![]() Memory is the most consistently affected domain ( 11– 16), with specific deficits in verbal memory ( 11, 12). Studies report decrements in general intelligence, attention/concentration, memory, perceptual function, language, psychomotor function, and executive function. ![]() Overt hypothyroidism can affect a range of cognitive domains ( 6, 7, 10, 11). Subclinical hypothyroidism is particularly pertinent, because it is common, especially in the older population with prevalent cognitive issues. In reality, these are part of a continuum of hypothyroidism, but they will be discussed separately. Overt hypothyroidism is defined as an elevated serum TSH level with a low free T4 (fT4) level, while mild or “subclinical” hypothyroidism is defined as an elevated TSH with a normal fT4. Hypothyroidism is usually divided into two conditions. The major emphasis will be on studies and reviews published in 2013–2014, although pertinent older studies will be summarized. This review will summarize data on neuropsychiatric (mood and cognitive) effects of adult-onset hypothyroidism, as well as two related issues: effects of variations in thyroid function within the normal range, and effects of nonstandard thyroid hormone therapies. This suggests that L-T4 is often prescribed for marginal reasons, which are commonly neuropsychiatric in nature. In this regard, a recent report from the United Kingdom showed that L-T4 is being prescribed more frequently and for more mild degrees of hypothyroidism ( 4**). ![]() This can lead to overtreatment or use of nonstandard thyroid hormone preparations, with attendant risks. On the other hand, patients with mild hypothyroidism may attribute unrelated symptoms to their thyroid condition. The brain is a major target organ for thyroid hormones, and adult-onset hypothyroidism can have significant effects on neuropsychiatric function ( 1*– 3*). ![]()
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