Neuropsychiatric aspects of hypothyroidism and treatment reversibility

In some ways, the utlimate question - can treatment reverse the symptoms?

Minerva Endocrinol. 2007 Mar;32(1):49-65.

Neuropsychiatric aspects of hypothyroidism and treatment reversibility.

Davis JD1, Tremont G.

Author information

1Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02903, USA. jdavis3@lifespan.org

Abstract

Thyroid hormone has important actions in the adult brain, and it is well accepted that hypothyroidism is associated with neuropsychiatric complaints and symptoms. Neuropsychiatric symptoms refer to a spectrum of emotional and cognitive problems that are directly related to changes in the brain secondary to multiple factors, including the direct effects of thyroid disease, as well as hormone deprivation in brain tissue. Hypothyroidism impacts aspects of cognitive functioning and mood. More severe hypothyroidism can mimic melancholic de-pression and dementia. Neuropsychiatric symptoms tend to improve with treatment and normalization to a euthyroid state, though the pattern is inconsistent and complete recovery is uncertain. The degree to which mild hypothyroidism, or subclinical hypothyroidism (SCH), impacts mood and cognitive functions and whether these symptoms respond to treatment, remains controversial. Most studies support a relationship between thyroid state and cognition, particularly slowed information processing speed, reduced efficiency in executive functions, and poor learning. Furthermore, hypo-thyroidism is associated with an increased susceptibility to depression and reductions in health-related quality of life. Controlled studies suggest that cognitive and mood symptoms improve with treatment, though the data are equivocal and limited by diverse methodologies. Functional neuroimaging data provide support for the mood and cognitive findings and treatment reversibility for both overt and SCH. These findings are not, however, without controversy. Recent investigations into the impact of SCH on cognition and mood, coupled epidemiological studies investigating the normal spectrum of thyroid stimulating hormone, have fueled significant debate regarding the appropriate, healthy range for TSH levels. This has led to concern over whether patients with overt hypothyroidism may be undertreated and whether SCH patients are truly out of the range of normal thyroid functioning and should be treated. The following is a review of the extant literature on the impact of hypothyroidism on cognition and mood, reversibility of symptoms, and treatment approaches. The spectrum of thyroid disease is reviewed, but mild, or subclinical, hypothyroidism is emphasized. The potential role of autoimmunity in neuropsychiatric symptoms and treatment resistance is addressed. Limitations of the current literature and future directions are discussed.

PMID:

17353866

[PubMed - indexed for MEDLINE]

ncbi.nlm.nih.gov/pubmed/173...

Promises so much. But it is locked away behind a paywall here:

minervamedica.it/en/journal...

13 Replies

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  • Helvella, would be very interesting if research into hypothyroid symptoms of patients with euthyroid bloods was undertaken. Some people are symptomatic long before bloods are even subclinically abnormal.

  • As were mine

  • Helbell, I was told for 9 months that symptoms were non-thyroidal because bloods were euthyroid with elevated antibodies, and autoimmune thyroiditis don't cause symptoms :o I don't believe it's a coincidence that the non-thyroidal symptoms disappeared almost immediately after thyroidectomy and subsequent blood tests show I have no thyroglobulin or antibodies.

  • me either.

  • I got away with virtually nothing, at least compared against what others here suffered. But even I asked for a test because of symptoms (first one I presented with was plantar fasciitis) - and it came back with my TSH just over 2. Of course, no other tests were done.

    Obviously, that was ignored. It was a continuing series of increasing TSH tests that finally convinced. In my view, my plantar fasciitis was due to thyroid, and at levels which would usually be regarded as euthyroid. Something was going wrong even then.

  • Helvella, my point, exactly. Waiting until bloods are abnormal simply means symptoms will accrue, worsen, and some may even be irreversible.

  • Really frightening how the doctors don't think this is very serious! Not at all. If it gets me my disability for Anxiety and Depression, so be it, because i just got re- diagnosed with those and i think it's B. S.!!

  • It did for me - definitely

  • THANKS FOR POSTING THIS.

    THERE MUST BE MORE AWARENESS in the UK and America (and worldwide) of how serious thyroid dysfunction is. A MASSIVE campaign, the way we see with cancer.

    When I ended up in hospital 18 months ago due to a concussion (after falling and hitting my head in my house, due to a bad reaction to my compounded NDT), my Hashimoto's was not treated for 3 weeks in hospital, resulting in mental illness: fits of sobbing, suicidal idealization, and more. I was then given 5 psych drugs simultaneously, making me a maniacally laughing idiot. All of my behavior was attributed to the concussion. TO THIS DAY, MOST OF MY RELATIVES claim that I am no longer working due to the concussion. They do not understand or accept the debilitating effects that Hashi's can have, EVEN THOUGH hypothyroidism and Hashi's run in my family!!!

    I have been on an intense, muliti-pronged healing journey since that time, and I am somewhat better, but still have a ways to go before I am completely functional.

    Ms. Klagh

  • Is there anyone in this forum who could get hold of the whole article? It looks very interesting. As far as I can see from the link you have to have published in Pub Med or know someone who's in it. I doubt any of us have those links but just in case there is someone or a medical person out there who is keeping an eye on this website - could you help us please?

  • the full article has to be purchased

  • Good article. The full text cazn be purchased if one clickcs on the blinks.... Whichbiscvtypo for links (on that guessing where the text box is tablet, again). Re Subclinical hypothyroidism, cant one also be euthroid but the gland struggling to produce under autoimmune attack.? In which case measurements could be completely within range and thyroid disease completely undetected? Brain fog, mood swings and depression werere disabling me long before overt hypot was picked up in lab results. Happy to say replacement has moved me far away from the worst place n0w0000, so, I assume a yes it potentially could.

  • Thanks - I'll click on the blinks - so long as I can work out where and what they are!

    I'm a bit of a slow old luddite with these things but I usually get there in the end!