Summary
Frank hypothyroidism is known to induce neurological and mental dysfunction. The aim of this study was to assess selected neuropsychological and behavioral features by means of standardized tests in a group of 14 patients with subclinical hypothyroidism who were free from neuropsychological complaints and to evaluate the possible effects of l-thyroxine treatment on their performance. Patients were submitted to the Crown and Crisp Experiential Index and to the Wechsler Memory Scale; their ratings on the neurobehavioral tests and their thyroid hormone profile were compared to those of a control group of 50 age- and sex-matched subjects. Comparison was also carried out between pretreatment ratings and those obtained following a 6-month l-thyroxine course (0.1–0.15 mg/day). The Wechsler Memory Scale ratings showed a significant impairment in patients' memory-related abilities [memory quotient (MQ)=89.1 ± 2.9; P=0.002 (patients versus controls)]; the Crown and Crisp Experiential Index ratings demonstrated moderate differences between untreated patients and controls with respect to hysteria (P=0.03), anxiety (P=0.05), somatic complaints (P=0.0005), and depressive features (P=0.002) scales; the total score was also significantly higher (42.0±3.8; P=0.005). After l-thyroxine treatment the patients' performances showed an improvement in memory skills, as evaluated by the Wechsler Memory Scale [MQ = 99.9±4.0; P=0.002 (treated versus untreated)]; somatic complaints (P=0.02) and obsessionality (P = 0.04) ratings and the Crown and Crisp Experiential Index total score (P=0.04) significantly decreased with respect to untreated patients. The remarkable effects of l-thyroxine treatment observed in the present study indicate that patients with subclinical hypothyroidism may require early therapy to provide specific treatment for their neuropsychological alterations and to avoid progression toward frank hypothyroidism.
Similar content being viewed by others
Abbreviations
- TSH:
-
thyrotropin
- TRH:
-
thyrotropin-releasing hormone
- l-T4 :
-
levothyroxine
- TT4 :
-
total thyroxine
- FT4 :
-
free thyroxine
- TT3 :
-
total 3,5,3′-triiodothyronine
- FT3 :
-
free 3,5,3′-triiodothyronine
- WMS:
-
Wechsler Memory Scale
- CCEI:
-
Crown and Crisp Experiential Index
References
Althaus BU, Staub JJ, Ryff-De Leche A, Oberhansli A, Stahelin HB (1988) LDL/HDL changes in subclinical hypothyroidism: possible risk factors for coronary heart disease. Clin Endocrinol 28:157–163
Arem R, Patsch W (1990) Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Arch Int Med 150:2097–2100
Bartalena L, Martino E, Placidi GF, Falcone M, Dell'Osso L, Pacchiarotti A, Pinchera A (1991) Nocturnal serum thyrotropin (TSH) and the TSH response to TSH-releasing hormone: disassociated behavior in untreated depressives. J Clin Endocrinol Metab 73:604–608
Bauer MS, Whybrow PC, Winokur A (1990) Rapid cycling bipolar affective disorders. I. Association with grade I hypothyroidism. Arch Gen Psychiatry 47:427–432
Caron P, Calazel C, Parra HJ, Hoff M, Louvet JP (1990) Decreased HDL cholesterol in subclinical hypothyroidism: the effect of l-thyroxine therapy. Clin Endocrinol 33:519–523
Cowdry R, Wehr T, Zis A, Goodwin F (1983) Thyroid abnormalities associated with rapid cycling bipolar illness. Arch Gen Psychiatry 40:414–420
Crantz FR, Silva JE, Larsen PR (1982) An analysis of the sources and quantity of 3,5,3′-triiodothyronine specifically bound to nuclear receptors in rat cerebral cortex and cerebellum. Endocrinology 110:367–368
Crown S, Crisp AH (1970) Manual of the Middlesex Hospital Questionnaire. Psychological Test Publications. Devon, Barn Staple
Dean JW, Fowler PBS (1985) Exaggerated responsiveness to thyrotrophin releasing-hormone: a risk factor in women with coronary artery disease. Br Med J 290:1555–1561
Evered D (1986) Subclinical hypothyroidism. In: Ingbar SH, Braverman LE (eds) Werner's the thyroid. Lippincott, Philadelphia, pp 1439–1444
Hamburger JI, Kaplan MM (1989) Hypothyroidism. Don't treat patients who don't have it. Postgrad Med 1:67–74
Hein MD, Jackson I (1990) Review: thyroid dysfunction in psychiatric illness. Gen Hosp Psychiatry 12:232–244
Joffe RT (1990) A perspective on the thyroid and depression. Can J Psychiatry 35:754–758
Laurberg P (1990) Hypothyroidism. In: Greer MA (ed) The thyroid gland. Raven, New York, pp 497–535
Lupoli G, Biondi B, Montedoro D, Valletta E, Sessa F, Spinelli L, Ferro G, Lombardi G (1991) Systolic time intervals (STI) in various thyroid disease. Acta Cardiologica 1:87–91
McLarty DG, Ratcliffe WA, Ratcliff JG, Shimmins JG, Goldberg A (1978) A study of thyroid function in psychotic inpatients. Br J Psychiatry 133:211–218
Nemeroff CB (1990) Subclinical hypothyroidism: a review of neuropsychiatric aspects. Int J Psychiatry Med 20:193–208
Nemeroff CB, Simon JS, Haggerty JJ, Evans DL (1983) Antithyroid antibodies in depressed patients. Am J Psychiatry 142:840–843
Nowotny B, Teuber J, an der Heiden W, Schlote B, Kleinbohl D, Schmidt R, Kaumeier S, Usadel KH (1990) Die Rolle des TSH für psychische Veränderungen und Befindlichkeitsänderungen bei Schilddrüsenfunktionsstörungen. Klin Wochenschr 68:964–970
Singer PA (1990) Physiology of thyroid hormone synthesis, secretion, and transport. In: Falk PA (ed) Thyroid disease: endocrinology, surgery, nuclear medicine, and radiotherapy. Raven, New York, pp 27–33
Stein MB, Hude TW (1988) Thyroid indices in panic disorder. Am J Psychiatry 145:745–747
Szabadi E (1991) Thyroid dysfunction and affective illness. Br Med J 302:923–924
Wechsler D (1960) Wechsler Memory Scale — Form 1. The Psychological Corp., New York
Wenzel K, Meinhold H, Raffenberg M, Hadlekofer F, Schleusener H (1974) Classification of hypothyroidism in evaluating patients after radioiodine therapy by serum cholesterol, T3 uptake, total T4, FT4 index, total T3, basal TSH, and TRH test. Eur J Clin Invest 4:141–148
Wolfe LK (1989) Subclinical hypothyroidism. Southern Med J 6:679–680
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Monzanil, F., Del Guerra, P., Caracciol, N. et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of l-thyroxine treatment. Clin Investig 71, 367–371 (1993). https://doi.org/10.1007/BF00186625
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00186625