Vol 71, No 1 (2020)
Review paper
Published online: 2020-02-24

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Can Hashimoto's thyroiditis cause vertigo? [Czy choroba Hashimoto może być przyczyną zawrotów głowy?]

Katarzyna A. Miśkiewicz-Orczyk1, Grażyna Lisowska1, Dariusz Kajdaniuk2, Matuesz Wojtulek1
Pubmed: 32129465
Endokrynol Pol 2020;71(1):76-86.


Vertigo and balance disorders are common symptoms reported by approximately 15–20% of the adult population worldwide. For many years thyroid diseases have been suspected as the cause of vertigo by ENT physicians. Almost every patient hospitalised due to severe vertigo is investigated for thyroid disease as a suspected cause of acute vestibulopathy. The issue presented in this paper is related to a difficult and poorly understood relationship between autoimmune thyroid disease and peripheral vertigo.

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  1. Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016; 137: 67–82.
  2. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017; 156(3_suppl): S1–S47.
  3. von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015; 25(3–4): 105–117.
  4. Oron Y, Cohen-Atsmoni S, Len A, et al. Treatment of horizontal canal BPPV: pathophysiology, available maneuvers, and recommended treatment. Laryngoscope. 2015; 125(8): 1959–1964.
  5. Tirelli G, Nicastro L, Gatto A, et al. Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention. Am J Otolaryngol. 2017; 38(1): 38–43.
  6. Shea JJ. Classification of Menière's disease. Am J Otol. 1993; 14(3): 224–229.
  7. Goebel JA. 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS Guidelines for the Definition of Ménière's Disease. Otolaryngol Head Neck Surg. 2016; 154(3): 403–404.
  8. Lopez-Escamez JA, Carey J, Chung WH, et al. [Diagnostic criteria for Menière's disease according to the Classification Committee of the Bárány Society]. HNO. 2017; 65(11): 887–893.
  9. Espinosa-Sanchez JM, Lopez-Escamez JA. Menière's disease. Handb Clin Neurol. 2016; 137: 257–277.
  10. Tamura T. [Studies on the correlation between thyroid function and M'eni'ere's syndrome]. Nihon Jibiinkoka Gakkai Kaiho. 1964; 67: 1434–1468.
  11. Modugno GC, Pirodda A, Ferri GG, et al. A relationship between autoimmune thyroiditis and benign paroxysmal positional vertigo? Med Hypotheses. 2000; 54(4): 614–615.
  12. Kim SH, Kim JY, Lee HJ, et al. Autoimmunity as a candidate for the etiopathogenesis of Meniere's disease: detection of autoimmune reactions and diagnostic biomarker candidate. PLoS One. 2014; 9(10): e111039.
  13. Greco A, Gallo A, Fusconi M, et al. Meniere's disease might be an autoimmune condition? Autoimmun Rev. 2012; 11(10): 731–738.
  14. Santosh UP, Rao MS. Incidence of Hypothyroidism in Meniere's Disease. J Clin Diagn Res. 2016; 10(5): MC01–MC03.
  15. Lok U, Hatipoglu S, Gulacti U, et al. The role of thyroid and parathyroid metabolism disorders in the etiology of sudden onset dizziness. Med Sci Monit. 2014; 20: 2689–2694.
  16. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014; 13(4-5): 391–397.
  17. Hu S, Rayman MP. Multiple Nutritional Factors and the Risk of Hashimoto's Thyroiditis. Thyroid. 2017; 27(5): 597–610.
  18. Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hell J Nucl Med. 2017; 20(1): 51–56.
  19. McLeod DSA, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012; 42(2): 252–265.
  20. Cho BY, Shong YK, Lee HK, et al. Role of blocking TSH receptor antibodies on the development of hypothyroidism and thyroid atrophy in primary myxedema. Korean J Intern Med. 1989; 4(2): 108–117.
  21. Kim D. Low vitamin D status is associated with hypothyroid Hashimoto's thyroiditis. Hormones (Athens). 2016; 15(3): 385–393.
  22. Ke W, Sun T, Zhang Y, et al. 25-Hydroxyvitamin D serum level in Hashimoto's thyroiditis, but not Graves' disease is relatively deficient. Endocr J. 2017; 64(6): 581–587.
  23. Rayman MP. Multiple nutritional factors and thyroid disease, with particular reference to autoimmune thyroid disease. Proc Nutr Soc. 2019; 78(1): 34–44.
  24. Zhernakova A, Withoff S, Wijmenga C. Clinical implications of shared genetics and pathogenesis in autoimmune diseases. Nat Rev Endocrinol. 2013; 9(11): 646–659.
  25. Li Y, Nishihara E, Kakudo K. Hashimoto's thyroiditis: old concepts and new insights. Curr Opin Rheumatol. 2011; 23(1): 102–107.
  26. Maciaszczyk K, Lewiński A. Phenotypes of SLC26A4 gene mutations: Pendred syndrome and hypoacusis with enlarged vestibular aqueduct. Neuro Endocrinol Lett. 2008; 29(1): 29–36.
  27. Chiarella G, Russo D, Monzani F, et al. Hashimoto thyroiditis and vestibular dysfunction. Endocr Pract. 2017; 23(7): 863–868.
  28. Sari K, Yildirim T, Borekci H, et al. The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity. Acta Otolaryngol. 2015; 135(8): 754–757.
  29. Papi G, Guidetti G, Corsello SM, et al. The association between benign paroxysmal positional vertigo and autoimmune chronic thyroiditis is not related to thyroid status. Thyroid. 2010; 20(2): 237–238.
  30. Modugno GC, Pirodda A, Ferri GG, et al. A relationship between autoimmune thyroiditis and benign paroxysmal positional vertigo? Med Hypotheses. 2000; 54(4): 614–615.
  31. Chiarella G, Tognini S, Nacci A, et al. Vestibular disorders in euthyroid patients with Hashimoto's thyroiditis: role of thyroid autoimmunity. Clin Endocrinol (Oxf). 2014; 81(4): 600–605.
  32. Mazokopakis EE, Kotsiris DA. Hashimoto's autoimmune thyroiditis and vitamin D deficiency. Current aspects. Hell J Nucl Med. 2014; 17(1): 37–40.
  33. Mazokopakis EE, Papadomanolaki MG, Tsekouras KC, et al. Is vitamin D related to pathogenesis and treatment of Hashimoto's thyroiditis? Hell J Nucl Med. 2015; 18(3): 222–227.
  34. Chaudhary S, Dutta D, Kumar M, et al. Vitamin D supplementation reduces thyroid peroxidase antibody levels in patients with autoimmune thyroid disease: An open-labeled randomized controlled trial. Indian J Endocrinol Metab. 2016; 20(3): 391–398.
  35. Talaat HS, Kabel AMH, Khaliel LH, et al. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016; 43(3): 237–241.
  36. Talaat HS, Abuhadied G, Talaat AS, et al. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol. 2015; 272(9): 2249–2253.
  37. AlGarni MA, Mirza AA, Althobaiti AA, et al. Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2018; 275(11): 2705–2711.
  38. Sheikhzadeh M, Lotfi Y, Mousavi A, et al. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study. Caspian J Intern Med. 2016; 7(2): 93–98.
  39. Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Semin Neurol. 2013; 33(3): 185–194.
  40. Kim JS, Kim HJ. Inferior vestibular neuritis. J Neurol. 2012; 259(8): 1553–1560.
  41. Taylor RL, McGarvie LA, Reid N, et al. Vestibular neuritis affects both superior and inferior vestibular nerves. Neurology. 2016; 87(16): 1704–1712.
  42. Büki B, Hanschek M, Jünger H. Vestibular neuritis: Involvement and long-term recovery of individual semicircular canals. Auris Nasus Larynx. 2017; 44(3): 288–293.
  43. Girasoli L, Cazzador D, Padoan R, et al. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res. 2018; 2018: 5072582.
  44. Greco A, Macri GF, Gallo A, et al. Is vestibular neuritis an immune related vestibular neuropathy inducing vertigo? J Immunol Res. 2014; 2014: 459048.
  45. Bumm P, Schlimok G. T-lymphocyte subpopulations and HLA-DR antigens in patients with Bell's palsy, hearing loss, neuronitis vestibularis, and Ménière's disease. Eur Arch Otorhinolaryngol. 1994: S447–S448.
  46. Brenner M, Hoistad DL, Hain TC. Prevalence of thyroid dysfunction in patients with Ménière's disease. Arch Otolaryngol Head Neck Surg. 2004; 130(2): 226–228.
  47. Sun Y, Zhang D, Sun G, et al. RNA-sequencing study of peripheral blood mononuclear cells in sporadic Ménière's disease patients: possible contribution of immunologic dysfunction to the development of this disorder. Clin Exp Immunol. 2018; 192(1): 33–45.
  48. Kim SH, Kim JY, Lee HJ, et al. Autoimmunity as a candidate for the etiopathogenesis of Meniere's disease: detection of autoimmune reactions and diagnostic biomarker candidate. PLoS One. 2014; 9(10): e111039.
  49. Altermatt HJ, Gebbers JO, Müller C, et al. Human endolymphatic sac: evidence for a role in inner ear immune defence. ORL J Otorhinolaryngol Relat Spec. 1990; 52(3): 143–148.
  50. Harris JP, Surgeon S. Choroby ucha wewnętrznego o podłożu immunologicznym. Otorynolaryngologia. 2007; 6(4): 163–178.
  51. Gopen Q, Keithley E, Harris J. Mechanisms underlying autoimmune inner ear disease. Drug Discovery Today: Disease Mechanisms. 2006; 3(1): 137–142.
  52. Bovo R, Aimoni C, Martini A. Immune-mediated inner ear disease. Acta Otolaryngol. 2006; 126(10): 1012–1021.
  53. Ruckenstein MJ. Autoimmune inner ear disease. Curr. Opin. Otolaryngol. Head Neck Surg. 2004; 12: 426–430.
  54. Harris JP. Immunology of the inner ear: response of the inner ear to antigen challenge. Otolaryngol Head Neck Surg. 1983; 91(1): 18–32.
  55. Solares CA, Edling AE, Johnson JM, et al. Murine autoimmune hearing loss mediated by CD4+ T cells specific for inner ear peptides. J Clin Invest. 2004; 113(8): 1210–1217.
  56. Arnold W, Altermatt HJ, Gebbers JO. [Qualitative detection of immunoglobulins in the human endolymphatic sac]. Laryngol Rhinol Otol (Stuttg). 1984; 63(9): 464–467.
  57. Rask-Andersen H, Stahle J. Immunodefence of the inner ear? Lymphocyte-macrophage interaction in the endolymphatic sac. Acta Otolaryngol. 1980; 89(3-4): 283–294.
  58. Nacci A, Dallan I, Monzani F, et al. Elevated antithyroid peroxidase and antinuclear autoantibody titers in Ménière's disease patients: more than a chance association? Audiol Neurootol. 2010; 15(1): 1–6.
  59. Fattori B, Nacci A, Dardano A, et al. Possible association between thyroid autoimmunity and Menière's disease. Clin Exp Immunol. 2008; 152(1): 28–32.
  60. Santosh UP, Rao MS. Incidence of Hypothyroidism in Meniere's Disease. J Clin Diagn Res. 2016; 10(5): MC01–MC03.
  61. Zamysłowska-Szmytke E, Śliwińska-Kowalska M. Opracowanie wartości normatywnych testów kinetycznych w badaniu wideonystagmografii (VNG). Medycyna Pr. 2011; 63(3): 237–246.
  62. Redondo-Martínez J, Bécares-Martínez C, Orts-Alborch M, et al. Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. Acta Otorrinolaringol Esp. 2016; 67(3): 156–161.
  63. Janky KL, Patterson J, Shepard N, et al. Video Head Impulse Test (vHIT): The Role of Corrective Saccades in Identifying Patients With Vestibular Loss. Otol Neurotol. 2018; 39(4): 467–473.
  64. van de Berg R, Rosengren S, Kingma H. Laboratory examinations for the vestibular system. Curr Opin Neurol. 2018; 31(1): 111–116.
  65. Blödow A, Heinze M, Bloching MB, et al. Caloric stimulation and video-head impulse testing in Ménière's disease and vestibular migraine. Acta Otolaryngol. 2014; 134(12): 1239–1244.
  66. Burston A, Mossman S, Mossman B, et al. Comparison of the video head impulse test with the caloric test in patients with sub-acute and chronic vestibular disorders. J Clin Neurosci. 2018; 47: 294–298.
  67. Johnson SA, O'Beirne GA, Lin E, et al. oVEMPs and cVEMPs in patients with 'clinically certain' Menière's disease. Acta Otolaryngol. 2016; 136(10): 1029–1034.
  68. Fife TD, Colebatch JG, Kerber KA, et al. Practice guideline: Cervical and ocular vestibular evoked myogenic potential testing: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2017; 89(22): 2288–2296.
  69. Hamid MA. Determining side of vestibular dysfunction with rotatory chair testing. Otolaryngol Head Neck Surg. 1991; 105(1): 40–43.
  70. Perez N, Martin E, Romero MD, et al. Influence of canal paresis and compensation on gain and time constant of nystagmus slow-phase velocity to yaw-axis rotation. Acta Otolaryngol. 2001; 121(6): 715–723.
  71. Arriaga MA, Chen DA, Cenci KA. Rotational chair (ROTO) instead of electronystagmography (ENG) as the primary vestibular test. Otolaryngol Head Neck Surg. 2005; 133(3): 329–333.
  72. Strupp M, Kim JS, Murofushi T, et al. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res. 2017; 27(4): 177–189.
  73. Honaker JA, Janky KL, Patterson JN, et al. Modified head shake sensory organization test: Sensitivity and specificity. Gait Posture. 2016; 49: 67–72.
  74. Hebert JR, Manago MM. Reliability and Validity of the Computerized Dynamic Posturography Sensory Organization Test in People with Multiple Sclerosis. Int J MS Care. 2017; 19(3): 151–157.
  75. Daneshi A, Bozorgzadeh N, Asghari A, et al. Dynamic posturography for staging of patients with Ménière's disease. J Laryngol Otol. 2009; 123(8): 863–867.
  76. Morisod B, Mermod M, Maire R. Posturographic pattern of patients with chronic subjective dizziness before and after vestibular rehabilitation. J Vestib Res. 2018; 27(5-6): 305–311.
  77. Di Fabio RP. Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction. Phys Ther. 1995; 75(4): 290–305.