ORLANDO (FRONTLINE MEDICAL NEWS) – The quality of life of someone with treated hypothyroidism is worse than that of the general population and requires endocrinologists to think “outside the pill box,” said Anna M. Sawka, MD, PhD, of the University of Toronto, at a spring symposium presented by the American Thyroid Association.

While issues such as whether monotherapy with T4 is the treatment of choice or whether there is a subset of patients who might benefit from treatment with either T4/T3 in combination or even with extract of dessicated thyroid, many patients with treated hypothyroidism continue to feel bad, judging from discussion during the symposium.

Exercise is one effective way of improving patient perceived low quality of life (QoL). While most of the insights on the effects of physical activity on QoL comes from the oncology literature, there is an apparent benefit for patients with hypothyroidism due to Hashimoto’s thyroiditis or thyroidectomy. One study providing direct evidence of this benefit involved 16 hypothyroidism patients who underwent observed stretching and treadmill exercise for 60 minutes twice a week and 17 controls who remained sedentary. The exercise group showed marked improvement in fatigue as well as other aspects of QoL at the end of 12 weeks, while the sedentary group showed no change ( Arq Bras Endocrinol Metab. 2014 Apr;58[3]:274-81 ).

As defined by the CDC, health-related quality of life can be energy level, mood, health risks and condition, functional and socioeconomic status. Here, at this meeting, the focus is on treatment. But QoL is so much more than that. It is recorded by the patient; it’s their perceptions. Of the available disease-specific–measures of QoL, many have not been validated.

One group of researchers assessed four QoL assessment questionnaires and gave top rating to the ThyPRO (thyroid-specific patient reported outcome) questionnaire for use in patients with hypothyroidism due to Hashimoto’s disease or thyroidectomy ( J Clin Epidemiol. 2016 Oct;78:63-72 ).

The ThyPRO looks at two factors that are key to QoL in hypothyroidism: satisfaction with thyroid hormone and symptom control.

Looking at hypothyroidism from the perspective of the patient is catching on in endocrinology. Dr. Sawka reviewed data from 6 studies of QoL in people with treated hypothyroidism. The years of the studies ranged from 2002 to 2017 and the number of patients ranged from 58 to 591. While only one study used the ThyPRO, all found that QoL was worse in patients with treated hypothyroidism than in the general population.

Findings from one study based on in-depth interviews with 16 patients, of whom 5 had hypothyroidism and 11 had hyperthyroidism, showed that a key trait of either condition was that of losing control over their physical and mental states, with the hypothyroid group reporting feeling drained while the others said they felt sped up. The signs of hypothyroidism can be attributed to other things, such as aging or stress, and that ambiguity frustrated the patients in the study. Also key was the experience of having to negotiate their disease, with a keen awareness that their endocrinologist did not validate their experience, that they had to look to lab tests to tell them the state of their disease, and they had to deal with functional limitations ( Qual Health Research. 2015 Jul;25[7]:945-53 ).

Dr. Sawka reported that she has no financial disclosures.


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