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. 2025 May 14;14(3):e250044.
doi: 10.1530/ETJ-25-0044. Print 2025 Jun 1.

Prevalence and severity of fatigue in treated hypothyroidism: results of a UK survey

Lydia Grixti, Holly Fisher, Julia Priestley, Cheryl McMullan, Anna Woollven, Petros Perros, Anna Louise Mitchell, Earn H Gan, Simon H Pearce

Prevalence and severity of fatigue in treated hypothyroidism: results of a UK survey

Lydia Grixti et al. Eur Thyroid J. .

Abstract

Background: A substantial proportion of patients taking thyroid hormone replacement for hypothyroidism show persistent symptoms. We sought to explore the prevalence and degree of fatigue in this patient group.

Methods: An online survey including the FACIT-F fatigue scale was distributed by two UK patient support organisations, the British Thyroid Foundation (BTF) and The Thyroid Trust (TTT). Overall, 1,334 responses were received, of which 1,251 were complete, unique and from patients with primary hypothyroidism/Hashimoto thyroiditis who reported taking thyroid hormone replacements.

Results: Ninety eight percent of respondents were women and the mean duration of treatment was 10.8 years (SD: 9.74). The mean fatigue score on the FACIT-F scale was 20.5 (SD: 10.5), with 89% of respondents fulfilling criteria for abnormal fatigue. Fatigue scores were not significantly different between respondents of different ages, gender, treatment type or treatment duration. FACIT-F scores were positively correlated with self-declared overall health state (Pearson r = 0.576, P < 0.001).

Conclusions: Fatigue in treated hypothyroidism is very common, and the FACIT-F scores reported are comparable or worse than those recorded for many other chronic conditions. This study suggests that addressing fatigue in this patient group will be key to improving wellbeing and quality of life.

Keywords: FACIT-F; Hashimoto thyroiditis; fatigue; hypothyroidism; levothyroxine; quality of life; tri-iodothyronine.

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Conflict of interest statement

PP discloses honoraria from IBSA (Institut Biochimique SA). SHP receives speaker fees from IBSA, Merck, Immunovant and is a consultant for Immunovant and Lycia.

Figures

Figure 1
Figure 1
Survey response flowchart. n = number of responses. Total responses were 1,334. Final dataset analysed were 1,251 responses, following elimination of duplicates, incomplete responses, respondents without a diagnosis of primary hypothyroidism and respondents not taking thyroid hormone replacement. Thyroid hormone replacement included levothyroxine (T4) (n = 1,162), combined levothyroxine and liothyronine (T4/T3) (n = 54), DTE (n = 18) and liothyronine alone (n = 17).
Figure 2
Figure 2
(Panel A): the distribution of FACIT-F scores according to thyroid hormone replacement received. All respondents taking any formulation of thyroid hormone replacement (n = 1,251), those on levothyroxine (LT4) n = 1,162, combined levothyroxine (T4) and liothyronine (T3) n = 54, DTE n = 18 and liothyronine (LT3) n = 17. No significant difference is present. Blue lines and error bars are median ± IQR; red dotted line is the threshold (34) for declaring abnormal fatigue (23). (Panel B): the respondents’ perception of overall health state (n = 1,251), scored using an ordinal scale of 0–10 with zero being ‘worst possible health state’ and ten being ‘best possible health state’, showing moderate positive correlation with FACIT-F scores (Pearson r = 0.576, P = < 0.001). Red line shows linear regression, with 5–95% confidence intervals in blue dashed lines.
Figure 3
Figure 3
Survey results of second most troublesome additional symptom, after fatigue. Data represented as percentage of total (n = 1,251).
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