Cognitive impairment in clinical hypothyroidism

Abstract

AbstractBackgroundHypothyroidism is a highly prevalent disease and has been associated with deficits in cognitive performance. It is generally accepted that these could be related to psychiatric symptoms. Hormone replacement therapy is the gold standard treatment for primary hypothyroidism, and it appears to be effective in correcting serum thyrotropin (TSH) values and the thyroid hormone profile. Despite the correction of the hormonal profile, some patients continue to manifest cognitive and psychiatric symptoms. The possibility of restitution of cognitive performance after achieving euthyroidism is still a matter of controversy, without having reports making any comparisons of the patient himself before and after hormonal treatment.MethodProspective, experimental study, own individual as control.All subjects over 18 years of age who consult the Endocrinology Service of the Churruca Visca Hospital and in whom a diagnosis of clinical hypothyroidism is made, defined by a TSH greater than 10 mIU/L, will be included until a sample size is completed. (N) of 78 patients, calculated for an estimated prevalence of cognitive failure of 40%, including patients who meet criteria for cognitive impairment and those who, even without meeting criteria, show a detriment to their best performance, with an alpha error of 0.05 and a beta error of 0.2, assuming a 50% improvement after treatment.These patients will be referred to the Cognitive Neurology Section of the same Hospital for a complete cognitive evaluation and depression and axiety scales.12 months after the first evaluation, euthyroidism achieved, the same cognitive evaluation will be repeated. The comparison will be made with the subject’s own performance, evaluating the remission of cognitive impairment after the hormonal treatment is installed, and the differences in their performance even without a diagnosis of cognitive impairment, comparing the performance of the subject himself before and after treatment.ResultWe expect to find cognitive impairment, with improvements between the same patient evaluation, before and after hypothyroidsm treatment.ConclusionClinical hypothyroidism is a treatable cause of cognitive failure. Although patients usually present improvements after the start of treatment, some subjects continue to present different cognitive failures once euthyroidism has been achieved.