Acute confusional state caused by Hashimoto’s encephalopathy in a patient with hypothyroidism: a case report

T3-responsive genes in brain areas show decreased T3 effects in these mice, and the behavioral deficits are improved more with LT4/LT3 than LT4 monotherapy (16,57). A study evaluated the effect of long-term thyroid hormone therapy on bone mineral density in 196 women (mean age, 74.4 years) compared to a control group comprised of 795 women (mean age, 72.1 years). The mean daily thyroxine dose was 1.99 mcg/kg (range, 0.3 to 6.6 mcg/kg) with a mean duration of therapy of 20.4 years (range, less than 1 to 68 years). Women taking daily doses of 1.6 mcg/kg or more had significantly lower bone mineral density levels at the ultradistal radius, midshaft radius, hip, and lumbar spine compared to controls.

• Children can take the medicine if the tablet is crushed and put into about 1 to 2 teaspoons of water; do not store or delay giving this crushed pill suspension.
• Nonspecific electroencephalographic (EEG) abnormalities are seen in 90 to 98 percent of patients with the most common finding being nonspecific slowing of background activity 9.
• Learning to manage your energy levels, gentle exercise and incorporating relaxation activities can all help to improve wellbeing.
• Levothyroxine is a synthetic version of the main hormone of the thyroid gland, known as thyroxine (T4).

Pregnancy and fertility in thyroid disorders

• Tell any doctor, dentist, or surgeon who treats you that you are using Synthroid.
• Consumption of certain foods and beverages such as soybean flour, cotton seed meal, walnuts, grapefruit juice, coffee, and dietary fiber can decrease the absorption of levothyroxine.
• Some side effects of levothyroxine may occur that usually do not need medical attention.
• If someone takes too much levothyroxine, symptoms might not occur for several days.
• There were some limitations to these studies, including relatively mild degrees of subclinical hypothyroidism, and a high rate of normalization of TSH levels in the placebo group in one study (36).

Do not administer in foods that decrease absorption of SYNTHROID, such as soybean-based infant formula see Drug Interactions (7.9). Levothyroxine toxicity is rare, but it can sometimes occur accidentally, especially in children. If someone takes too much levothyroxine, symptoms might not occur for several days.

5 Antidepressant Therapy

• In reality, these are part of a continuum of hypothyroidism, but they will be discussed separately.
• However, taking tablets irregularly can upset your hormone balance and aggravate the psychological symptoms.
• For pregnant patients with pre-existing hypothyroidism, measure serum TSH and free-T4 as soon as pregnancy is confirmed and, at minimum, during each trimester of pregnancy.
• Doctors often may have to slowly increase the dose; patients should not increase or decrease this medication themselves.

Although mainstream sources of information provide balanced perspectives, there are many sources such as the internet or social media that promulgate skewed information and opinions, which could affect reports of symptoms. In a relevant study, women with breast cancer were interviewed regarding cancer-related cognitive problems (87). Half of the women received a letter before the interview that described the occurrence of cognitive complaints in cancer, while the other half received a neutral letter.

Patients were asked what was the cause of their hypothyroidism, how often the symptom presented, what time of the day, what made it better and what other symptoms were present when feeling brain fog. Complementing these thyroid-targeted approaches, successful strategies from other disease states include optimizing rest, sleep, exercise, and nutrition, and reducing stress. In some cases, referrals to specialists in occupational therapy, physical therapy, nutrition, and/or stress management may be beneficial. Co-existing medical problems such as obesity, iron deficiency, vitamin D deficiency, and sleep and mood disorders, which are common in the general population and hypothyroid people, should be diagnosed and treated. Overt hypothyroidism can affect a range of cognitive domains (6, 7, 10, 11). Studies report decrements in general intelligence, attention/concentration, memory, perceptual function, language, psychomotor function, and executive function.

Psychiatric and cognitive manifestations of hypothyroidism

The women who received the letter describing this association reported significantly more cognitive symptoms, suggesting that they were primed to notice or report symptoms. This may also occur in people with hypothyroidism and should be considered when counseling patients and designing research studies. In adult patients with primary hypothyroidism, monitor serum TSH levels after an interval of 6 to 8 weeks after any change in dosage. In patients on a stable and appropriate replacement dosage, evaluate clinical and biochemical response every 6 to 12 months and whenever there is a change in the patient’s clinical status.

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects. Enter medications to view a detailed interaction report using our Drug Interaction Checker. Do not share this medicine with another person, even if they have the same symptoms you have.

Cognitive symptoms of people with hypothyroidism include memory problems and difficulty concentrating. Hashimoto’s Encephalopathy should be considered in the differential diagnosis of an acute confusional state since it is responsive to steroid therapy and represents a readily reversible cause acute mental status changes. Clues to this diagnosis include elevated antithyroid antibodies, abnormal Thyroid stimulating hormone values, and exclusion of other causes of acute mental status changes.

Retrospective data suggest that many patients experience brain fog symptoms before the diagnosis of hypothyroidism (4) and are disappointed when LT4 therapy does not resolve all their symptoms (5,6). One particular symptom that patients often report is brain fog, which is described as a group of symptoms including low energy, forgetfulness, sleepiness and difficulty focusing. Interestingly, while this symptom is frequently reported in patients with hypothyroidism, it is also reported by patients with other medical conditions, such as lupus, chronic fatigue syndrome, COVID-19 (“long COVID”) and depression. Because brain fog is not specific to one particular medical problem, it is difficult to manage.

These interactions can be avoided if levothyroxine is taken at least 30–60 minutes before consuming any of these foods and beverages. It’s generally safe to drink alcohol as long as the alcohol is not consumed at the same time as the levothyroxine dose. Oral levothyroxine sodium is a synthetic T4 hormone that exerts the same physiologic effect as endogenous T4, thereby maintaining normal T4 levels when a deficiency is present. The recommended daily dosage of SYNTHROID in pregnant patients is described in Table 3. Levoxyl adipex synthroid treats hypothyroidism (low thyroid hormone) and treats or prevents goiter.

Approximately 80% of the daily dose of T4 is deiodinated to yield equal amounts of T3 and reverse T3 (rT3). Thyroid hormones are also metabolized via conjugation with glucuronides and sulfates and excreted directly into the bile and gut where they undergo enterohepatic recirculation. Reduce the SYNTHROID dosage or discontinue temporarily if signs or symptoms of overdosage occur. Initiate appropriate supportive treatment as dictated by the patient’s medical status.