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Mary H. Samuels, Cognitive Function in Subclinical Hypothyroidism, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 8, 1 August 2010, Pages 3611–3613, https://doi.org/10.1210/jc.2010-1242
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Over the past 20 yr, there have been major advances in understanding the neural basis for cognitive processes (1, 2). Cognitive domains include attention and concentration, language, memory, psychomotor function, and executive function. These domains map to neural systems that involve multiple, often overlapping brain regions. There are validated neurocognitive tests to measure these domains, mapped to critical brain regions by lesional studies and functional imaging.
Because thyroid hormone has profound effects on the central nervous system, it is logical to ask how hypothyroidism affects cognition. The consequences of overt hypothyroidism (particularly congenital hypothyroidism) are well known and include widespread cognitive deficits that can affect all the domains listed above (3). In contrast, there is less evidence regarding cognitive effects of subclinical hypothyroidism. This unresolved issue is a problem in clinical practice because subclinical hypothyroidism is prevalent in older patients, many of whom already have some cognitive decline. It is not clear whether these patients should be treated to ameliorate further cognitive dysfunction. Two recent systematic literature reviews did not find enough evidence to recommend treatment of subclinical hypothyroidism based on cognitive effects (4, 5).
