPV [47,48], and one article investigated BPPV promoted by hyperglycemia [51]. Additionally, 24 of the 64 articles explored hormonal changes in patients with Ménière disease. ...
... Hyperglycemia is also a risk factor for recurrence of BPPV [51]. BPPV is also associated with thyroid disorders such as goiter, hypothyroidism, thyroiditis, and hyperthyroidism [47]. Ménière's disease is a common inner ear disease, found in patients who are generally anxious. ...
The interaction between endocrine and vestibular systems remains poorly documented so far, despite numerous observations in humans and animals revealing direct links between the two systems. For example, dizziness or vestibular instabilities often accompany the menstrual cycle and are highly associated with the pre-menopause period, while sex hormones, together with their specific receptors, are expressed at key places of the vestibular sensory network. Similarly, other hormones may be associated with vestibular disorders either as causal/inductive factors or as correlates of the pathology. This review was carried out according to the PRISMA method, covering the last two decades and using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system and/or vestibular pathologies and hormones. Our literature search identified 646 articles, 67 of which referred directly to vestibular dysfunction associated with hormonal variations. While we noted specific hormonal profiles depending on the pathology considered, very few clinical studies attempted to establish a direct link between the expression of the vestibular syndrome and the level of circulating hormones. This review also proposes different approaches to shed new light on the link between hormones and vestibular disorders, and to improve both the diagnosis and the therapeutic management of dizzy patients.
... Less frequent conditions of the inner ear responsible for peripheral vertigo include Meniere's disease or vestibular neuronitis [8][9][10][11][12][13][14]. Considering the fact that one of the causes of the above diseases of the inner ear is related to autoimmune processes in the labyrinth, the authors searched for the relationship between peripheral vertigo and Hashimoto's thyroiditis, which is one of the most prevalent autoimmune diseases worldwide [15][16][17][18][19][20][21]. Mechanisms that underlie autoimmune thyroiditis and involve attacking the thyroid gland by autoreactive lymphocytes and autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG) lead to impaired production of thyroid hormones and hypothyroidism [22]. ...
... Although thyroid diseases are a common cause of vertigo, there are not many scientific reports that objectively confirm such an association [15][16][17][18][19][20]. The groups of patients are usually heterogeneous and the studies include patients with a mixed etiology of vertigo (i.e., peripheral and central vertigo). ...
... Their study did not confirm that treatment with levothyroxine had a positive effect on the prevalence of BPPV. Their results may have been influenced by the relatively small number of patients with autoimmune thyroiditis because they found a statistically significant correlation between hypothyroidism or goiter and the prevalence of BPPV in larger cohorts of patients [19]. ...
The aim of this study was to assess the relationship between the results of the objective assessment of the vestibular organ in patients with peripheral vertigo with Hashimoto’s thyroiditis and thyroid hormone metabolism. Twenty eight women with Hashimoto’s thyroiditis and chronic vertigo were enrolled in the study. Patients underwent audiological assessment of hearing, Dix–Hallpike test, videonystagmography with caloric test, head impulse test (HIT) and cervical vestibular-evoked myogenic potentials (cVEMPs). Levels of thyroid hormones and anti-thyroid antibodies were determined. Relationships between age, weight, height, BMI and the results of the objective assessment of the vestibular organ were calculated. The mean age in the study group was 48 years, while the mean BMI was 26.425. The causes of peripheral vertigo in the study group were benign paroxysmal positional vertigo (BPPV) (n = 19), Meniere’s disease (n = 7) and vestibular neuronitis (n = 2). No correlation was found between age, weight, height, BMI and the results of thyroid function tests or the objective assessment of the vestibular organ. The study did not confirm the influence of thyroid metabolism (i.e., thyroid hormone levels or the increase in antithyroid antibodies) on the results of cVEMP or the directional preponderance in the caloric test.
... Several epidemiological studies reveal that certain physiological states displaying particular hormonal profiles are especially exposed to vestibular disorders. This is the case in diabetes [47][48][49][50][51][52][53] and in thyroid pathologies [54][55][56]. Benign paroxysmal positional vertigo (BPPV) is predominant in postmenopausal women [57][58][59][60][61][62][63][64][65][66][67], while vestibular migraines may be linked to hormonal alterations [68,69]. If we can multiply the examples of comorbidity between specific hormonal profiles and vestibular disorders, the precise role of circulating hormones as triggers, accompanying factors, or reactive mechanisms to vestibular disorders remains to be determined. ...
The vestibular system exerts control over various functions through neural pathways that are not yet fully mapped. Functional dysregulations or tissue lesions at different levels of the peripheral and the central vestibular networks can alter these different functions, causing a wide variety of symptoms, ranging from posturo-locomotor alterations to psychiatric syndromes such as PPPD, including the deregulation of the main biological functions. These different symptoms differ by their expression kinetics (they each appear and regress with their own kinetics) by the targets affected (muscles, organs, and brain areas) and by the sensitivity specific to each individual. Vestibular pathologies thus cover a mosaic of distinct effects, and they involve various effectors—which constitute the many markers of their different types and stages. It is therefore crucial, to predict the onset of a vertigo syndrome, to follow its temporal course, or to monitor the impact of therapeutic approaches, and to have specific and reliable biomarkers. Hormonal variations are among the possible sources of biomarkers for neurotology. We know that specific hormonal profiles can promote the appearance of vestibular disorders. We also know that the expression of vertigo syndrome is accompanied by measurable hormonal variations. The link between endocrine deregulation and vestibular alterations therefore no longer needs to be proven. However, there are still few data on their precise correlations with the vertigo syndrome. This study was undertaken with the aim to deliver an extensive review of the hormonal alterations linked to vestibular disorders. A review of the literature covering the last two decades was carried out using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system or vestibular pathologies and hormones. Bibliographic data provides several outcomes in terms of therapeutic innovation in the diagnosis and therapeutic follow-up of vestibular pathologies.
... The most typical clinical manifestations of hypothyroidism include fatigue, lethargy, bradycardia, weight gain and cold intolerance, but it has also been recently associated with ENT disorders, such as hearing loss 4 , tinnitus 5 and vestibular disorders 6 . Among the different vestibular pathologies, the association between hypothyroidism and benign paroxysmal positional vertigo (BPPV) has recently been investigated 7 . BPPV is the most common peripheral vestibular disease accounting for approximately 17-42% of diagnoses of dizziness in specialised clinics. ...
Objective:
To investigate the relationship between risk of Benign Paroxysmal Positional Vertigo (BPPV) recurrence and hypothyroidism treated with hormone replacement therapy (HRT).
Methods:
797 patients with idiopathic BPPV were divided into two groups: 250 patients with recurrence of BPPV (R-BPPV) and 547 patients without recurrence (NR-BPPV). Regarding patients with thyroid disease on HRT, we collected serum test results of thyroidstimulating hormone (TSH), free triiodothyronine f-T3, free thyroxine f-T4, thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab).
Results:
Hypothyroidism in long-term HRT was found in 61/250 (24.4%) patients of the RBPPV group vs 79/547 (14.4%) of the NR-BPPV-group (p = 0.0006). Hashimoto thyroiditis (HT) was associated with recurrence (p < 0.0001). A significant correlation was found between recurrence and level of serum TPO-Ab (p = 0.0117) and TG-Ab (p = 0.0025), but not with mean serum TSH, f-T3 and f-T4.
Conclusions:
We assume that patients with hypothyroidism in HRT have an increased risk of BPPV recurrence, which is particularly strong for patients with HT and positive thyroid antibodies, suggesting an association between autoimmunity and recurrent vertigo.
... In both cases a primary vascular disorder of the macula could be the triggering factor leading to the detachment of otoconia 26,27 . Moreover, our data support the possibility that recurrence may be linked to autoantibodies per se rather than increased plasma levels of hormones; our data are not different with those of previous works reporting that in the recurrence the hormonal situation is less important than the hormonal status 27,29 , while, on the opposite, a recent work based on data obtained by the Korean public register demonstrated an association between hormonal status and BPPV 30 . Some limitations of our work should be underlined. ...
Objectives:
Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear with a high rate of recurrence. Vascular disorders, migraine and autoimmune disorders have been considered facilitating factors for relapsing episodes. Our aim was to assess the role of vascular disorders, migraine and anti-thyroid antibodies in patients with recurrences.
Methods:
We retrospectively analysed records of 3042 patients treated for BPPV without other lifetime vertigo. Clinical data included previous vascular disorders of the central nervous system, heart disorders, migraine and recent head trauma. The presence of anti-thyroid autoantibodies was assessed in all patients.
Results:
Mean age of the first BPPV was 52.8 ± 14.5 years; there were 2339 females (76.9%), while 2048 (67.3%) of patients presented recurrences within two years of follow-up. Previous disorders of the central nervous system, presence of anti-thyroid antibodies, head trauma and migraine showed an association with recurrences. Above all, in subjects having the first BPPV while aged between 40 and 60 years, anti-thyroid antibodies were predictive for recurrences.
Conclusions:
Our data are consistent with the hypothesis that anti-thyroid autoantibodies may play a role in recurrences in subjects with initial manifestations between 40 and 60 years.
