Quality of Life in Patients with Biologically Controlled Primary Hypothyroidism: Assessment and Relationship with TSH Level
DOI:
https://doi.org/10.35516/jmj.v59i3.2541Keywords:
Hypothyroidism, Quality of life, Treatment adherence, Questionnaire, TSHAbstract
Some biologically well-controlled patients with primary hypothyroidism (PH) report persistent symptoms which can impact their quality of life (QoL). The aim of this study was to evaluate the QoL of patients with biologically controlled PH, and to determine the cutoff value of TSH associated with a better QoL.
Methods: This was a cross-sectional study including 70 adult patients with biologically controlled PH (TSH in the normal range). QoL was assessed by the SF36 questionnaire and treatment adherence was assessed by the Girerd questionnaire.
Results: The patients mean age was 51.2±9.6 years and the sex ratio (Men/Women) was 0.08. The mean duration of hypothyroidism was 8.4±6.7 years and the mean TSH level was 2.29±0.92mIU/L [0.62–4.25]. The mean value of the overall SF36 score was 61.11±23.8%. QoL was good in 53% of cases and impaired in 47% of cases. The altered items were related to physical state, perceived health, vitality, and psychological health. The TSH value at the time of the study was the only factor associated with impaired QoL (2.55±0.97 vs 2.05±0.80 mIU/L; p=0.024). A TSH>2.45mIU/L was the cutoff value associated with impaired QoL (p=0.015). After multivariate analysis, a TSH level > 2.45 mIU/L remained the only factor independently associated with impaired QoL.
Conclusions: Nearly half of patients with biologically controlled PH had impaired QoL. A TSH between 0.4 and 2.45 mUI/L is the target value to be achieved by the replacement therapy to improve the QoL of these patients.
References
Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022 May;8(1):30.
Bettaieb J, Wafa A, Salah R, Salah F, Mrabet A. Quality of life of working women: Results of a tunisian study using the 36 item short from health survery questionnaire (SF-3-6). Tunis. Med. 2015 Oct;93(10):623-7.
Chelbi S., Abdesslam H., Bendag N., Sallaouti M., Naceur K. Ben, Oueslati I et al. Diabétiques type 2 : observance thérapeutique et Ramadan. Annales d'Endocrinologie. Sep 2018; 79: 484
Kelderman Bolk N, Visser TJ, Tijssen JP, Berghout A. Quality of life in patients with primary hypothyroidism related to BMI. Eur J Endocrinol. 2015 Oct;173(4):507-15.
Al Quran T, Bataineh Z, Al Mistarehi AH, Okour A, Beni Yonis O, Khassawneh A, et al. Quality of life among patients on levothyroxine: a cross-sectional study. Ann Med Surg. 2020 Oct;60:182-7.
Djurovic M, Pereira AM, Smit JA, Vasovic O, Damjanovic S, Jemuovic Z, et al. Cognitive functioning and quality of life in patients with Hashimoto thyroiditis on long-term levothyroxine replacement. Endocrine. 2018 Oct;62(1):136-43.
Sawicka Gutaj N, Ruchala M, Feldt Rasmussen U, Rasmussen ÅK, Hegedüs L, Bonnema SJ, et al. Patients with benign thyroid diseases experience an impaired sex life. Thyroid. 2018 Oct;28(10):1261-9.
Mitchell AL, Hegedüs L, Žarković M, Hickey JL, Perros P. Patient satisfaction and quality of life in hypothyroidism: an online survey by the british thyroid foundation. Clin Endocrinol. 2021 Mar;94(3):513-20.
Werneck FZ, Coelho EF, Almas SP, Garcia MM, Bonfante HM, Lima JP, et al. Exercise training improves quality of life in women with subclinical hypothyroidism: a randomized clinical trial. Arch Endocrinol Metab. 2018 Oct;62(5):530-6.
Morón Díaz M, Saavedra P, Alberiche Ruano MP, Rodríguez Pérez CA, López Plasencia Y, Marrero Arencibia D, et al. Correlation between TSH levels and quality of life among subjects with well-controlled primary hypothyroidism. Endocrine. 2021 Apr;72(1):190-7.
Walsh JP, Shiels L, Lim EM, Bhagat CI, Ward LC, Stuckey BA, et al. Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J Clin Endocrinol Metab. 2003 Oct;88(10):4543-50.
Mithal A, Dharmalingam M, Tewari N. Are patients with primary hypothyroidism in India receiving appropriate thyroxine replacement? An observational study. Indian J Endocrinol Metab. 2014 Jan;18(1):83-8.
Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T 4 and T 3 in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.
Hansen PS, Brix TH, Sørensen TA, Kyvik KO, Hegedüs L. Major genetic influence on the regulation of the pituitary-thyroid axis: a study of healthy Danish twins. J Clin Endocrinol Metab. 2004 Mar;89(3):1181-7.
Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, et al. Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case–control study in women undergoing thyroidectomy for benign goiter. Thyroid. 2011 Feb;21(2):161-7.
Watt T, Watt T, Hegedüs L, Hegedüs L, Bjorner JB, Bjorner JB, et al. Is Thyroid autoimmunity per se a determinant of quality of life in patients with autoimmune hypothyroidism? Eur Thyroid J. 2012 Oct;1(3):186-92.
Márquez A, Finol HJ, De Blanco MC, Adjounian H, Pulido Méndez M. Skeletal muscle microvascular alterations in euthyroid and hypothyroid patients with autoimmune thyroid disease. J Submicrosc Cytol Pathol. 2001 Oct;33(4):425-32.
Wiersinga WM. T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity. Endocrinol Metab (Seoul). 2021; 36(5):938-951.
Millan-Alanis JM, Gonzalez-Gonzalez JG, Flores-Rodríguez A, et al. Benefits and harms of levothyroxine/L-triiothyronine versus levothyroxine monotherapy for adult patients with hypothyroidism: systematic review and meta-analysis. Thyroid 2021; 31:1613–25..
