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Cited by 42Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryMenopause: Health Impacts and Treatments

Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective

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Ettleson, Matthew D., Raine, Ava, Batistuzzo, Alice, Batista, Samuel P., McAninch, Elizabeth, Teixeira, Maria Cristina T.V., Jonklaas, Jacqueline, Laiteerapong, Neda +2 more·2022·Endocrine Practice
DOI 10.1016/j.eprac.2021.12.003PMC PMC8901556
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Abstract

Objective Patient-centered studies have shown that several patients on thyroid hormone replacement therapy for hypothyroidism exhibit persistent symptoms, including "brain fog." Here, we aimed to determine which of these specific symptoms are associated with brain fog, identify patient-reported factors that modify these symptoms, and identify patient concerns related to brain fog not included in thyroid-specific questionnaires. Methods A survey on brain fog symptoms adapted from thyroid-specific patient-reported outcome was distributed online. Textual data analysis was performed to identify common areas of concern from open-ended survey responses. Results A total of 5170 participants reporting brain fog while being treated for hypothyroidism were included in the analysis. Of these, 2409 (46.6%) participants reported symptom onset prior to the diagnosis of hypothyroidism, and 4096 (79.2%) participants experienced brain fog symptoms frequently. Of the symptoms listed, participants associated fatigue and forgetfulness most frequently with brain fog. More rest was the most common factor provided for improving symptoms. The textual data analysis identified areas of concern that are not often included in thyroid-specific quality of life questionnaires, including a focus on the diagnosis of hypothyroidism, the types and doses of medications, and the patient-doctor relationship. Conclusion Brain fog in patients treated for hypothyroidism was associated most frequently with fatigue and cognitive symptoms. Several additional areas of patient concern were found to be associated with brain fog, which are not typically addressed in thyroid-specific questionnaires.

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  • These areas of concern include a focus on the diagnosis of hypothyroidism, the types and doses of medications, and the patient-doctor relationship.

    “These include a focus on the diagnosis of hypothyroidism, the types and doses of medications, and the patient-doctor relationship (33).”

    From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [33]

    The Results section (Textual Data Analysis of Open-Ended Comments; page unavailable) identifies disease/diagnosis, patient/doctor, and medication as categories of patients’ concerns. The Discussion also identifies the patient-doctor relationship as an important concern. The body text does not establish that medication doses specifically were a concern; its mention of dose changes in the Introduction concerns a historical treatment shift, not the patients’ responses. (LLM, conf=0.82)

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  • The textual analysis of open-ended questions in a survey of 5170 participants self-reporting brain fog while being treated for hypothyroidism identified areas of concern that are not often included in thyroid-specific QoL questionnaires.

    “For example, the textual analysis of open-ended questions in a survey of 5170 participants self-reporting brain fog while being treated for hypothyroidism identified areas of concern that are not often included in thyroid-specific QoL questionnaires.”

    From Treatment Preferences in Patients With Hypothyroidism (2025) · cites this paper as [33]

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References 35 · Cited by 42

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Authors
Ettleson, M. D., Raine, A., Batistuzzo, A., Batista, S. P., McAninch, E., Teixeira, M. C. T. V., Jonklaas, J., Laiteerapong, N., Ribeiro, M. O., & Bianco, A. C.
Affiliations
  • University of Chicago (US)
  • Carleton College (US)
  • Universidade Presbiteriana Mackenzie (BR)
  • Stanford Medicine (US)
  • Georgetown University Medical Center (US)
Corresponding author
Ettleson, Matthew D.
ORCID
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2022-03
Volume
28
Issue
3
Pages
257-264
ISSN
1530-891X (ISSN-L)
DOI
10.1016/j.eprac.2021.12.003
PMC
PMC8901556
OpenAlex
W4200057809
Cited by
42
References
35
Citations by year
2026: 4 · 2025: 10 · 2024: 11 · 2023: 9 · 2022: 8
FWCI
5.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR001409)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949, P30DK020595, T32DK007011)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
brain fog, hypothyroidism, thyroid hormone replacement, patient-reported outcomes, fatigue, forgetfulness, cognitive symptoms, patient concerns, physician-patient relationship, quality of life questionnaires, symptom onset
MeSH terms
Brain, Humans, Hypothyroidism, Quality of Life, Surveys and Questionnaires, Thyroxine, Hormone Replacement Therapy

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