Do Thyroid Disorders Cause Forgetfulness and Brain Fog?

Although not all of these side effects may occur, if they do occur they may need medical attention. 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. If you’re experiencing forgetfulness or difficulty concentrating along with your thyroid issues, be synthroid instructions sure to alert your healthcare provider. Thyroid problems can cause mild thinking, memory, and concentration issues, and an adjustment of your medications may help. It’s also important that you have an evaluation for other potential problems.

• Cognition assessments have included tests of memory and executive function, the cognitive domains that best approximate patient-reported symptoms of brain fog, and which are known to be affected by thyroid hormone.
• Levothyroxine is generally continued for life in these patients see Warnings and Precautions (5.1).
• In addition, many drugs and foods affect T4 absorption see Drug Interactions (7).
• Closely monitor coagulation tests to permit appropriate and timely dosage adjustments.

Important Administration Instructions

• Do not administer in foods that decrease absorption of SYNTHROID, such as soybean-based infant formula see Drug Interactions (7.9).
• Rarely, severely hypothyroid patients present with agitation and frank psychosis (“myxedema madness”) (5).
• The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.
• Enter medications to view a detailed interaction report using our Drug Interaction Checker.

Celi et al recently reported results of a randomized, double-blind experiment in 14 hypothyroid patients (69). Subjects were given L-T4 or L-T3 as sole therapy for 6 weeks to achieve normal TSH levels, and then were crossed over to the other treatment. Subjects lost a small amount of weight on L-T3, but there were no differences in SF-36 or thyroid-specific quality of life questionnaires. There are no studies that investigate mood or cognitive function in subjects receiving L-T3 as sole therapy, and this regimen is not recommended due to difficulties in maintaining stable thyroid hormone levels.

Psychiatric and cognitive effects of subclinical hypothyroidism

Dementia refers to several conditions that cause a decline in memory and cognitive skills needed to perform the basic activities of daily living. Consumption of certain foods may affect SYNTHROID absorption thereby necessitating adjustments in dosing see Dosage and Administration (2.1). Soybean flour, cottonseed meal, walnuts, and dietary fiber may bind and decrease the absorption of SYNTHROID from the gastrointestinal tract.

Indeed, brain fog may persist after the other symptoms of hypothyroidism resolve on thyroid hormone therapy. In another study, 150 patients with treated hypothyroidism, normal TSH levels, markedly elevated TPOAb titers, persistent symptoms, and elevated fatigue and lower HRQoL scores were randomized to optimal medical therapy or thyroidectomy. TPOAbs decreased and fatigue and HRQoL improved markedly only in thyroidectomy group (62). Surgery may have conferred a large nonspecific effect in these patients, but the results are impressive and intriguing.

Thyroid eye disease

• In the case of patients who cannot tolerate corticosteroids or who do not respond to corticosteroids, agents such as Azathioprine and Cyclophosphamide have been employed.
• Because of the increased prevalence of cardiovascular disease among the elderly, initiate SYNTHROID at less than the full replacement dose see Dosage and Administration (2.3) and Warnings and Precautions (5.2).
• In respondents with known thyroid disorders, the rate of reported fatigue increased to 50% and was independent of the TSH level (85).
• The medical team that provided his outpatient endocrine care was unaware he was not taking the hormone replacement medication.
• It’s generally safe to drink alcohol as long as the alcohol is not consumed at the same time as the levothyroxine dose.
• Atypical symptoms that raise the question of alternate etiologies or structural neurological disorders should be evaluated as potential separate diagnoses.

In the ward, because it was assumed he had been in daily use of levothyroxine, his prescription was maintained. Two days after admission, although the renal failure had already been reversed, he woke up confused, disoriented, with psychomotor agitation and impaired judgment of reality, saying that he was being pursued and that people wanted to kill him. When a bed was brought to the corridor by nurses, he considered that it was an ambush. Desperate to flee, he threw himself from the 6th floor (a drop of eight meters). Following this episode, the psychiatric disorder was reversed, after temporary introduction of haloperidol, with no new episodes.

T4 absorption is increased by fasting, and decreased in malabsorption syndromes and by certain foods such as soybeans. In addition, many drugs and foods affect T4 absorption see Drug Interactions (7). TSH may not normalize in some patients due to in utero hypothyroidism causing a resetting of pituitary-thyroid feedback.

He was discharged with a prescription for 50 mcg/day of levothyroxine, without suicidal ideation. The iatrogenic levothyroxine poisoning had precipitated or exacerbated the confusion in this previously weakened patient, thereby leading to psychiatric symptoms that resulted in his jumping. Serum TSH levels should be monitored and the SYNTHROID dosage adjusted during pregnancy. Since postpartum TSH levels are similar to preconception values, the SYNTHROID dosage should return to the pre-pregnancy dose immediately after delivery see Dosage and Administration (2.3). Biotin supplementation may interfere with immunoassays for TSH, T4, and T3, resulting in erroneous thyroid hormone test results.

Use In Specific Populations

Symptoms of levothyroxine overdose include irregular heartbeat, headache, anxiety, agitation, shaking, fatigue, confusion, and disorientation. Certain foods and medications can interfere with the absorption of levothyroxine. The most common medications are aluminum- and magnesium-containing antacids, calcium carbonate, iron, cholestyramine, sucralfate, and sevelamer. To reduce the risk of impaired absorption, it’s recommended to take levothyroxine at least 4 hours before taking any of the medications listed above. Monitor serum free-T4 levels and maintain in the upper half of the normal range in these patients. To minimize the risk of hyperactivity, start at one-fourth the recommended full replacement dosage, and increase on a weekly basis by one-fourth the full recommended replacement dosage until the full recommended replacement dosage is reached.

NP Thyroid

Seizures occurred in a 3-year-old child ingesting 3.6 mg of levothyroxine. Symptoms may not necessarily be evident or may not appear until several days after ingestion of levothyroxine sodium. Initiation of thyroid hormone therapy prior to initiating glucocorticoid therapy may precipitate an acute adrenal crisis in patients with adrenal insufficiency.

Numerous hypotheses have been proposed to explain cognitive decrements in hypothyroidism, including autoimmunity, inflammation, oxidative stress, and altered neurotransmission (50), although none have been proven. In patients with treated hypothyroidism, a leading hypothesis is the concept of “tissue hypothyroidism” in brain areas that subserve mood and cognitive functions. This has been shown most conclusively in animal experiments, but not yet proven in human studies.