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Neurologic manifestations of hyperthyroidism and Graves' disease

Devon I Rubin, MD
Section Editors
Michael J Aminoff, MD, DSc
Douglas S Ross, MD
Deputy Editor
Janet L Wilterdink, MD


Hyperthyroidism is a common medical condition in the general population. The most common cause of hyperthyroidism is Graves' disease, but elevated thyroid hormone levels may occur due to thyroiditis, multinodular goiter, toxic thyroid nodule, or excess thyroid hormone supplementation.

Common systemic features of hyperthyroidism include palpitations, heat intolerance, and weight loss. A number of central and peripheral nervous system manifestations may also occur in patients with hyperthyroidism (table 1). In many cases, the neurologic manifestations occur in conjunction with the systemic features of the disease, but these may be the presenting symptom in some patients.

This topic reviews the neurologic manifestations of hyperthyroidism. Other clinical features of hyperthyroidism are discussed separately. (See "Overview of the clinical manifestations of hyperthyroidism in adults" and "Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents".) The diagnosis of hyperthyroidism is also discussed separately. (See "Diagnosis of hyperthyroidism".)


Cognitive impairment is common in hyperthyroidism and may present as one or more different syndromes. In one review of elderly patients with hyperthyroidism, dementia and confusion was found in 33 percent and 18 percent of patients, respectively [1]. Studies in younger individuals with newly-diagnosed or induced hyperthyroidism have found lower cognitive scores compared with controls [2-4].

There is also inconclusive evidence suggesting that mild hyperthyroidism may be a risk factor for dementia. Case control and population-based cohort studies have had conflicting results, with some finding a positive association between low thyrotropin (TSH) levels and others not [5-9]. Low TSH in this setting may represent subclinical hyperthyroidism, but may instead be associated with hypothyroidism if it is the result of decreased thyrotropin-releasing hormone production, itself a consequence of neurodegeneration. (See "Neurologic manifestations of hypothyroidism", section on 'Alzheimer disease'.)

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Literature review current through: Dec 2017. | This topic last updated: Jun 06, 2016.
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