Thyroid hormone replacement adequacy and its impact on cognitive function scores in elderly patients with overt hypothyroidism
Bibliographic record
Abstract
Cognitive impairment in elderly hypothyroid patients is widely assumed to be reversible with levothyroxine, yet the degree to which normalisation of thyroid-stimulating hormone (TSH) actually restores cognitive scores in older adults remains contentious. This cross-sectional research assessed the relationship between TSH normalisation on levothyroxine therapy and Montreal Cognitive Assessment (MoCA) scores in 94 patients aged 65 years and older with a documented history of overt hypothyroidism attending a specialist endocrine outpatient clinic at the Melbourne Research Institute of Endocrine Sciences, Melbourne, Australia, between June 2018 and March 2020. Participants were grouped by their most recent TSH value into three categories: euthyroid (TSH ≤ 4.0 mIU/L, n = 52), mildly elevated (4.1-8.0 mIU/L, n = 26), and persistently overt (> 8.0 mIU/L, n = 16). The MoCA was administered by a trained psychometrist blinded to biochemical results. MoCA scores differed significantly across groups (26.8 ± 2.1 vs 24.1 ± 2.7 vs 21.3 ± 3.4; one-way ANOVA p<0.001), and TSH correlated inversely with MoCA (Pearson r = −0.58, p<0.001). After adjusting for age, years of education, and Geriatric Depression Scale score in a multiple linear regression, TSH remained a significant independent predictor of cognitive performance (β = −0.39, p<0.001), while age (β = −0.24, p = 0.006) and education (β = 0.21, p = 0.012) also contributed to the model, which explained 47.8% of MoCA variance. These findings confirm that adequate levothyroxine replacement is associated with preserved cognitive function in elderly hypothyroid patients and that even mildly elevated TSH values carry a measurable cognitive penalty.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".