Central hypothyroidism: are patients undertreated?

Abstract

Introduction: Thyroid hormone replacement in central hypothyroidism (CHT) is more difficult than in primary hypothyroidism (PHT), putting patients at risk for inappropriate substitution. In this study, we compared dosage of thyroid hormone replacement in patients with CHT with that of patients with PHT. In addition, we explored and compared quality of life (QoL) between both groups, based on two questionnaires, the SF-36 health score and the thyroid specific ThyPRO score. Methods: This is a monocentric, cross-sectional study, performed at the Ghent University Hospital (Belgium). We included 82 patients in total, 41 patients with CHT and 41 patients with PHT. At the time of inclusion, all patients had to have a stable dose of levothyroxine over the past six months and patients with PHT needed to be euthyroid (defined as having a TSH level within the reference range, 0.2 – 4.5mU/L). All data was retrieved from medical files, questionnaires on QoL were self-administered. Results: The CHT and PHT groups were comparable regarding age and BMI. There was no significant difference between both groups regarding total daily dose of levothyroxine or daily dose of levothyroxine per kg body weight. Serum levels of fT4 and fT3 also did not differ between the two groups and both were in the normal (mid)range for the two groups. Regarding QoL, patients with CHT scored worse in terms of depressive and emotional symptoms, impaired daily and social life. Conclusion: We could demonstrate a difference in quality of life between patients with central and primary hypothyroidism. Although patients with CHT had a somewhat lower levothyroxine substitution dose than patients with PHT, this difference was also not significant and probably does not explain the difference in quality of life.

Sintomas vocais, ansiedade e depressão pré e pós-tireoidectomia

“…A pontuação global em cada subescala vai de 0 a 21. Os escores de ansiedade e depressão são categorizados em normal (0-7), leve (8-10), moderado (11)(12)(13)(14) e grave (15-21). O ponto de corte de 8 ou mais identifica casos possíveis de ansiedade/depressão e 11 ou mais casos prováveis de ansiedade/depressão 17 .…”

“…Portanto, além dos aspectos funcionais, é importante considerar as questões emocionais associadas ao diagnóstico dos nódulos tireoidianos e seu tratamento 6,13 . O tempo longo de espera para realização da cirurgia e o diagnóstico de malignidade são fatores determinantes nos sintomas de ansiedade/depressão do paciente 14 .…”