How is Your Brain Working Now? A Questionnaire for Hypothyroid Patients In the Volume XIII, Number 1 issue of The Bridge, we asked patients who had formerly been hyperthyroid how they felt. Most thyroidologists would have guessed along with me that the majority of thyroid patients would have said they felt well, but that wasn t the case. Only 34% of these patients said they felt well. 66% complained of weight gain and 32% felt they were more than 20 pounds over their optimum weight. There is a good deal of research going on right now about weight loss in general and if some research suggests that special techniques work best for thyroid patients with weight problems, we will keep you informed in this newsletter and on our website, www.allthyroid.org. Cognitive Function Complaints Thyroid patients had other concerns that were almost as common. 59% complained of myalgia, lethargy, depression, or a combination of all three, and a surprising number commented without a related question being asked that they felt their brain just wasn t working right. This vague area about how hypothyroid patients feel on their treatment is a particularly hot topic in thyroid research today. Investigators are looking in particular at the question of whether individuals with hypothyroidism feel better with a combination of rapidly acting T3 hormone (cytomel) in addition to the usually prescribed T4 (thyroxine) including Levythroid, Levoxyl, and Synthroid. (See Bridge Vol. XIV, No. 1.) We thought we would take a closer look and try to find out exactly what kind of cognitive problems thyroid patients are experiencing and see if we can get some clues which might help guide researchers into understanding these patients better. If You Take Thyroid, Please Respond! It could be that individuals who are hypothyroid after treatment for Graves disease are different from those whose thyroid has been removed for thyroid cancer or a hyperfunctioning thyroid nodule. Therefore, if you are hypothyroid now from any cause, please complete this questionnaire so we can tell if there are differences in individuals with these different disorders. We re particularly anxious to have patients with cancer who have never been hyperthyroid answer the questionnaire. Obtaining the Results of the Survey If you will send us your address we will send you a copy of the survey report when completed. Your name, address, and/or e-mail will not be shared with anyone else and is only retained by us to be able to send you the report or possibly to contact you if we can t
read your handwriting or want to understand one of your answers to a survey question. Finally, if you know of other individuals who are hypothyroid, please do not hesitate to pass the questionnaire along to them too. Additional copies can be obtained by telephoning our home office at 800-832-8321. Background Information Cognitive Function in Patients with Hypothyroidism Name Last First Middle Initial Address Street City State ZIP Telephone number ( ) - E-mail Your Diagnosis (note all that apply to you): Hyperthyroidism ψ Graves disease (diffuse toxic goiter) ψ Hyperfunctioning thyroid nodule Hypothyroidism Hypothyroidism after treatment for hyperthyroidism ψ Radioiodine ψ Surgery ψ Medication ψ Hypothyroidism due to chronic thyroiditis (Hashimoto s disease) ψ Hypothyroidism after surgery for goiter ψ Hypothyroidism after treatment for thyroid cancer Year of onset of hyperthyroidism Year of onset of hypothyroidism Year of treatment for thyroid cancer: Surgery Radioiodine
Current thyroid medication and dose Date of last TSH blood test to be sure treatment dose is correct Do you have problems with mental function including thinking, concentration, memory, organizing, planning, and distractibility? Yes No If yes, what year did these problems begin? If yes, please answer the questions under A below Do you have problems with depression or sadness Yes No If yes, please write the year(s) when depression occurred If yes, please answer the questions under B below A (Cognitive Function) 1. I have difficulty concentrating. 2. I have a hard time completing tasks. 3. I have trouble getting organized. 4. I have trouble planning how to do something. 5. I am easily distracted. 6. I get mad easily. 7. I have trouble planning to do what is most important. 8. I can t keep track of time. 9. I can t remember appointments. 10. I have trouble paying attention. 11. I feel hyperactive a lot of the time. 12. I am not as productive as I used to be. 13. I feel guilty a lot. 14. It s hard to adjust when plans must be changed. 15. I am impulsive. 17. Because my brain isn t working right, I had to A Lot (Yes) A Little Not at All (No)
change jobs. 18 I am confrontive (argue a lot). B (Depression) 1. I am often moody and sad. 2. I cry a lot. 3. I have trouble sleeping. 4. I have an eating disorder because I am depressed. 5. Sometimes I don t think much of myself. 6. I have been treated for depression with medication. 7. I have been hospitalized for depression. 8. I have an intermittent depression, sometimes feeling well and sometimes depressed. A Lot (Yes) A Little Not at All (No) Childhood recollections and general characteristics 1. I am left-handed. 2. I am right-handed. 3. I am ambidextrous. (Do you do anything lefthanded? Please comment.) A Lot (Yes) A Little Not at All (No) When you fold your arms comfortably in front of your chest, which arm is on top? 4. I have trouble spelling. 5. I have poor handwriting that others often cannot read. 6. I sometimes reverse letters or numbers. 7. I don t read books for pleasure, preferring other sources of information. 8. I stayed back one or more years in school. 9. I have had a diagnosis of dyslexia. (Please state
year.) 10. I have had a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). (Please state year.) 11. I know I am smart, but do not do well in school. 12. I have had trouble with confrontive behavior (fighting or arguing). 13. I have an addictive disorder (gambling, alcohol, smoking). 14. I am a very good athlete. 15. I am a very good musician. 16. I am very artistic. 17. I have trouble with muscle spasm (tics). (Please state years.) The effect of illness and medication on cognitive function I felt better before age 20 than I do now. When I was hyperthyroid, I felt ψ Better (please specify) ψ Worse (please specify) During pregnancy I felt ψ Better (please specify) ψ Worse (please specify) Treatments If you have received any of the following treatments we would like to know whether it helped so that we can encourage thyroid investigators to study these treatments more. Please tell us whether you have been treated with any of the following and say whether it helped a lot, a little, or not at all. Date Helped Helped Did Not
Educational counseling in school Psychotherapy Hospitalization Medications Lithium Amitriptyline Desipramine A Lot A Little Help Welbutrin Prozac Paxil Ritalin Dexedrine Conserta Adderal Tomoxetine Provigil Other (specify) What s Next? Thank you for answering these questions. We hope that by summarizing the experience of a number of thyroid patients we ll be able to tell whether particular patterns of cognitive function seem to be more common inpatients with certain kinds of hypothyroidism. We will send you a copy of the summary and pass it on to thyroid specialists who are investigating these areas in the hope that it will help develop new techniques to treat thyroid patients who are having trouble with cognitive function. Thank you for taking the time to respond to this informal survey. We hope that our efforts will help investigators understand thyroid patients better and enable them to develop new techniques to help those in need. Lawrence C. Wood, M.D., F.A.C.P. Medical Director, TFA e-mail the completed questionnaire to: info@tsh.org or mail to: The Thyroid Foundation of America, Inc., 410 Stuart Street Boston, MA 02116