OBJECTIVES: Hearing impairment can have major impacts on behavior, educational attainment, social status, and quality of life. In congenital hypothyroidism, the incidence of hearing impairment reaches 35-50%, while in acquired hypothyroidism there is a reported incidence of 25%. Despite this, knowledge of the pathogenesis, incidence and severity of hearing impairment remains greatly lacking. The aim of our study was to evaluate hearing in patients with acquired hypothyroidism. METHODS: 30 patients with untreated and newly diagnosed peripheral hypothyroidism (H) and a control group of 30 healthy probands (C) were enrolled in the study. Biochemical markers were measured, including median iodine urine concentrations (IUC) µg/L. The hearing examination included a subjective complaint assessment, otomicroscopy, tympanometry, transitory otoacoustic emission (TOAE), tone audiometry, and brainstem auditory evoked potential (BERA) examinations. The Mann-Whitney U test, Fisher's Exact test and multivariate regression were used for statistical analysis. RESULTS: The H and C groups had significantly different thyroid hormone levels (medians with 95% CI) TSH mU/L 13.3 (8.1, 19.3) vs. 1.97 (1.21, 2.25) p = 0 and fT4 pmol/L 10.4 (9.51, 11.1) vs. 15 (13.8, 16.7) p = 0. The groups did not significantly differ in age 39 (34, 43) vs. 41 (36,44) p = 0.767 and IUC 142 (113, 159) vs. 123 (101, 157) p = 0.814. None of the hearing examinations showed differences between the H and C groups: otomicroscopy (p = 1), tympanometry (p = 1), TOAE (p = 1), audiometry (p = 0.179), and BERA (p = 0.505). CONCLUSIONS: We did not observe any hearing impairment in adults with acquired hypothyroidism, and there were no associations found between hearing impairment and the severity of hypothyroidism or iodine status. However, some forms of hearing impairment, mostly mild, were very common in both studied groups.

Department of Internal medicine Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Otorhinolaryngology Faculty Hospital Kralovske Vinohrady and 3rd Faculty of Medicine Charles University Prague Czech Republic

Institute of Endocrinology Prague Czech Republic

See more in PubMed

Ragusa F, Fallahi P, Elia G, Gonnella D, Paparo SR, Giusti C, et al.. Hashimotos’ thyroiditis: epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367 PubMed DOI

Melse-Boonstra A, Mackenzie I. Iodine deficiency, thyroid function and hearing deficit: a review. Nutr Res Rev. 2013;26(2):110–7. doi: 10.1017/S0954422413000061 PubMed DOI

Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid. 2007;17(9):829–35. doi: 10.1089/thy.2007.0108 PubMed DOI

Clark C, Sörqvist P. A 3 year update on the influence of noise on performance and behavior. Noise Health. 2012;14(61):292–6. doi: 10.4103/1463-1741.104896 PubMed DOI

Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, et al.. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013;173(4):293–9. doi: 10.1001/jamainternmed.2013.1868 PubMed DOI PMC

Anand VT, Mann SB, Dash RJ, Mehra YN. Auditory investigations in hypothyroidism. Acta Otolaryngol. 1989;108(1–2):83–7. doi: 10.3109/00016488909107396 PubMed DOI

Malik V, Shukla GK, Bhatia N. Hearing profile in hypothyroidism. Indian J Otolaryngol Head Neck Surg. 2002;54(4):285–90. doi: 10.1007/BF02993744 PubMed DOI PMC

Sohmer H, Freeman S. The importance of thyroid hormone for auditory development in the fetus and neonate. Audiol Neurootol. 1996;1(3):137–47. doi: 10.1159/000259194 PubMed DOI

Graven SN, Browne JV. Auditory development in the fetus and infant. Newborn Infant Nurs Rev. 2008;8(4):187–93. doi: 10.1053/j.nainr.2008.10.010 DOI

Knipper M, Richardson G, Mack A, Müller M, Goodyear R, Limberger A, et al.. Thyroid hormone-deficient period prior to the onset of hearing is associated with reduced levels of β -tectorin protein in the tectorial membrane: implication for hearing loss. J Biol Chem. 2001;276(42):39046–52. doi: 10.1074/jbc.M103385200 PubMed DOI

Wasniewska M, De Luca F, Siclari S, Salzano G, Messina MF, Lombardo F, et al.. Hearing loss in congenital hypothalamic hypothyroidism: a wide therapeutic window. Hear Res. 2002;172(1–2):87–91. doi: 10.1016/s0378-5955(02)00515-4 PubMed DOI

Bradley DJ, Towle HC, Young WS. Alpha and beta thyroid hormone receptor (TR) gene expression during auditory neurogenesis: evidence for TR isoform-specific transcriptional regulation in vivo. Proc Natl Acad Sci USA. 1994;91:439–43. PubMed PMC

Forrest D. Deafness and goiter: molecular genetic considerations. J Clin Endocrinol Metab. 1996;81(8):2764–7. doi: 10.1210/jcem.81.8.8768825 PubMed DOI

Bizhanova A, Kopp P. Controversies concerning the role of pendrin as an apical iodide transporter in thyroid follicular cells. Cell Physiol Biochem. 2011;28(3):485–90. doi: 10.1159/000335103 PubMed DOI

Brucker-Davis F, Skarulis MC, Grace MB, Benichou J, Hauser P, Wiggs E, et al.. Genetic and clinical features of 42 kindreds with resistance to thyroid hormone. The national institutes of health prospective study. Ann Intern Med. 1995;123(8):572–83. doi: 10.7326/0003-4819-123-8-199510150-00002 PubMed DOI

Dumitrescu AM, Liao XH, Best TB, Brockmann K, Refetoff S. A novel syndrome combining thyroid and neurological abnormalities is associated with mutations in a monocarboxylate transporter gene. Am J Hum Genet. 2004;74(1):168–75. doi: 10.1086/380999 PubMed DOI PMC

Comer DM, McConnell EM. Hypothyroid-associated sensorineuronal deafness. Ir J Med Sci. 2010;179(4):621–2. doi: 10.1007/s11845-010-0579-y PubMed DOI

Bircher H. Der endemische Kropf. Basel; 1883.

Howarth AE, Lloyd HE. Perceptive deafness in hypothyroidism. Br Med J. 1956;1(4964):431–3. doi: 10.1136/bmj.1.4964.431 PubMed DOI PMC

Bhatia PL, Gupta OP, Agrawal MK, Mishr SK. Audiological and vestibular function tests in hypothyroidism. Laryngoscope. 1977;87(12):2082–9. doi: 10.1288/00005537-197712000-00014 PubMed DOI

Aggarwal MK, Singh GB, Nag RK, Singh SK, Kumar R, Yadav M. Audiological evaluation in goitrous hypotyhroidism. Int J Otolaryngol Head Neck Surg. 2013;2(5):201–6. doi: 10.4236/ijohns.2013.25042 DOI

Post JT. Hypothyroid deafness. a clinical study of sensori-neural deafness associated with hypothyroidism. Laryngoscope. 1964;74:221–32. doi: 10.1002/lary.5540740205 PubMed DOI

DeVos JA, Parving A, Ostri B, Bretlau P, Hansen JM, Parving HH. Audiological and temporal bone findings in myxedema. Ann Otol Rhinol Laryngol. 1986;95:278–83. PubMed

Balaji PV, Thirumaran M, Sharathbabu V. Assessment of audiologic evaluation in patients with acquired hypothyroidism. IAIM. 2016;3(7):222–7.

Santos KT, Dias NH, Mazeto GM, Carvalho LR, Lapate RL, Martins RH. Audiologic evaluation in patients with acquired hypothyroidism. Braz J Otorhinolaryngol. 2010;76:478–84. PubMed PMC

Scinicariello F, Buser MC. Association of iodine deficiency with hearing impairment in US adolescents aged 12 to 19 years: analysis of NHANES 2007–2010 data. JAMA Otolaryngol Head Neck Surg. 2018;144(7):644–5. doi: 10.1001/jamaoto.2018.0651 PubMed DOI PMC

Millon-Ramirez C, García-Fuentes E, Soriguer F. Iodine deficiency and hearing impairment. JAMA Otolaryngol Head Neck Surg. 2019;145(1):94–5. doi: 10.1001/jamaoto.2018.2755 PubMed DOI

Zamrazil V, Bilek R, Cerovska J, Delange F. The elimination of iodine deficiency in the Czech Republic: the steps toward success. Thyroid. 2004;14(1):49–56. doi: 10.1089/105072504322783849 PubMed DOI

Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet. 2017;390:1550–62. PubMed PMC

World Health Organization 2007. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers 3rd ed. Geneva, Switzerland: World Health Organization; 2007. Available from: http://apps.who.int/iris/bitstream/10665/43781/1/9789241595827_eng.pdf

Skevington SM, Lotfy M, O’Connell KA, WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13(2):299–310. doi: 10.1023/B:QURE.0000018486.91360.00 PubMed DOI

Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA. Declining prevalence of hearing loss in US adults aged 20 to 69 years. JAMA Otolaryngol Head Neck Surg. 2017;143(3):274–85. doi: 10.1001/jamaoto.2016.3527 PubMed DOI PMC

GBD 2019 Hearing Loss Collaborators. Hearing loss prevalence and years lived with disability, 1990–2019: findings from the global burden of disease study 2019. Lancet. 2021;397(10278):996–1009. doi: 10.1016/S0140-6736(21)00516-X PubMed DOI PMC

Meloun M, Hill M, Militký J, Kupka K. Transformation in the PC-aided biochemical data analysis. Clin Chem Lab Med. 2000;38(6):553–9. :doi: 10.1515/CCLM.2000.081 PubMed DOI

Taylor P, Albrecht D, Scholz A. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14:301–16. PubMed

Graydon K, Waterworth C, Miller H, Gunasekera H. Global burden of hearing impairment and ear disease. J Laryngol Otol. 2019;133(1):18–25. doi: 10.1017/S0022215118001275 PubMed DOI

Jung SY, Kim SH, Yeo SG. Association of nutritional factors with hearing loss. Nutrients. 2019;11(2):307. doi: 10.3390/nu11020307 PubMed DOI PMC

Kim SH, Won YS, Kim MG, Baek YJ, Oh IH, Yeo SG. Relationship between obesity and hearing loss. Acta Otolaryngol. 2016;136(10):1046–50. doi: 10.1080/00016489.2016.1179787 PubMed DOI

Singh R, Aftab M, Jain S, Kumar D. Audiological evaluation in hypothyroid patients and effect of thyroxine replacement therapy. Indian J Otolaryngol Head Neck Surg. 2019;71(Suppl 1):548–52. doi: 10.1007/s12070-018-1395-3 PubMed DOI PMC

Mahfzah M, Alhawari H, Momani SM, Abbasi H. The prevalence of hearing loss in patients with autoimmune thyroid disease: a prospective study.. Jordan Med J. 2018;52:109–16.

Van’t Hoff W, Stuart DW. Deafness in myxoedema. Q J Med. 1979;48(190):361–7. PubMed

Knudsen N, Bülow I, Jørgensen T, Perrild H, Ovesen L, Laurberg P. Serum Tg: a sensitive marker of thyroid abnormalities and iodine deficiency in epidemiological studies. J Clin Endocrinol Metab. 2001;86(8):3599–603. doi: 10.1210/jcem.86.8.7772 PubMed DOI

Iodine Global Network. Global scorecard 2016: moving toward optimal iodine status; 2016. Available from: http://www.ign.org/newsletter/idd_nov16_global_scorecard_2016.pdf

Chen ZP, Hetzel BS. Cretinism revisited. Best Pract Res Clin Endocrinol Metab. 2010;24(1):39–50. doi: 10.1016/j.beem.2009.08.014 PubMed DOI

Kessler JH. The effect of supraphysiologic levels of iodine on patients with cyclic mastalgia. Breast J. 2004;10(4):328–36. doi: 10.1111/j.1075-122X.2004.21341.x PubMed DOI

Salas-Lucia F, Bianco AC. T3 levels and thyroid hormone signaling. Front Endocrinol (Lausanne). 2022;13:1044691. doi: 10.3389/fendo.2022.1044691 PubMed DOI PMC