Understanding Brain Fog in Hypothyroidism

brain fog and confusion are symptoms of thyroid
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Many thyroid patients, especially when undiagnosed, untreated, or undertreated for hypothyroidism, complain about a little-understood symptom: brain fog. 

While "brain fog" is not a medical term, it has become a well-recognized description of a group of symptoms that can include:

  • difficulty concentrating
  • short-term and long-term memory problems
  • forgetfulness
  • lack of focus
  • feeling "spaced out;"
  • confusion
  • difficulty with clear thinking
  • feeling inexplicably anxious or irritable
  • feeling tired and unmotivated.

Your brain, along with its many neurotransmitters and hormones, require sufficient levels of thyroid hormone in order to function properly, so it's no surprise that a symptom like brain fog is often reported by patients who have an underactive thyroid and are either not being treated, or who are not receiving sufficient or optimal treatment. 

Amy's Experience With Brain Fog

Amy, a thyroid patient, shared her personal experience and battle with brain fog and hypothyroidism:

Since being diagnosed with hypothyroidism, I have experienced a few very disturbing episodes of "brain fog." I was noticing that my short-term memory was getting significantly worse over about a two-month period. The other symptoms are bad enough, but I absolutely can't abide my brain going on the blink. I mentioned it to my doctor and he ran blood tests. My thyroid levels were in "normal" range. The memory problems continued and got worse, including major difficulty concentrating.

One day at lunch I realized that I just couldn't focus on what the person with me was saying. I couldn't even figure out how to respond to her when she spoke to me. I heard what she was saying but couldn't concentrate enough to formulate a response. I went into a total panic! When I returned to work I immediately called my doctor. I was sure that something dramatic was wrong. Maybe I had a tumor? After a doctor ordered a CT scan (normal) and a lot of web surfing I came across some references to anemia in hypothyroid patients and some symptoms of anemia were similar to what I was experiencing. 

I asked my doctor if he had run a red blood cell count on me. Of course the answer was no, so I asked politely if he would please run a CBC. Sure enough, my numbers were slightly low. After a week of prescription iron, taken at the opposite end of the day from my thyroid meds, it was like a light switch was flipped. My brain turned back on and my short-term memory and concentration problems were gone.

Now if I feel a real slip in my memory/concentration I get a CBC and add iron. For me, even a slightly low iron level causes major brain fog. I could not have survived and finally thrived without sites and info such as this. Educate yourself folks and know your body. It makes a world of difference.

Brain Fog Causes and Solutions

In Amy's case, her brain fog was related to iron deficiency, a condition that is more in people with thyroid conditions. Low iron levels can also contribute to fatigue and hair loss, other common complaints of thyroid patients. 

In addition to iron defciciency, some other common causes of brain fog include: 

  • lack of sleep
  • nutritional deficiencies
  • excessive carbohydrate intake
  • inflammation
  • autoimmune disease

If you are being treated for a thyroid condition, brain fog may be a symptom that your treatment is not optimal. The concept of "optimal" hypothyroidism treatment is not one that is generally recognized by mainstream physicians and endocrinologists. They consider hypothyroidism treatment to be complete when medication returns thyroid blood test levels, primarily the TSH level, to the reference range, or what is referred to as the "normal range."

Integrative and functional physicians, however, focus on several goals for your hypothyroidism treatment:

  • Improvement or resolution of symptoms (among them, brain fog) 
  • Restoration of blood test levels, including TSH, free T4, and free T3 at minimum, to optimal levels, rather than simply levels within the reference range.

For these physicians, optimal levels tend to be as follows:

  • A TSH below 2.0
  • Free T4 and free T3 levels that fall within the top half of the reference range

What Should You Do?

If you have brain fog or other potential thyroid symptoms and are not diagnosed or treated, your first step is to see your physician for a complete thyroid evaluation.

If you are a thyroid patient experiencing brain fog, you should first discuss it with your physician, and consider asking for testing to evaluate your iron levels, as well as thyroid levels, to determine if you need iron supplementation, or a change in your thyroid treatment to ensure that it is optimal. 

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