Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement
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Intrinsic imperfections of thyroid hormone replacement therapy may affect long-term general well-being. In patients with Hashimoto thyroiditis (HT), cognitive functioning may be affected via altered thyroid hormones action as well as by the autoimmune process. The aim of this study was to evaluate cognitive function and quality of life (QoL) in patients on long-term levothyroxine replacement for HT in relation to thyroid function tests and TPO (thyroid-peroxidase) antibody (TPOAb) status.
Retrospective cross-sectional study.
Patients and measurements
One-hundred-and thirty patients with HT on long-term levothyroxine replacement and 111 euthyroid control subjects. Both groups were divided into two age subgroups, 20–49 years (N = 59 vs N = 79) and > 50 years (N = 71 vs N = 32). Evaluation included biochemical and neuropsychological tests, evaluating attention, global cognitive status, verbal and working memory, executive function, depression and anxiety, and quality of life. We used ANOVA and partial correlations to test for significant associations.
FT4 (free-thyroxine), FT3 (free-triiodothyronine) levels and FT3/FT4 ratio were not different between patients and controls. Mean TSH (thyroid-stimulating hormone) was normal in all subjects but significantly higher in the patients (20–49 yrs:3.64 ± 2.74 vs 1.93 ± 1.10, >50 yrs:3.93 ± 2.84 vs 1.91 ± 0.90). Antibodies (TgAb,TPOAb) were higher in patients. Global cognitive function (MMSE-Mini mental state examination), conceptual tracking (TMT-Trail Making Test:A/B), verbal divergent thinking (like Phonemic fluency test), and anxiety and depression scores were significantly worse in patients vs controls. QoL was impaired in patients. there was a significant negative correlation between antibodies (TPOAb, TgAb) and quality in life (total SF36 score).
Patients on long-term levothyroxine replacement show persistent impairments in both cognitive functioning and general well-being.
KeywordsHypothyroidism Cognitive function Quality of life L-thyroxine Long-term replacement Anti-TPO
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.J. Parle, L. Roberts, S. Wilson et al. Randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: The Birmingham Elderly thyroid study. J. Clin. Endocrinol. Metab. 95, 3623–3632 (2010)CrossRefPubMedGoogle Scholar
- 12.V. Giannouli, N. Syrmos, A 2-year preliminary longitudinal study of neuropsychological functioning in Hashimoto’s thyroiditis under levothyroxine treatment: only Trail Making Test is making a difference. Probl. Psychol. 21st Century 11(1), 15–21 (2017)Google Scholar
- 21.M.D. Pavlovic. Diagnostic tests in Neuropsychology. (Kaligraf, Belgrade, 2003). in SerbianGoogle Scholar
- 22.D. Wechsler. WAIS-R. Wechsler Adult Intelligence Scale-Revised. Manual. (Psychological Corporation, San Antonio, 1981)Google Scholar
- 24.J. Ware, K. Snow, M. Kosinski, B. Gandek. SF-36 Health Survey: Manual and Interpretation Guide. (The Health Institute, Boston), 1993)Google Scholar