Association between thyroid dysfunction and cognitive impairment in type 2 diabetes mellitus: A cross‐sectional study

OBJECTIVE: To investigate the association between thyroid dysfunction and cognitive impairment in patients with type 2 diabetes mellitus (T2DM). METHODS: In this cross-sectional study, 486 adult T2DM patients between January 2022 and January 2024 were enrolled. General clinical data and laboratory parameters [glycated hemoglobin (HbA1c), thyroid-stimulating hormone (TSH), free thyroxine (FT4)] were collected. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA <26 defined impairment). Patients were categorized into euthyroid, hypothyroid, and hyperthyroid groups based on TSH and FT4 levels. Multivariable logistic regression was used to analyze independent associations, followed by dose-response and subgroup analyses. RESULTS: The hypothyroid group had significantly lower MoCA scores and a higher prevalence of cognitive impairment compared to other groups (all P < 0.001). Hypothyroidism was an independent risk factor for cognitive impairment (P = 0.002), whereas hyperthyroidism showed no significant association. Other independent risk factors included age, BMI, diabetes duration, hypertension, and coronary heart disease (P < 0.05). A significant linear dose-response relationship was observed between increasing TSH levels and higher risk of cognitive impairment (P < 0.05), while FT4 showed a non-significant decreasing trend (P = 0.08). The association of hypothyroidism with cognitive impairment was consistent across all subgroups (all P > 0.05). CONCLUSION: Hypothyroidism is an independent risk factor for cognitive impairment in T2DM patients, with a progressive risk increase associated with higher TSH levels. These findings underscore the importance of integrating thyroid function evaluation into the cognitive assessment and management strategy for this patient population.