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TSH-suppressive levothyroxine therapy affects mood, not CNS
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Recent study data show that women receiving thyroid-stimulating hormone-suppressive doses of levothyroxine do not exhibit signs of central nervous system dysfunction, but levothyroxine replacement-treated hypothyroid patients appear to have slight reductions in overall health and mood.
“We found slight decrements in health status and mood in subjects treated with replacement or suppressive doses of [levothyroxine], particularly greater fatigue and depression,” the researchers wrote. “This suggests that the known presence of thyroid disease has a negative effect on patients’ perceived health status and mood.”
In the cross-sectional comparative study, the researchers evaluated three groups of women seen at an outpatient clinic for a single visit. The levothyroxine-suppressed group consisted of 24 women receiving TSH-suppressive doses of levothyroxine. They were aged 22 to 53 years and had normal or slightly high free thyroxine levels. A second group, the euthyroid group, included 35 women aged 21 to 57 years. These patients had been receiving levothyroxine to treat either primary hypothyroidism (n=29); hypothyroidism subsequent to iodine-131 treatment for Graves’ disease (n=3); postpartum thyroiditis leading to permanent hypothyroidism (n=1); or underwent thyroidectomy for nodular goiter or history of low-risk thyroid cancer (n=2). A third control group consisted of 20 healthy women aged 20 to 54 years with normal TSH levels.
During an initial screening visit, all participants were tested for overall health, medications, thyroid status, and mood or cognitive dysfunction based on history, physical examination and laboratory tests. The patients returned 6 weeks later, at which time their thyroid levels were tested again. Participants also filled out various questionnaires pertaining to overall health, psychological symptoms and variability of mood. An experienced research assistant administered cognitive tests pertaining to memory and motor learning.
The researchers hypothesized that the women on the TSH-suppressive dose of levothyroxine would demonstrate decreases in health status and/or mood, and this group showed slight decreases in the SF-36 mental health scales and the SCL90-R obsessive-compulsive subscale. Notably, however, the levothyroxine euthyroid group showed similarly diminished values on these scales, as well as on additional scales pertaining to fatigue, depression and vitality.
The researchers said these findings suggest that patient awareness of thyroid disease may have a greater effect on mood and perceived health than actual thyroid levels.
Disclosure: The researchers report no relevant financial disclosures.
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