Quality of life, daily functioning, and symptoms in hypothyroid patients on thyroid replacement therapy: A Dutch survey

Abstract

Objective: To explore the nature and extent of possible residual complaints among Dutch hypothyroid patients using thyroid replacement therapy, we initiated a comprehensive study measuring health-related quality of life (QoL), daily functioning, and hypothyroidism-associated symptoms in patients and control persons.

Methods: An online survey measuring thyroid-specific QoL (ThyPRO), daily functioning, and hypothyroidism-associated symptoms (ThySHI) was distributed among treated hypothyroid patients and control individuals. The advertising text was formulated in an open-ended manner. Patients also provided their most recent thyroid blood values and their thyroid medication.

Results: There was a large-sized impairment of QoL (Cohen's d = 1.04, +93 % ThyPRO score) in hypothyroid patients on thyroid replacement therapy (n = 1195) as compared to controls (n = 236). Daily functioning was significantly reduced i.e., general health (-38 %), problems with vigorous- (+64 %) and moderate activities (+77 %). Almost 80 % of patients reported having complaints despite thyroid medication and in-range thyroid blood values, with 75 % expressing a desire for improved treatment options for hypothyroidism (total n = 1194). Hypothyroid patients experienced 2.8 times more intense hypothyroidism-associated symptoms than controls (n = 865, n = 203 resp). Patients' median reported serum concentrations were: TSH 0.90 mU/L, FT4 17.0 pmol/L, and FT3 2.67 pmol/L, with 52 % having low T3 levels (<3.1 pmol/L). The QoL was not found to be related to age, sex, BMI, menopausal status, stress, serum thyroid parameters, the origin and duration of hypothyroidism, the type of thyroid medication, or the LT4 dose used.

Conclusions: Our study revealed major reductions in quality of life and daily functioning, and nearly three times more intense hypothyroidism-associated symptoms in treated hypothyroid patients as compared to controls, despite treatment and largely in-range serum TSH/FT4 concentrations. The QoL was not associated with serum thyroid parameters. We recommend future research into the origin of persisting complaints and the development of improved treatment modalities for hypothyroidism.

Keywords: Daily functioning; Hypothyroid patients; Hypothyroidism-associated symptoms; Persisting complaints; Quality of life; Thyroid serum parameters.

Graphical abstract

Fig. 1

Quality of Life (QoL, using the ThyPRO, expressed as means) in treated hypothyroid patients (orange, n = 1195) and controls (blue, n = 240). Mean QoL and all domains were significantly more impaired in hypothyroid patients as compared to controls (p < 0.001). Orange = hypothyroid patients (treated with thyroid hormone), Blue = controls. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Daily Functioning of treated hypothyroid patients (n = 1206) and controls (n = 250) (number of respondents, as % of total response). Treated hypothyroid patients had significantly reduced daily functioning as compared to controls on all 3 items (p < 0.001). Red = worst functioning, green = best functioning. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Symptoms (at present, 0–3 scale) in treated hypothyroid patients (right panel, n = 940) and controls (left panel, n = 214), as a percentage of the population. White = score 0 (absent), yellow = score 1(little), orange = score 2 (moderate) and blue = score 3 (intense). All symptoms were significantly more intensely present in treated hypothyroid patients than in controls (p < 0.001). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)