Disease-Specific as Well as Generic Quality of Life Is Widely Impacted in Autoimmune Hypothyroidism and Improves during the First Six Months of Levothyroxine Therapy

Kristian Hillert Winther, Per Cramon, Torquil Watt, Jakob Bue Bjorner, Ola Ekholm, Ulla Feldt-Rasmussen, Mogens Groenvold, Åse Krogh Rasmussen, Laszlo Hegedüs, Steen Joop Bonnema, Kristian Hillert Winther, Per Cramon, Torquil Watt, Jakob Bue Bjorner, Ola Ekholm, Ulla Feldt-Rasmussen, Mogens Groenvold, Åse Krogh Rasmussen, Laszlo Hegedüs, Steen Joop Bonnema

Abstract

Background: Hypothyroidism is often diagnosed, and subsequently treated, due to health-related quality of life (HRQL) issues. However, HRQL following treatment has never previously been assessed in longitudinal descriptive studies using validated instruments.

Objective: To investigate disease-specific (ThyPRO) and generic (SF-36) HRQL, following levothyroxine therapy in patients with hypothyroidism due to autoimmune thyroiditis.

Methods: This prospective cohort study was set at endocrine outpatient clinics at two Danish university hospitals. Seventy-eight consecutive patients were enrolled and completed HRQL questionnaires before, six weeks, and six months after initiation of levothyroxine therapy. Normative ThyPRO (n = 739) and SF-36 (n = 6,638) data were available for comparison and changes in HRQL following treatment were estimated and quantified.

Results: Prior to treatment, all ThyPRO scales were significantly impacted (p<0.0001), compared to the general population sample. The same was observed for seven of eight SF-36 scales, the exception being Bodily Pain. Tiredness (ThyPRO) and Vitality (SF-36) were the most markedly impacted scales. After six weeks of treatment, nine of thirteen ThyPRO scales had significantly improved. ThyPRO improvements were consistent at six months, where five of eight SF-36 scales had also significantly improved, but deficits persisted for a subset of both ThyPRO and SF-36 scales.

Conclusions: In this population of hypothyroid patients, HRQL was widely affected before treatment, with tiredness as the cardinal impairment according to both ThyPRO and SF-36. Many aspects of HRQL improved during the first six months of LT4 therapy, but full recovery was not obtained. Our results may help clinicians inform patients about expected clinical treatment effects.

Conflict of interest statement

Competing Interests: JBB is commercially affiliated via his employment at Optum Patient Insights. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. ThyPRO radar plot.
Fig 1. ThyPRO radar plot.
Radar plot showing ThyPRO scale scores for patients with autoimmune hypothyroidism (AIT) at baseline and 6-months follow-up as well as scores from the general population sample. Each scale ranges 0–100, with higher scores indicating poorer quality of life. Items in ThyPRO scales marked* are asked with attribution to thyroid disease and cannot be answered by respondents from the general population.
Fig 2. SF-36 Radar plot.
Fig 2. SF-36 Radar plot.
Radar plot showing SF-36 scale scores for patients with autoimmune hypothyroidism (AIT) at baseline and 6-months follow-up as well as scores from the general reference population. Higher scores indicate better health status.

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