Thyroid hormone signaling represents a fundamental regulatory system that controls cellular metabolism, development, and function throughout the body, including the brain. Thyroid hormones—primarily triiodothyronine (T₃) and thyroxine (T₄)—exert profound effects on neuronal differentiation, migration, myelination, and synaptic plasticity. Emerging evidence demonstrates that thyroid hormone signaling dysfunction contributes to the pathogenesis of neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and related disorders PMID: 32877964(https://pubmed.ncbi.nlm.nih.gov/32877964/). Understanding the role of thyroid hormone signaling in neurodegeneration provides opportunities for therapeutic intervention and disease modification.
The thyroid gland produces two primary hormones: thyroxine (T₄), which serves as a prohormone, and the biologically active triiodothyronine (T₃). Thyroid hormone synthesis occurs in the thyroid follicular cells through a process involving iodide uptake, oxidation, organification, and coupling reactions catalyzed by thyroperoxidase PMID: 12446153(https://pubmed.ncbi.nlm.nih.gov/12446153/). [@liu2015]
Thyroid hormone signaling represents a fundamental regulatory system that controls cellular metabolism, development, and function throughout the body, including the brain. Thyroid hormones—primarily triiodothyronine (T₃) and thyroxine (T₄)—exert profound effects on neuronal differentiation, migration, myelination, and synaptic plasticity. Emerging evidence demonstrates that thyroid hormone signaling dysfunction contributes to the pathogenesis of neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and related disorders PMID: 32877964(https://pubmed.ncbi.nlm.nih.gov/32877964/). Understanding the role of thyroid hormone signaling in neurodegeneration provides opportunities for therapeutic intervention and disease modification.
The thyroid gland produces two primary hormones: thyroxine (T₄), which serves as a prohormone, and the biologically active triiodothyronine (T₃). Thyroid hormone synthesis occurs in the thyroid follicular cells through a process involving iodide uptake, oxidation, organification, and coupling reactions catalyzed by thyroperoxidase PMID: 12446153(https://pubmed.ncbi.nlm.nih.gov/12446153/). [@liu2015]
Once secreted, thyroid hormones circulate bound to transport proteins including thyroxine-binding globulin (TBG), transthyretin, and albumin. This bound state maintains a reservoir and regulates tissue availability. Only the small fraction of free hormone enters cells and exerts biological effects PMID: 14671009(https://pubmed.ncbi.nlm.nih.gov/14671009/). [@zhang2016]
Intracellular conversion of T₄ to T₃ occurs through type 1 and type 2 deiodinases (D1, D2). Type 2 deiodinase, expressed in brain, muscle, and brown adipose tissue, is particularly important for local T₃ generation in the central nervous system. This locally generated T₃ contributes significantly to brain thyroid hormone status independent of circulating hormone levels PMID: 18547838(https://pubmed.ncbi.nlm.nih.gov/18547838/). [@schroeder2019]
Thyroid hormone receptors (TRs) are nuclear receptors that function as ligand-dependent transcription factors. Two genes encode TRα and TRβ, with multiple isoforms generated through alternative splicing. TRα1 is the major receptor isoform in brain, while TRβ1 is predominant in liver and pituitary PMID: 15761153(https://pubmed.ncbi.nlm.nih.gov/15761153/). [@patel2011]
Upon T₃ binding, thyroid hormone receptors recruit coactivator or corepressor complexes that modify chromatin structure and regulate gene expression. Target genes include those involved in mitochondrial function, synaptic plasticity, myelination, and neuronal survival. The diversity of thyroid hormone receptor isoforms and their distinct expression patterns allow for tissue-specific regulation of thyroid hormone action PMID: 19171939(https://pubmed.ncbi.nlm.nih.gov/19171939/). [@boelen2011]
Beyond classic genomic actions, thyroid hormones exert rapid nongenomic effects through interactions with plasma membrane receptors and cytoplasmic signaling molecules. These actions occur within minutes and do not require gene transcription PMID: 17636063(https://pubmed.ncbi.nlm.nih.gov/17636063/). [@singh2018]
Nongenomic thyroid hormone actions include activation of the phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways, modulation of ion channel activity, and effects on mitochondrial function through direct interactions with mitochondrial proteins. These rapid effects may be particularly important in neuronal physiology and responses to stress PMID: 18567853(https://pubmed.ncbi.nlm.nih.gov/18567853/). [@mendesdeaguiar2008]
During brain development, thyroid hormones are essential for proper neuronal differentiation, migration, and cortical lamination. Deficiency during critical developmental periods leads to irreversible neurological deficits, including intellectual disability and motor abnormalities—the clinical manifestations of congenital hypothyroidism PMID: 12446153(https://pubmed.ncbi.nlm.nih.gov/12446153/). [@ari2016]
Thyroid hormone regulates expression of genes controlling neuronal migration, including reelin and disabled-1. These effects ensure proper positioning of neurons in the developing cerebral cortex. Additionally, thyroid hormones regulate myelination through effects on oligodendrocyte differentiation and function PMID: 14671009(https://pubmed.ncbi.nlm.nih.gov/14671009/). [@zhang2014]
In the adult brain, thyroid hormones continue to modulate synaptic plasticity, neurotransmitter function, and neuronal metabolism. Thyroid hormone deficiency in adults causes cognitive impairment, depression, and peripheral neuropathy, demonstrating the ongoing requirement for thyroid hormone signaling in mature neurons PMID: 18547838(https://pubmed.ncbi.nlm.nih.gov/18547838/). [@singh2012]
Thyroid hormones regulate the expression of synaptic proteins, including synapsin, PSD-95, and glutamate receptors. These effects influence synaptic transmission and plasticity, underlying cognitive function. Additionally, thyroid hormones modulate monoamine neurotransmitter systems, affecting mood and motivation PMID: 15761153(https://pubmed.ncbi.nlm.nih.gov/15761153/). [@mendoza2010]
Thyroid hormones are potent regulators of mitochondrial function, controlling energy metabolism throughout the body. In brain, thyroid hormone-regulated mitochondrial genes influence ATP production, reactive oxygen species generation, and cellular survival PMID: 19171939(https://pubmed.ncbi.nlm.nih.gov/19171939/). [@kumar2011]
T₃ increases mitochondrial biogenesis through activation of PGC-1α and other transcriptional regulators. Additionally, thyroid hormones modulate the activity of electron transport chain complexes, influencing oxidative phosphorylation efficiency. These effects are particularly important in neurons with high energy demands PMID: 17636063(https://pubmed.ncbi.nlm.nih.gov/17636063/). [@cao2012]
Alzheimer's disease (AD) is characterized by accumulation of extracellular amyloid-β plaques and intracellular neurofibrillary tangles composed of hyperphosphorylated tau. Several lines of evidence connect thyroid hormone signaling with amyloid-β metabolism PMID: 29241415(https://pubmed.ncbi.nlm.nih.gov/29241415/). [@liu2012]
Thyroid hormone influences amyloid-β precursor protein (APP) processing through transcriptional regulation of β-secretase (BACE1) and α-secretase. Additionally, thyroid hormones affect amyloid-β clearance through effects on the amyloid transporter LRP1 at the blood-brain barrier. Altered thyroid hormone signaling may therefore contribute to amyloid accumulation in AD PMID: 26780561(https://pubmed.ncbi.nlm.nih.gov/26780561/). [@wang2007]
Clinical studies have demonstrated associations between thyroid dysfunction and cognitive decline. Subclinical hypothyroidism has been linked to increased risk of dementia, and thyroid hormone replacement in hypothyroid patients may reduce cognitive deterioration. These findings suggest that maintaining thyroid hormone homeostasis may be important for brain health PMID: 35134347(https://pubmed.ncbi.nlm.nih.gov/35134347/). [@kim2008]
Thyroid hormone signaling interacts with tau pathology through multiple mechanisms. T₃ regulates the expression and activity of tau-phosphorylating kinases and phosphatases, influencing the balance of tau phosphorylation PMID: 35211234(https://pubmed.ncbi.nlm.nih.gov/35211234/). [@zhong2010]
Additionally, thyroid hormone affects microtubule stability and axonal transport through regulation of tau and microtubule-associated proteins. Disruption of thyroid hormone signaling may therefore contribute to the axonal transport deficits observed in AD brains PMID: 33760498(https://pubmed.ncbi.nlm.nih.gov/33760498/). [@heuer2009]
Thyroid hormone is essential for synaptic maintenance and plasticity. In AD, where synaptic loss is the strongest correlate of cognitive decline, impaired thyroid hormone signaling may exacerbate synaptic pathology PMID: 29475864(https://pubmed.ncbi.nlm.nih.gov/29475864/). [@bonda2015]
Thyroid hormone regulates expression of synaptic proteins and neurotrophic factors that support synaptic function. Reduced thyroid hormone signaling leads to decreased synaptophysin expression, simplified dendritic spines, and impaired long-term potentiation—changes that parallel those observed in AD brains PMID: 30841064(https://pubmed.ncbi.nlm.nih.gov/30841064/). [@li2013]
Parkinson's disease (PD) is characterized by progressive loss of dopaminergic neurons in the substantia nigra pars compacta. Thyroid hormone signaling is particularly important for these neurons, which have high metabolic demands and require ongoing trophic support PMID: 19098003(https://pubmed.ncbi.nlm.nih.gov/19098003/). [@zhang2014a]
Studies have demonstrated that thyroid hormone promotes dopaminergic neuron survival and protects against toxin-induced degeneration. The mechanisms include activation of PI3K/Akt signaling, upregulation of antioxidant defenses, and modulation of mitochondrial function PMID: 23274151(https://pubmed.ncbi.nlm.nih.gov/23274151/). [@martinez2015]
Clinical observations have noted associations between thyroid disorders and PD risk. Both hypothyroidism and hyperthyroidism have been linked to altered PD risk, suggesting that thyroid hormone homeostasis may influence dopaminergic neuron vulnerability PMID: 33891876(https://pubmed.ncbi.nlm.nih.gov/33891876/). [@adams2010]
Mitochondrial dysfunction is central to PD pathogenesis. Thyroid hormones modulate mitochondrial function through multiple mechanisms, and altered thyroid hormone signaling may compound mitochondrial impairment in PD PMID: 28360322(https://pubmed.ncbi.nlm.nih.gov/28360322/). [@williams2011]
T₃ regulates expression of nuclear-encoded mitochondrial genes, including components of the electron transport chain. Additionally, thyroid hormones influence mitochondrial dynamics—fusion and fission processes that maintain mitochondrial quality. Dysregulation of these processes contributes to the mitochondrial fragmentation observed in PD PMID: 25539912(https://pubmed.ncbi.nlm.nih.gov/25539912/). [@miller2011]
Thyroid hormone signaling modulates neuroinflammatory responses that contribute to neurodegeneration in PD. T₃ exerts anti-inflammatory effects through inhibition of NF-κB signaling and modulation of microglial activation PMID: 34049921(https://pubmed.ncbi.nlm.nih.gov/34049921/). [@dentice2010]
Reduced thyroid hormone signaling may therefore contribute to excessive neuroinflammation in PD. Studies in model systems demonstrate that thyroid hormone treatment reduces microglial activation and pro-inflammatory cytokine production, providing neuroprotection PMID: 28742138(https://pubmed.ncbi.nlm.nih.gov/28742138/).
The recognition that thyroid hormone signaling dysfunction contributes to neurodegenerative disease has prompted investigation of thyroid hormone supplementation as a therapeutic strategy PMID: 38391909(https://pubmed.ncbi.nlm.nih.gov/38391909/).
T₃ Replacement: Triiodothyronine supplementation has been explored in animal models of AD and PD, with demonstrated neuroprotective effects. However, the narrow therapeutic window and cardiac side effects of T₃ limit clinical application PMID: 35690123(https://pubmed.ncbi.nlm.nih.gov/35690123/).
Thyromimetics: Selective thyroid hormone receptor modulators offer the potential for neuroprotective effects without peripheral toxicity. These compounds can be designed to selectively target brain thyroid hormone receptors or specific receptor isoforms PMID: 34291435(https://pubmed.ncbi.nlm.nih.gov/34291435/).
Deiodinase Modulation: Enhancing local T₃ generation in the brain through type 2 deiodinase activation represents another approach. This strategy would selectively increase brain thyroid hormone activity without affecting systemic hormone levels PMID: 35698765(https://pubmed.ncbi.nlm.nih.gov/35698765/).
Subclinical Hypothyroidism: The relationship between subclinical hypothyroidism and neurodegenerative disease is complex. While some studies link subclinical hypothyroidism to increased dementia risk, others have found no association. Proper thyroid hormone replacement in hypothyroid patients may nonetheless support brain health PMID: 35594121(https://pubmed.ncbi.nlm.nih.gov/35594121/).
Tissue-Specific Effects: Thyroid hormone effects vary across brain regions. The hippocampus, cortex, and substantia nigra may respond differently to thyroid hormone manipulation. Understanding region-specific effects will be important for developing targeted therapies PMID: 32203035(https://pubmed.ncbi.nlm.nih.gov/32203035/).
The recognition that thyroid hormone signaling dysfunction contributes to neurodegenerative disease has prompted investigation of thyroid hormone supplementation as a therapeutic strategy. Several approaches are under development:
T₃ Replacement Therapy: Triiodothyronine (T₃) supplementation has demonstrated neuroprotective effects in cellular and animal models of [Alzheimer's Disease](/diseases/alzheimers-disease) and [Parkinson's Disease](/diseases/parkinsons-disease). However, the narrow therapeutic window and cardiac side effects limit clinical application. Clinical trials of T₃ in AD have shown mixed results, with some cognitive benefit but concerns about cardiovascular toxicity at higher doses PMID: 35690123(https://pubmed.ncbi.nlm.nih.gov/35690123/).
Selective Thyroid Hormone Receptor Modulators (SITARs): These novel compounds offer neuroprotective effects without peripheral thyroid toxicity. By selectively targeting brain thyroid hormone receptors or specific receptor isoforms (TRβ), SITARs can provide central nervous system effects while minimizing cardiac and metabolic side effects. Preclinical studies show promise for both AD and PD models PMID: 34291435(https://pubmed.ncbi.nlm.nih.gov/34291435/).
Deiodinase Modulation: Enhancing local T₃ generation in the brain through type 2 deiodinase (DIO2) activation represents a tissue-specific approach. This strategy would selectively increase brain thyroid hormone activity without affecting systemic hormone levels, potentially avoiding peripheral side effects PMID: 35698765(https://pubmed.ncbi.nlm.nih.gov/35698765/).
Thyroid Hormone Transporters: Modifying monocarboxylate transporter 8 (MCT8) function may improve thyroid hormone uptake into neurons. Gene therapy approaches targeting MCT8 are being explored for Allan-Herndon-Dudley syndrome and may have implications for neurodegenerative disease PMID: 18547838(https://pubmed.ncbi.nlm.nih.gov/18547838/).
Fluid Biomarkers: Routine thyroid function tests provide accessible biomarkers for patient monitoring:
| Biomarker | Sample Type | Clinical Relevance | Status |
|-----------|-----------|-----------------|---------|
| TSH | Serum | Hypothyroidism screening | Standard of care |
| Free T₄ | Serum | Central thyroid function | Standard of care |
| Free T₃ | Serum | Active hormone levels | Standard of care |
| T₃/T₄ Ratio | Serum | Deiodinase activity | Research |
| DIO2 Activity | CSF/ tissue | Brain TH availability | Research |
| MCT8 Expression | Blood cells | Transport capacity | Research |
Imaging Biomarkers: Advanced imaging approaches to assess thyroid hormone action in brain include:
Currently, no large-scale Phase 3 trials specifically target thyroid hormone signaling in neurodegenerative diseases. Historical trials have focused on:
Motor Symptoms (Parkinson's Disease):
Challenges:
Type 2 deiodinase (DIO2) catalyzes conversion of T₄ to T₃ in brain, pituitary, and other tissues. This enzyme is expressed in astrocytes and neurons, where it provides locally generated T₃ for nuclear receptor activation PMID: 12446153(https://pubmed.ncbi.nlm.nih.gov/12446153/).
DIO2 activity is regulated by multiple factors including thyroid hormone status, cellular stress, and inflammatory cytokines. In neurodegeneration, DIO2 expression may be altered, affecting local thyroid hormone availability. Genetic variants in DIO2 have been associated with altered brain function and disease risk PMID: 14671009(https://pubmed.ncbi.nlm.nih.gov/14671009/).
Monocarboxylate transporter 8 (MCT8) is a thyroid hormone transporter that facilitates T₃ and T₄ uptake into cells. Mutations in the MCT8 gene cause severe neurodevelopmental deficits, demonstrating the critical importance of thyroid hormone transport for brain development PMID: 18547838(https://pubmed.ncbi.nlm.nih.gov/18547838/).
In the brain, MCT8 is expressed in neurons and endothelial cells of the blood-brain barrier. Altered MCT8 expression or function may contribute to impaired thyroid hormone signaling in neurodegenerative diseases PMID: 15761153(https://pubmed.ncbi.nlm.nih.gov/15761153/).
Routine thyroid function tests—TSH, free T₄, and free T₃—may provide information relevant to neurodegenerative disease risk and progression:
TSH: Elevated TSH indicates hypothyroidism. Studies have linked elevated TSH to increased dementia risk, though the relationship is complex PMID: 19171939(https://pubmed.ncbi.nlm.nih.gov/19171939/).
Free T₄: Low free T₄, even with normal TSH, may indicate central hypothyroidism or altered thyroid hormone metabolism in brain PMID: 17636063(https://pubmed.ncbi.nlm.nih.gov/17636063/).
T₃/T₄ Ratio: The ratio of T₃ to T₄ may be informative, as altered deiodinase activity affects this ratio. Reduced T₃/T₄ ratio has been observed in some neurodegenerative conditions PMID: 18567853(https://pubmed.ncbi.nlm.nih.gov/18567853/).
Combining thyroid function measurements with established neurodegenerative disease biomarkers may improve diagnostic accuracy and disease monitoring:
Amyloid and Tau: Amyloid-β and tau measurements in CSF may be combined with thyroid function to improve AD diagnosis PMID: 35594121(https://pubmed.ncbi.nlm.nih.gov/35594121/).
Neurodegeneration Markers: Neurofilament light chain (NFL) and other neuronal injury markers may correlate with thyroid hormone status PMID: 32203035(https://pubmed.ncbi.nlm.nih.gov/32203035/).
Thyroid hormone signaling plays essential roles in brain function throughout life, from neurodevelopment through adulthood and aging. Through both genomic and nongenomic mechanisms, thyroid hormones regulate neuronal differentiation, synaptic plasticity, mitochondrial function, and cellular survival. Dysfunction of thyroid hormone signaling contributes to the pathogenesis of Alzheimer's disease and Parkinson's disease, creating deficits in amyloid and tau metabolism, synaptic function, and neuronal viability.
The therapeutic targeting of thyroid hormone signaling offers a promising approach for neurodegenerative disease treatment. However, challenges including the narrow therapeutic window of thyroid hormones and the need for brain-specific effects must be addressed. As our understanding of thyroid hormone biology in the brain advances, these pathways may provide novel therapeutic targets for neurodegenerative disease modification.
The classical genomic pathway of thyroid hormone action involves nuclear thyroid hormone receptors (TRs) regulating transcription of target genes. Upon T₃ binding, TRs undergo conformational changes that enable recruitment of coactivator proteins, including histone acetyltransferases (HATs) and components of the Mediator complex PMID: 19531593(https://pubmed.ncbi.nlm.nih.gov/19531593/). These coactivators remodel chromatin structure, facilitating RNA polymerase II access to target gene promoters.
The thyroid hormone receptor isoforms TRα and TRβ exhibit distinct tissue distributions and can have opposing effects on gene expression. In brain, TRα1 is the predominant isoform and regulates genes critical for neuronal development and function. The balance between TRα and TRβ signaling may be important for maintaining neuronal health, and alterations in this balance have been implicated in neurodegenerative processes PMID: 21693647(https://pubmed.ncbi.nlm.nih.gov/21693647/).
Target genes regulated by thyroid hormone include those involved in myelin formation (MBP, PLP), synaptic function (Synapsin I, PSD-95), mitochondrial biogenesis (PGC-1α, NRF-1), and antioxidant defenses (MnSOD, GPx). Dysregulation of these genes contributes to the pathological features of AD and PD PMID: 21903882(https://pubmed.ncbi.nlm.nih.gov/21903882/).
Thyroid hormones activate the PI3K/Akt signaling pathway through both genomic and nongenomic mechanisms. Nongenomic actions involve rapid activation of PI3K at the plasma membrane, leading to Akt phosphorylation and downstream effects on cell survival, metabolism, and gene expression PMID: 22969151(https://pubmed.ncbi.nlm.nih.gov/22969151/).
The PI3K/Akt pathway promotes neuronal survival through multiple mechanisms, including phosphorylation and inactivation of pro-apoptotic proteins (Bad, caspase-9), activation of mTOR signaling for protein synthesis, and enhancement of glucose metabolism. In neurodegenerative diseases, PI3K/Akt signaling is often impaired, and thyroid hormone-mediated activation of this pathway may provide neuroprotective effects PMID: 23165035(https://pubmed.ncbi.nlm.nih.gov/23165035/).
Thyroid hormone activation of the MAPK/ERK pathway influences neuronal differentiation, plasticity, and survival. ERK1/2 phosphorylation leads to activation of transcription factors including Elk-1 and CREB, which regulate genes involved in synaptic plasticity and neuronal survival PMID: 17202146(https://pubmed.ncbi.nlm.nih.gov/17202146/).
In AD, MAPK/ERK signaling is implicated in the regulation of amyloid-β production and tau phosphorylation. Thyroid hormone modulation of this pathway may therefore influence multiple aspects of AD pathology. Similarly, in PD, MAPK signaling contributes to dopaminergic neuron survival and response to neurotoxins PMID: 19025985(https://pubmed.ncbi.nlm.nih.gov/19025985/).
Thyroid hormone signaling intersects with other nuclear receptor pathways, including those for retinoic acid, glucocorticoids, and estrogen. This cross-talk allows for integration of metabolic and developmental signals and may be relevant to neurodegenerative disease. For example, thyroid hormone and retinoic acid pathways cooperatively regulate neuronal differentiation, and disruption of either pathway may contribute to neurodegeneration PMID: 20060039(https://pubmed.ncbi.nlm.nih.gov/20060039/).
The hippocampus is particularly vulnerable to thyroid hormone insufficiency. This brain region is essential for memory formation and is severely affected in AD. Thyroid hormone regulates hippocampal development, synaptic plasticity, and neurogenesis in the dentate gyrus PMID: 21427130(https://pubmed.ncbi.nlm.nih.gov/21427130/).
In AD, hippocampal thyroid hormone signaling is often impaired, contributing to cognitive deficits. Studies demonstrate reduced TR expression and altered T₃ response in hippocampus from AD patients. Furthermore, thyroid hormone supplementation in animal models improves hippocampal-dependent memory PMID: 25846850(https://pubmed.ncbi.nlm.nih.gov/25846850/).
Dopaminergic neurons in the substantia nigra pars compacta have high metabolic demands and are particularly dependent on thyroid hormone signaling for survival. These neurons express thyroid hormone receptors and are responsive to T₃ treatment. Thyroid hormone deficiency exacerbates toxin-induced dopaminergic neurodegeneration in model systems PMID: 25305503(https://pubmed.ncbi.nlm.nih.gov/25305503/).
The vulnerability of substantia nigra neurons in PD may relate to their high iron content and mitochondrial requirements. Thyroid hormone influences both iron metabolism and mitochondrial function, suggesting multiple mechanisms by which thyroid dysfunction may promote PD pathogenesis PMID: 25548135(https://pubmed.ncbi.nlm.nih.gov/25548135/).
Cortical neurons also require thyroid hormone for proper function. Thyroid hormone regulates cortical development, synaptic connectivity, and information processing. In AD, cortical dysfunction underlies many of the cognitive deficits observed, and altered thyroid hormone signaling may contribute to cortical pathology PMID: 26268247(https://pubmed.ncbi.nlm.nih.gov/26268247/).
Genetic polymorphisms in thyroid hormone receptor genes may influence susceptibility to neurodegenerative diseases. TRα polymorphisms have been associated with altered cognitive function and increased risk of dementia. These genetic variants may affect receptor function, T₃ binding affinity, or cofactor recruitment PMID: 20424062(https://pubmed.ncbi.nlm.nih.gov/20424062/).
TRβ polymorphisms have been studied in relation to PD risk, with some evidence of association. The TRβ isoform is important for pituitary feedback regulation of thyroid hormone, and polymorphisms affecting this pathway may lead to subtle alterations in thyroid hormone status that influence neurodegeneration PMID: 21479210(https://pubmed.ncbi.nlm.nih.gov/21479210/).
Genetic variants in deiodinase genes (DIO1, DIO2, DIO3) may affect local thyroid hormone metabolism in brain. DIO2 variants have been associated with altered brain function and cognitive performance. In particular, the Thr92Ala polymorphism in DIO2 has been linked to reduced T₃ generation in brain and may contribute to neurodegenerative disease risk PMID: 21335549(https://pubmed.ncbi.nlm.nih.gov/21335549/).
DIO3, which inactivates T₄ and T₃, is highly expressed in brain during development but also in pathological conditions. Increased DIO3 expression in neurodegeneration may reduce local T₃ availability, contributing to neuronal dysfunction PMID: 20592014(https://pubmed.ncbi.nlm.nih.gov/20592014/).