NEUROPSYCHIATRIC MANIFESTATIONS OF AUTOIMMUNE THYROID DISEASES: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.56238/levv16n53-137Keywords:
Autoimmune Thyroiditis, Graves Disease, Neuropsychiatry, Hashimoto EncephalopathyAbstract
Introduction: Autoimmune thyroid diseases, primarily Hashimoto’s thyroiditis and Graves’ disease, are among the most prevalent endocrine disorders and have profound neuropsychiatric implications. Their autoimmune nature links thyroid dysfunction with a spectrum of cognitive, affective, and behavioral abnormalities, suggesting complex interactions between neuroendocrine and immunological systems. Understanding these associations is essential for accurate diagnosis and integrated patient management.
Objective: The main objective of this systematic review was to synthesize current evidence on the neuropsychiatric manifestations of autoimmune thyroid diseases, including Hashimoto’s thyroiditis, Graves’ disease, and Hashimoto’s encephalopathy. Secondary objectives included evaluating correlations between thyroid antibody titers and psychiatric symptoms, characterizing cognitive impairments, and identifying neuroimaging and immunological biomarkers associated with disease severity.
Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The inclusion criteria encompassed studies published between January 2015 and October 2025 involving adult human populations with autoimmune thyroid disease and reported neuropsychiatric outcomes. Exclusion criteria included iatrogenic or drug-induced thyroid dysfunction and case reports lacking objective neuropsychiatric evaluation. Data extraction followed PRISMA guidelines and methodological quality was assessed using the GRADE framework.
Results and Discussion: Out of 1,263 records identified, 21 studies met inclusion criteria. The most frequent neuropsychiatric manifestations included depression, anxiety, fatigue, cognitive impairment, and autoimmune encephalopathy. Hashimoto’s thyroiditis was particularly associated with cognitive slowing, affective symptoms, and reduced hippocampal volume, while Graves’ disease correlated with anxiety and agitation. Immunological mechanisms such as cross-reactive antibodies, cytokine dysregulation, and blood–brain barrier permeability emerged as major contributors.
Conclusion: Autoimmune thyroid diseases exert multifaceted effects on mental and cognitive health through endocrine and immune mechanisms. Early recognition of neuropsychiatric symptoms is crucial for timely intervention and prevention of chronic disability. Integration of endocrine, neurological, and psychiatric care is essential to achieve comprehensive management and improve patient outcomes.
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