Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective

Ettleson, Matthew D; Raine, Ava; Batistuzzo, Alice; Batista, Samuel P.; McAninch, Elizabeth A.; Teixeira, María Cristina Triguero Veloz; Jonklaas, Jacqueline; Laiteerapong, Neda; Ribeiro, Miriam O.; Bianco, Antonio C.

doi:10.1016/j.eprac.2021.12.003

Cited by 25 publications

(10 citation statements)

References 35 publications

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“…Despite TSH concentrations within the reference interval, 5-10% of hypothyroid patients receiving L-T4 report impaired psychological well-being, depression or anxiety ( 30 ). Furthermore, the presence of so-called brain fog in L-T4 treated hypothyroid patients is a well-known phenomenon experienced by many patients ( 31 ). Several mechanisms may underlie the discrepancy between ‘normal’ laboratory outcomes and persistent symptoms.…”

Section: Persistent Symptoms In Levothyroxine-treated Patientsmentioning

confidence: 99%

Hypothyroidism: The difficulty in attributing symptoms to their underlying cause

et al. 2023

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Common symptoms of overt hypothyroidism are non-specific and include fatigue, lethargy, and dry skin. Although the diagnosis is considered to be straightforward, no single symptom can be used to identify patients with overt hypothyroidism, while many patients with subclinical hypothyroidism are asymptomatic. A large population-based study on the spectrum of symptoms in subclinical hypothyroidism showed similar rates of thyroid disease-related symptoms compared with euthyroid subjects, while the TSH concentration had no impact on symptom score. Together, these findings make it challenging to attribute symptoms to their underlying cause. This is also true in the case of unexplained persistent symptoms in levothyroxine-treated patients. Although generally considered a life-long replacement therapy, successful thyroid hormone discontinuation resulting in euthyroidism has been reported in approximately one third of patients. Thus, we overtreat patients with (subclinical) hypothyroidism, highlighting the importance of reliable diagnostic criteria. The diagnostic process, including the implementation of robust TSH and FT4 reference intervals, is especially challenging in specific situations including aging, pregnancy, non-thyroidal illness, and central hypothyroidism. There is a clear need for improved adherence to current guidelines from scientific societies and for willingness to manage symptoms without a clear pathological correlate, especially in the case of mild TSH elevations. This review will highlight recent literature on this topic and offers some practice points.

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Section: Persistent Symptoms In Levothyroxine-treated Patientsmentioning

confidence: 99%

Hypothyroidism: The difficulty in attributing symptoms to their underlying cause

et al. 2023

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“…Numerous studies of benign thyroid diseases have demonstrated deficits in multiple QoL domains ( 4 – 6 , 40 – 43 ). In this section we discuss a few selected studies that have examined the impact of treatment on QoL.…”

Section: Important Qol Issues In Benign Thyroid Diseasesmentioning

confidence: 99%

Implementation of thyroid-related patient-reported outcomes in routine clinical practice

et al. 2022

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Patient-reported outcomes (PROs) are increasingly used in clinical practice to improve clinical care. Multiple studies show that systematic use of PROs can enhance communication with patients and improve patient satisfaction, symptom management and quality of life. Further, such data can be aggregated to examine health levels for patient groups, improve quality of care, and compare patient outcomes at the institutional, regional or national level. However, there are barriers and challenges that should be handled appropriately to achieve successful implementation of PROs in routine clinical practice. This paper briefly overviews thyroid-related PROs, describes unsolved quality of life issues in benign thyroid diseases, provides examples of routine collection of PROs, and summarizes key points facilitating successful implementation of thyroid-related PROs in routine clinical practice. Finally, the paper touches upon future directions of PRO research.

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“…However, a variable proportion of patients, typically reported as approximately 15%, continue to have persistent symptoms ( 7 – 10 ). These symptoms can include fatigue, low energy levels, weight management difficulties, low mood, impaired memory, and brain fog ( 11 , 12 ). Many potential explanations for these unresolved symptoms can be offered, and these can be broadly divided into thyroid-related and thyroid-unrelated causes, although there may be overlap between these categories ( 2 ) (see Figures 1A, B ).…”

Section: Restoration Of the Euthyroid Statementioning

confidence: 99%

Restoration of euthyroidism with levothyroxine: implications of etiology of hypothyroidism and the degree of residual endogenous thyroid function

Jonklaas

2022

Front. Endocrinol.

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There are many thyroid-related factors that combine with non-thyroid-related factors in order to affect the patient response to treatment of hypothyroidism, in terms of their satisfaction with therapy. Some of the thyroid-derived factors include the etiology of the hypothyroidism and the amount of residual thyroid function that the patient retains. These two factors may be intertwined and affected by a third influence, the presence of thyroid peroxidase antibodies. The downstream consequences of the interactions between these three factors may influence both free thyroxine and free triiodothyronine levels, TSH concentrations, and various thyroid biomarkers. Evidence of the widespread importance of thyroid hormones can be inferred from the multiple genes that are regulated, with their regulation affecting multiple serum biomarkers. Thyroid biomarkers may extend from various well-known serum markers such as lipids and sex hormone-binding globulin to serum levels of thyroid hormone metabolites. Moreover, the interplay between thyroid hormones and biomarkers and their relative ratios may be different depending on the hypothyroidism etiology and degree of residual thyroid function. The ultimate significance of these relationships and their effect on determining patient-reported outcomes, quality of life, and patient satisfaction is, as yet, poorly understood. However, identification of better biomarkers of thyroid function would advance the field. These biomarkers could be studied and correlated with patient-reported outcomes in future prospective studies comparing the impact of various thyroid hormone therapies.

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Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective

Cited by 25 publications

References 35 publications

Hypothyroidism: The difficulty in attributing symptoms to their underlying cause

Hypothyroidism: The difficulty in attributing symptoms to their underlying cause

Implementation of thyroid-related patient-reported outcomes in routine clinical practice

Restoration of euthyroidism with levothyroxine: implications of etiology of hypothyroidism and the degree of residual endogenous thyroid function

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