This lack of consistency across studies is a challenge since little research has been conducted specifically in hypothyroid people reporting cognitive symptoms. There is significant variation in how brain fog is studied and what outcome measures are used. In a recent joint conference held by the American, British, and European Thyroid Associations, thyroid-associated brain fog was defined as “mental cloudiness or lack of mental alertness” ( 16). Findings usually indicate deficits in focused and sustained attention, memory recall, and multitasking. A variety of other clinical populations whose medical conditions do not directly involve the central nervous system have similar cognitive symptoms and dysfunction, including patients with cancer treated with chemotherapy ( 8), the menopausal transition ( 9), postural tachycardia syndrome ( 10), chronic fatigue syndrome (CFS) ( 11), celiac disease ( 12), non-celiac gluten sensitivity ( 12), systemic lupus erythematosus ( 13), hypoparathyroidism ( 14), and recently post-Covid-19 infection ( 15). These two approaches are complimentary, as they measure overlapping but nonidentical variables.īrain fog symptoms are not unique to people with hypothyroidism. Cognitive dysfunction can be assessed through patient report (e.g., symptom questionnaire) or objective performance-based tests. The term is applied to a symptom complex that has been described in various ways in the literature but always involves some level of cognitive dysfunction. The term brain fog is broadly used to describe what individuals experience when their cognitive functioning is not as sharp as usual, but there is no standard definition nor diagnostic criteria. This narrative review summarizes the literature regarding (what we call) hypothyroid-associated brain fog in adult patients, data from other pertinent conditions, and areas for further research in this understudied condition. Persistent brain fog symptoms are distressing to patients, may be associated with decreased adherence to LT4 therapy ( 7), and may lead patients to seek higher doses of LT4 or alternative therapies, including combined LT4/liothyronine (LT3) therapy or desiccated thyroid extract (DTE), despite lack of evidence supporting these alternate therapies. Retrospective data suggest that many patients experience brain fog symptoms before the diagnosis of hypothyroidism ( 4) and are disappointed when LT4 therapy does not resolve all their symptoms ( 5, 6). Patients call this symptom constellation “brain fog” ( 4). Common symptoms are fatigue, depressed mood, and cognitive difficulties, including problems with memory and word-finding, and these symptoms tend to cluster. However, 10–15% report residual symptoms, poor quality of life, and dissatisfaction with LT4 treatment despite normal thyrotropin (TSH) levels ( 1–3). Levothyroxine (LT4) monotherapy is standard of care for hypothyroidism, and most hypothyroid patients are satisfied with LT4 treatment.
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