Effects of Altering Levothyroxine (L-T4) Doses on Quality of Life, Mood, and Cognition in L-T4 Treated Subjects

Abstract Background The brain is a critical target organ for thyroid hormone, but it is unclear whether variations in thyroid function within and near the reference range affect quality of life, mood, or cognition. Methods A total of 138 subjects with levothyroxine (L-T4)-treated hypothyroidism and...

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Published in:The journal of clinical endocrinology and metabolism Vol. 103; no. 5; pp. 1997 - 2008
Main Authors: Samuels, Mary H, Kolobova, Irina, Niederhausen, Meike, Janowsky, Jeri S, Schuff, Kathryn G
Format: Journal Article
Language:English
Published: Washington, DC Endocrine Society 01.05.2018
Copyright Oxford University Press
Oxford University Press
Subjects:
Adult
Affect - drug effects
Aged
Clinical s
Clinical trials
Cognition
Cognition & reasoning
Cognition - drug effects
Dose-Response Relationship, Drug
Emotional behavior
Executive function
Female
Hormone Replacement Therapy - methods
Humans
Hypothyroidism
Hypothyroidism - blood
Hypothyroidism - drug therapy
Hypothyroidism - psychology
Lability
Male
Memory
Middle Aged
Mood
Motivation
Quality of life
Quality of Life - psychology
Thyroid
Thyroid gland
Thyroid-stimulating hormone
Thyrotropin - blood
Thyroxine
Thyroxine - administration & dosage
Treatment Outcome
ISSN:0021-972X, 1945-7197, 1945-7197
Online Access:Get full text
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Summary:Abstract Background The brain is a critical target organ for thyroid hormone, but it is unclear whether variations in thyroid function within and near the reference range affect quality of life, mood, or cognition. Methods A total of 138 subjects with levothyroxine (L-T4)-treated hypothyroidism and normal thyrotropin (TSH) levels underwent measures of quality of life (36-Item Short Form Health Survey, Underactive Thyroid-Dependent Quality of Life Questionnaire), mood (Profile of Mood States, Affective Lability Scale), and cognition (executive function, memory). They were then randomly assigned to receive an unchanged, higher, or lower L-T4 dose in double-blind fashion, targeting one of three TSH ranges (0.34 to 2.50, 2.51 to 5.60, or 5.61 to 12.0 mU/L). Doses were adjusted every 6 weeks based on TSH levels. Baseline measures were reassessed at 6 months. Results At the end of the study, by intention to treat, mean L-T4 doses were 1.50 ± 0.07, 1.32 ± 0.07, and 0.78 ± 0.08 μg/kg (P < 0.001), and mean TSH levels were 1.85 ± 0.25, 3.93 ± 0.38, and 9.49 ± 0.80 mU/L (P < 0.001), respectively, in the three arms. There were minor differences in a few outcomes between the three arms, which were no longer significant after correction for multiple comparisons. Subjects could not ascertain how their L-T4 doses had been adjusted (P = 0.55) but preferred L-T4 doses they perceived to be higher (P < 0.001). Conclusions Altering L-T4 doses in hypothyroid subjects to vary TSH levels in and near the reference range does not affect quality of life, mood, or cognition. L-T4-treated subjects prefer perceived higher L-T4 doses despite a lack of objective benefit. Adjusting L-T4 doses in hypothyroid patients based on symptoms in these areas may not result in significant clinical improvement. L-T4 doses were adjusted in hypothyroid subjects to achieve low-normal, high-normal, or mildly elevated TSH levels. No effects were seen in quality of life, mood, or cognition after 6 months.
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ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/jc.2017-02668