Hypothyroid patients described what brain fog feels like

Carefully monitor glycemic control after starting, changing, or discontinuing SYNTHROID see Drug Interactions (7.2). Carefully monitor glycemic control after starting, changing, or discontinuing SYNTHROID see DRUG INTERACTIONS. Initiate SYNTHROID therapy in this population at lower synthroid bulk doses than those recommended in younger individuals or in patients without cardiac disease see DOSAGE AND ADMINISTRATION and Use In Specific Populations.

Treatment of Thyroid Disease

It is reasonable to initiate treatment for mild hypothyroidism in patients with affective or cognitive complaints, but realistic expectations should be set regarding the likelihood of symptom resolution. Moderate to severe symptoms are unlikely to be due to subclinical hypothyroidism, and need to be evaluated and treated as separate disorders. Randomized, placebo-controlled blinded studies of LT4 therapy in people with subclinical hypothyroidism have failed to demonstrate improvement in HRQoL, mood, or cognitive measures (34,38–40).

Tell any doctor, dentist, or surgeon who treats you that you are using Synthroid. It may take several weeks before your body starts to respond to Synthroid. Thyroid problems often run in families and if family members are unwell, they should be encouraged to discuss with their own GP whether thyroid testing is warranted. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. By Esther Heerema, MSWEsther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer’s disease and other kinds of dementia.

• Over and underactivity of the thyroid may put a strain on personal relationships.
• Administer SYNTHROID at least 4 hours before or after drugs known to interfere with SYNTHROID absorption see DRUG INTERACTIONS.
• Clues to this diagnosis include elevated antithyroid antibodies, abnormal Thyroid stimulating hormone values, and exclusion of other causes of acute mental status changes.
• Limitations include the survey instrument was not validated, it was not known whether symptoms were related to underlying hypothyroidism or other medical or psychiatric comorbidities, and lack of information on thyroid hormone levels.
• A portion of the conjugated hormone reaches the colon unchanged and is eliminated in the feces.

Desiccated thyroid extract therapy

Studies of brain fog in other clinical populations provide insights into additional contributing factors for these symptoms. In a study of people with postural tachycardia syndrome, the most frequent triggers for brain fog were fatigue and lack of sleep (10). Even in the general population, fatigue is common, with a prevalence of 22% and significant associations with obesity, insomnia, depression, anemia, low self-rated health status, and young age in one study (69).

Based on these studies, a recent clinical practice guideline from an international panel of thyroid specialists concluded that treating subclinical hypothyroidism has no benefit on fatigue, depressive symptoms, or cognitive function (41). These latter findings lend credence to the concept that slight decrements in memory and executive function exist in subclinical hypothyroidism but do not explain persistent and severe brain fog symptoms in LT4-treated people. Focusing specifically on LT4-treated hypothyroid people, the literature regarding HRQoL, mood, and cognitive outcomes is divergent and inconclusive. Some studies have shown that people treated with LT4 have decreased psychological well-being or cognitive function compared with control groups, while other studies report no differences (34). In studies when LT4 doses were altered in a blinded manner in euthyroid LT4-treated people, maintaining TSH levels in the reference range, there were no changes in HRQoL, mood, or cognitive outcomes (45,46). These data suggest that subjects with self-knowledge of a thyroid condition are more likely to report symptoms (“labeling effect”).

These treatments are not curative, and many people take the medication for life. Evaluate the need for dosage adjustments when regularly administering within one hour of certain foods that may affect SYNTHROID absorption see Dosage and Administration (2.2 and 2.3), Drug Interactions (7.9), and Clinical Pharmacology (12.3). Administer SYNTHROID at least 4 hours before or after drugs known to interfere with SYNTHROID absorption see Drug Interactions (7.1). A portion of the conjugated hormone reaches the colon unchanged and is eliminated in the feces. Long-term carcinogenicity studies in animals to evaluate the carcinogenic potential of levothyroxine have not been performed.

Concurrent use of tricyclic (e.g., amitriptyline) or tetracyclic (e.g., maprotiline) antidepressants and SYNTHROID may increase the therapeutic and toxic effects of both drugs, possibly due to increased receptor sensitivity to catecholamines. Toxic effects may include increased risk of cardiac arrhythmias and central nervous system stimulation. Administration of sertraline in patients stabilized on SYNTHROID may result in increased SYNTHROID requirements.

Pregnancy and fertility in thyroid disorders

If the rats are treated with combined LT4/LT3, DIO2 activity in the cortex and hippocampus is restored, and T3-responsive gene expression normalizes (52). Future studies should clearly segregate symptomatic people to avoid diluting potential positive findings with large numbers of relatively asymptomatic people (16). While corroborative cognitive testing and functional imaging is labor-intensive, expensive, and not always available, efforts should be made to incorporate such techniques in subsets of symptomatic people in research trials.

The preliminary data from Shakir et al. (48) suggest that the most symptomatic patients may derive the greatest benefit from LT4/LT3 combination therapy, although other intervention studies have been less impressive in unselected patients. Another population-based study of almost 6000 people found that the prevalence of fatigue in respondents who were euthyroid with no known thyroid disease was 34%. Rates were similar in overt or subclinical hypothyroid respondents, who were unaware that they had an abnormal TSH level. In respondents with known thyroid disorders, the rate of reported fatigue increased to 50% and was independent of the TSH level (85). Another study reported that there was no correlation between subclinical hypothyroidism and depressive symptoms when people were unaware of their thyroid status (86). These studies suggest that patients who know they have hypothyroidism are more likely to notice symptoms and attribute them to their thyroid condition, even when they may be unrelated, termed diagnostic labeling or attribution bias.

• Soybean flour, cottonseed meal, walnuts, and dietary fiber may bind and decrease the absorption of SYNTHROID from the gastrointestinal tract.
• On the other hand, deficits related to thyroid dysfunction are usually mild in subclinical hypothyroidism, and realistic expectations need to be set regarding symptom reversibility with treatment.
• Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.
• Overt hypothyroidism can affect a range of cognitive domains (6, 7, 10, 11).
• Overt hypothyroidism is defined as an elevated serum TSH level with a low free T4 (fT4) level, while mild or “subclinical” hypothyroidism is defined as an elevated TSH with a normal fT4.

Some people with hyperthyroidism, such as Graves’ disease, commonly experience poor concentration, slower reaction times, decreased spatial organization, and memory lapses. Researchers aren’t entirely certain why these issues surface, but thyroid hormones play an important role in the hippocampus, a part of the brain that’s important for learning and memory. Both hypothyroidism and hyperthyroidism can also cause cognitive problems that can mimic symptoms of mild dementia. Inquire whether patients are taking biotin or biotin-containing supplements. If so, advise them to stop biotin supplementation at least 2 days before assessing TSH and/or T4 levels see Dosage and Administration (2.4) and Drug Interactions (7.10). Consumption of certain foods and beverages such as soybean flour, cotton seed meal, walnuts, grapefruit juice, coffee, and dietary fiber can decrease the absorption of levothyroxine.