Brain Fog in Hypothyroidism: Understanding the Patients Perspective

Also, patients reported that the relationship between the patient and their doctor was particularly important in the management of brain fog. 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). 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).

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.
In some cases, the fatigue and/or lethargy may be transient and only occur during early stages of treatment when dosing isn’t fully calibrated.
If you struggle with attention, critical thinking, planning, and problem solving after taking synthroid – there’s a good chance it’s from the medication.
Because these symptoms are generally subjective, doctors can consider them too mild or unspecific to diagnose cognitive impairment.

Term of administration

Improved patient education could address these expectations and motivate patients to engage in other interventions that could improve their symptoms, as summarized in the next section. Another potential bias is a tendency for hypothyroid patients to assume that higher doses of LT4, or perhaps alternate thyroid preparations, are intrinsically superior to standard LT4 therapy. Be sure that you’re taking synthroid on an empty stomach, as a standalone agent (without other medications unless instructed by your doctor), at a precise time each morning, and at least 30 to 60 minutes before consuming food. Following these exact dosing instructions may prevent certain side effects from occurring and maximize likelihood of therapeutic efficacy. Synthroid is a medication with a NTI (narrow therapeutic index), and as such, if the dosage is slightly “off” – unnecessary side effects may ensue.

Dosing specifics

The overall combined symptom burden was highest for fatigue, forgetfulness, sleepiness, and difficulty focusing. Know that synthroid could cause you to sweat excessively throughout the day, leaving your school/work clothing soaked by the afternoon. While not everyone will experience and/or notice daytime sweating, others may notice that their bed sheets are drenched in sweat upon waking. Synthroid elicits a profound effect on the endocrine system, which can affect thermoregulation and ultimately lead to increased sweating.

Patients over 16 years-old who experience brain fog in spite of treatment were included in the study.
Most individuals won’t swell to gigantic proportions, but it may be obvious that some swelling has occurred.
A subset of users report that after taking synthroid they don’t get enough quality sleep, while others report sleeping too much (oversleeping).
Negative impact scores represent the frequency at which each participant rated brain fog negatively affects their life, where 1 indicated never and 4 indicated all the time.

What other conditions can cause brain fog symptoms?

The emergence of new side effects should be carefully monitored, as they may progressively worsen with continued treatment. It is possible that your dosage may need adjusting and/or that a different medication may reduce the occurrence of tremors. Synthroid may be altering neural activation and/or neurotransmission throughout your brain, which in turn could cause you to feel more irritable than usual.

It may turn out that the side effects you thought were from synthroid, were actually from another co-administered substance. It is ultimately a personal decision as to whether you’d like to continue taking synthroid, switch to another medication, and/or alternative intervention. You may find it helpful to keep a journal of your entire synthroid treatment to determine how you feel over a long-term span, rather than being prisoner to short-term, transient, or moment-by-moment side effects. If you feel as if synthroid isn’t a good fit for your neurophysiology, discuss this with your doctor. Assuming your dosage is properly calibrated, yet you’re synthroid appearance still feeling sleepy – it is possible that the tiredness/sleepiness is caused by neurochemical changes and/or interference with sleep.

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. Triiodothyronine (T3) is the active thyroid hormone in the brain and other tissues, and most T3 in the brain is produced locally through regulated deiodination of thyroxine (T4) by the type 2 deiodinase (DIO2) (51). This informs the question of whether the thyroid field already has validated tools to measure brain fog in treated hypothyroid patients, or whether we need to develop new disease-specific instruments.

Does the type of thyroid hormone replacement affect brain fog symptoms?

Discuss all potential interventions with a doctor and consider consulting a sleep specialist. Minimizing your stress response via activities such as deep breathing and/or meditation may reduce the severity of insomnia as a side effect. A future avenue of research involves adding vitamin E to LT4 therapy as some scientists believe it will increase its effectiveness for cognitive symptoms because it protects the brain from free radicals. Some brains had a normal appearance, while others had alterations in white matter, reduced blood supply, swelling, and injuries 78, 79, 80, 81, 82. Untreated hypothyroidism may lead to dementia in adults and irreversible brain damage in children with inborn hypothyroidism 40, 41. Improving gut health is one way to improve the efficacy of the immune system, which can have a positive effect on brain and thyroid function.

Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective

Small changes in executive functioning have also been noted in untreated or under-treated hypothyroidism. Executive functioning includes abilities such as planning, impulse control, and making decisions. Both hypothyroidism and hyperthyroidism can also cause cognitive problems that can mimic symptoms of mild dementia.

What do your genes tell you about your health?

Unlike most other conditions which cause brain fog, a close temporal relation between symptom onset and the diagnosis of hypothyroidism is often not the case. This raises the question of how much of the symptom complex is actually due to hypothyroidism and/or inadequate treatment. The textual analysis opens a new window into the concerns exhibited by some patients with hypothyroidism and brain fog. These concerns have been missed because they are not addressed in commonly used questionnaires that focus mostly on residual thyroid-related symptoms.

In addition to further psychoeducation, neuropsychologists can provide cognitive rehabilitation, which has been shown to be beneficial in a variety of clinical populations with cognitive symptoms, including attention, memory, and executive function (72–79). If you’ve been taking synthroid along with food and/or later in the day than is medically recommended, it may decrease the likelihood that you’ll attain therapeutic benefit. Time of synthroid dosing is of critical importance not only to ensure that synthroid is properly absorbed, but to minimize likelihood of side effects and/or interactions. To decrease propensity of side effects related to dosage timing, synthroid is recommended to be taken at the exact same time each day. While sleep may normalize after weeks (or months) of synthroid treatment, a hypnotic may be prescribed to ensure that sleep disturbances aren’t taking an additional toll on your health.