Fatigue common with ‘brain fog’ among adults with hypothyroidism
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Lack of energy, forgetfulness and feeling sleepy are the most common symptoms adults with hypothyroidism face with “brain fog,” a phrase patients use to describe a type of cognitive dysfunction, according to a speaker.
“There are many patients with hypothyroidism that experience brain fog,” Matthew Ettleson, MD, a clinical fellow at the University of Chicago, told Healio. “Fatigue appears to be the most prominent symptom that patients associate with brain fog. Lifestyle changes focusing on rest and relaxation seem to be the major strategies to alleviate brain fog symptoms.”
Adults with hypothyroidism were invited through hypothyroid support groups and the American Thyroid Association to complete an online survey about patient satisfaction and symptom severity. Responses were recorded using a 4-point Likert scale and in free text format. Factors that improved or worsened brain fog were reviewed and ranked by frequency. Researchers used Kendall rank correlation coefficients to measure the association between symptom severity and patient satisfaction. The findings were presented at the American Association of Clinical Endocrinology annual meeting.
Of the 5,282 people responding to the survey, 905 reported brain fog symptoms shortly after the diagnosis of hypothyroidism. There were 432 respondents with brain fog who underwent thyroid surgery or radioactive iodine therapy. Difficulty focusing (tau-b = 0.431), mental confusion (tau-b = 0.382) and difficulty making decisions (tau-b = 0.367; P < .001 for all) were the three symptoms most strongly correlated with patient satisfaction score.
The most frequent symptoms respondents listed were lack of energy, forgetfulness and sleepiness. Changes to behavior or diet and thyroid hormone replacement were the factors that most frequently improved or worsened brain fog symptoms. Ettleson said there was a wide variety of responses participants gave when asked about how they deal with their symptoms.
“Many patients are finding their own ways to cope with brain fog symptoms,” Ettleson said. “As clinicians, it is imperative that we participate in that challenge and try to assist patients, even if their thyroid function tests are normal.”
Ettleson said he believes that the findings can help providers offer lifestyle modifications to alleviate symptoms in addition to checking thyroid hormone status and adjusting hormone replacement.
He said future research should examine symptoms and the mechanisms behind them in greater detail.
“Further research is needed to explore how different forms of thyroid hormone — thyroxine vs. triiodothyronine — affect brain fog symptoms,” Ettleson said. “The effect of specific lifestyle changes, in particular sleep habits, on brain fog symptoms should be examined in the context of hypothyroidism.”
Perspective
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The term “brain fog” has been used to describe cognitive dysfunction among patients treated for hypothyroidism. In this study, over 5,000 patients with hypothyroidism were surveyed to characterize the prominent symptoms experienced and the correlation between symptom severity and patient satisfaction, and to look for factors that improve or worsen this cognitive dysfunction. Seventeen percent of individuals reported onset of brain fog symptoms weeks to months after diagnosis of hypothyroidism. Fatigue was the most prominent symptom reported. Difficulty focusing, mental confusion and difficulty making decisions were strongly correlated with patient satisfaction scores. Lifestyle and behavioral modifications and adjustment of thyroid hormone doses were the most important factors that improved or worsened symptoms.
As clinicians, we struggle to help patients with persistent symptoms, despite adequate treatment with thyroid hormone. Over 58% of subjects in this study attributed improvement in their symptoms to adequate rest and relaxation, followed by exercise and some dietary modifications. Interestingly, 46% of subjects reported “brain fog” symptoms prior to their diagnosis of hypothyroidism, which points to a multifactorial etiology of this condition. This study emphasizes the importance of engaging our patients in a conversation about behavioral and lifestyle modifications, in addition to adequate thyroid hormone supplementation, to achieve optimal health.
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Ettleson M. Seeing through the fog: Characterizing “brain fog” in those treated for hypothyroidism. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).
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