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J Clin Endocrinol Metab. 2014 Mar;99(3):843-51. doi: 10.1210/jc.2013-3686. Epub 2014 Jan 13.

The effects of levothyroxine replacement or suppressive therapy on health status, mood, and cognition.

Author information

1
Division of Endocrinology, Diabetes, and Clinical Nutrition (M.H.S., I.K., A.S., K.G.S.), Division of Biostatistics (D.P.), and Department of Behavioral Neurosciences (J.S.J.), Oregon Health & Science University, Portland, Oregon 97239.

Abstract

CONTEXT:

TSH-suppressive doses of levothyroxine (L-T4) have adverse effects on bone and cardiac function, but it is unclear whether central nervous system function is also affected.

OBJECTIVE:

The aim of the study was to determine whether women receiving TSH-suppressive L-T4 doses have decrements in health status, mood, or cognitive function.

DESIGN AND SETTING:

A cross-sectional comparison was made among three groups of women in an academic medical center research clinic.

PATIENTS:

Twenty-four women receiving chronic TSH-suppressive L-T4 doses, 35 women receiving chronic replacement L-T4 doses, and 20 untreated control women participated in the study.

INTERVENTIONS:

Subjects underwent testing at a single outpatient visit.

MAIN OUTCOME MEASURES:

We measured health status (SF-36), mood (Profile of Mood States, Symptom Checklist 90-R, Affective Lability Scale), and cognitive function (declarative memory [Paragraph Recall], working memory [N-back, Subject Ordered Pointing], motor learning [Pursuit Rotor, Motor Sequence Learning Test], and executive function [Letter Cancellation Test, Trail Making Test, Iowa Gambling Test]).

RESULTS:

Women receiving TSH-suppressive or replacement L-T4 doses had decrements in health status and mood compared to healthy controls. These decrements were more pronounced in women receiving replacement, rather than suppressive, L-T4 doses. Memory and executive function were not affected in either treated group, compared to healthy controls.

CONCLUSIONS:

Women receiving TSH-suppressive doses of L-T4 do not have central nervous system dysfunction due to exogenous subclinical thyrotoxicosis, but TSH-suppressed and L-T4-replaced women have slight decrements in health status and mood that may be related to self-knowledge of the presence of a thyroid condition or other uncharacterized factors. These mood alterations do not impair cognitive function.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00565864.

PMID:
24423358
PMCID:
PMC3942231
DOI:
10.1210/jc.2013-3686
[Indexed for MEDLINE]
Free PMC Article

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