Beyond hormone replacement: A systematic review of lifestyle, cognition, and psychological well-being in hypothyroidism

Background:-Hypothyroidism is an endocrine disorder that may affect physical health, cognitive performance, emotional functioning, and health-related quality of life. Thyroid hormone replacement is the standard treatment when indicated, but some individuals continue to report fatigue, reduced concentration, memory complaints, sleep disturbance, depressive symptoms, or impaired daily functioning. Non-dietary lifestyle and behavioural factors may be associated with these outcomes, although their direction and clinical significance can be difficult to establish. A careful synthesis should distinguish observational associations from intervention effects and should consider differences in hypothyroidism classification, treatment status, and outcome measurement. Objective:-To systematically review evidence on non-dietary lifestyle and behavioural factors associated with cognitive function and psychological well-being in people with overt or subclinical hypothyroidism, and to evaluate the effects of lifestyle-based interventions on cognitive, psychological, and other patient-centred outcomes.