ArticleThyroid : official journal of the American Thyroid Association2016
Effect of Thyroid Function Variations Within the Laboratory Reference Range on Health Status, Mood, and Cognition in Levothyroxine-Treated Subjects.
Article in Thyroid : official journal of the American Thyroid Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Effects of Altering Levothyroxine Dose on Energy Expenditure and Body Composition in Subjects Treated With LT4.The Journal of clinical endocrinology and metabolism · 2018Trial
- Effects of Altering Levothyroxine (L-T4) Doses on Quality of Life, Mood, and Cognition in L-T4 Treated Subjects.The Journal of clinical endocrinology and metabolism · 2018Trial
- Clinical thyroidology: beyond the 1970s' TSH-T4 Paradigm.Frontiers in endocrinology · 2025Review
- Evaluating health outcomes in the treatment of hypothyroidism.Frontiers in endocrinology · 2022Review
- Subclinical thyroid dysfunction and major depressive disorder.Hormones (Athens, Greece) · 2021Review
- What Is the Quality of Life in Patients Treated with Levothyroxine for Hypothyroidism and How Are We Measuring It? A Critical, Narrative Review.Journal of clinical medicine · 2021Review
- Reference range: Which statistical intervals to use?Statistical methods in medical research · 2021Article
- Subclinical Hypothyroidism and Depression: Is There a Link?The Journal of clinical endocrinology and metabolism · 2018Article
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Authors and funding
6 authors.
Funding
Abstract
backgroundThere has been recent debate within the thyroid field regarding whether current upper limits of the thyrotropin (TSH) reference range should be lowered. This debate can be better informed by investigation of whether variations in thyroid function within the reference range have clinical effects. One important target organ for thyroid hormone is the brain, but little is known about variations in neurocognitive measures within the reference range for thyroid function.
methodsThis was a cross-sectional study of 132 otherwise healthy hypothyroid subjects receiving chronic replacement therapy with levothyroxine (LT4) who had TSH levels across the full span of the laboratory reference range (0.34-5.6 mU/L). Subjects underwent detailed tests of health status, mood, and cognitive function, with an emphasis on memory and executive functions.
resultsSubjects with low-normal (≤2.5 mU/L) and high-normal (>2.5 mU/L) TSH levels did not differ on most tests of health status, mood, or cognitive function, and there were no correlations between TSH, free T4, or free T3 levels and most outcomes. There was, however, a suggestion that thyroid function affected performance on the Iowa Gambling Task, which mimics real life decision-making. Subjects with low-normal TSH levels made more advantageous decisions than those with high-normal TSH levels.
conclusionsVariations in thyroid function within the laboratory reference range do not appear to have clinically relevant effects on health status, mood, or memory in LT4 treated subjects. However, decision making, which encompasses many executive functions, may be affected. Unless further studies strengthen this finding, these data do not support narrowing the TSH reference range.
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