Severity of hypothyroidism is inversely associated with impaired quality of life in patients referred to an endocrine clinic.

IF 1.9 Q3 ENDOCRINOLOGY & METABOLISM Thyroid Research Pub Date : 2023-09-01 DOI:10.1186/s13044-023-00178-0
Camilla B Larsen, Kristian Hillert Winther, Per Karkov Cramon, Åse Krogh Rasmussen, Ulla Feldt-Rasmussen, Mogens Groenvold, Jakob Bue Bjorner, Laszlo Hegedüs, Torquil Watt, Steen Joop Bonnema
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Abstract

Purpose: We investigated the association between health-related quality of life (HRQL) and the severity of hypothyroidism at diagnosis in patients referred to a secondary hospital clinic.

Methods: Sixty-seven adult patients referred from primary care were enrolled. All patients had newly diagnosed hypothyroidism due to autoimmune thyroiditis and were treated with levothyroxine (LT4). The dose was adjusted according to thyroid function tests aiming at a normal plasma thyrotropin. Patients were stratified according to the severity of hypothyroidism in two different ways: the conventional approach (subclinical or overt hypothyroidism) and a novel approach according to the change (decrease or increase) in plasma level of free triiodothyronine index (FT3I) following LT4 treatment. The ThyPRO-39 questionnaire was used for measurement of HRQL at referral to the Endocrine Outpatient Clinic (higher score corresponds to worse HRQL).

Results: Free thyroxine index (FT4I) at diagnosis correlated positively with the scores on the Hypothyroid Symptoms and Tiredness scales (p = 0.018 for both). In accordance, patients with subclinical hypothyroidism (n = 36) scored higher on Hypothyroid Symptoms (p = 0.029) than patients with overt hypothyroidism (n = 31). The difference in HRQL was more pronounced if patients were stratified according to the dynamics in FT3I following LT4 treatment. Thus, patients who showed a decrease in FT3I following treatment (n = 24) scored significantly worse for Anxiety (p = 0.032) and Emotional Susceptibility (p = 0.035) than patients with an increase in FT3I (n = 43).

Conclusion: Patients referred to an endocrine clinic with mild hypothyroidism had an impaired HRQL, compared to patients with more severe hypothyroidism. The most likely explanation of this finding is a lower threshold for seeking medical consultation and secondary care referral if HRQL is deteriorated. The dynamics in plasma FT3I following treatment may be more sensitive for such a discrimination in HRQL than a stratification according to the thyroid function tests at diagnosis.

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甲状腺功能减退的严重程度与内分泌门诊患者的生活质量受损呈负相关。
目的:我们调查与健康相关的生活质量(HRQL)与转介到二级医院诊所诊断的甲状腺功能减退患者的严重程度之间的关系。方法:纳入67例从初级保健转介的成年患者。所有患者均为新诊断的自身免疫性甲状腺炎引起的甲状腺功能减退,并接受左旋甲状腺素(LT4)治疗。剂量根据甲状腺功能测试调整,目标是血浆促甲状腺素正常。根据甲状腺功能减退的严重程度,采用两种不同的方法对患者进行分层:常规方法(亚临床或明显甲状腺功能减退)和根据LT4治疗后血浆游离三碘甲状腺原氨酸指数(FT3I)水平的变化(降低或增加)的新方法。采用ThyPRO-39问卷测量转诊至内分泌门诊的HRQL(评分越高HRQL越差)。结果:诊断时游离甲状腺素指数(FT4I)与甲状腺功能减退和疲劳量表得分呈正相关(p = 0.018)。与此同时,亚临床甲状腺功能减退患者(n = 36)在甲状腺功能减退症状上的得分高于显性甲状腺功能减退患者(n = 31) (p = 0.029)。如果根据LT4治疗后FT3I的动态对患者进行分层,HRQL的差异更为明显。因此,治疗后FT3I水平下降的患者(n = 24)在焦虑(p = 0.032)和情绪敏感性(p = 0.035)方面的得分明显低于FT3I水平升高的患者(n = 43)。结论:转介内分泌诊所的轻度甲状腺功能减退患者的HRQL受损,与更严重的甲状腺功能减退患者相比。这一发现最可能的解释是,如果HRQL恶化,寻求医疗咨询和二级保健转诊的门槛较低。治疗后血浆FT3I的动态变化可能比诊断时根据甲状腺功能检查进行分层更敏感。
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来源期刊
Thyroid Research
Thyroid Research Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
3.10
自引率
4.50%
发文量
21
审稿时长
8 weeks
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