Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life

Abstract

Objectives:To evaluate the impact of subclinical hypothyroidism (sHT) treatment on health--related quality of life (QoL), psychiatric symptoms, clinical score, and muscle function. Materials and methods: In this randomized double-blind study, patients were assigned either to treatment (n = 35) or placebo (n = 36). Clinical and psychiatric symptoms were assessed by the Zulewski, Hamilton and Beck scales. QoL was assessed by the SF-36 questionnaire. Assessments of quadriceps (QS) and inspiratory muscle (IS) strength were performed by a chair dynamometer and a manuvacuometer. Results: Treatment improved IS (+11.5 ± 17.2; p = 0.041), as did QoL domains "Pain" and "Role Physical" (+19.7 ± 15.2, 0.039 and +22.1 ± 47.5, p = 0.054; respectively). Clinical and psychiatric symptoms showed similar responses to both interventions. Conclusions: sHT treatment improved IS and physical aspects of QoL, despite no impact in other muscle parameters. Clinical score, psychiatric symptoms, and SF-36 domains, based on mental dimensions of QoL may be more susceptible to "placebo effect" in patients with sHT.Arq Bras Endocrinol Metab. 2012;56(2):128-36 Keywords Anxiety; depression; quality of life; levothyroxine RESUMO Objetivos: Avaliar o impacto do tratamento do hipotireoidismo subclínico (sHT) na qualidade de vida relacionada à saúde (QoL), aos sintomas psiquiátricos, ao escore clínico e à função muscular. Materiais e métodos: Em um ensaio randomizado duplo-cego, pacientes foram randomizados para tratamento (n = 35) ou uso de placebo (n = 36). Sintomas clínicos e psiquiá-tricos foram acessados por meio das escalas de Zulewski, Hamilton e Beck. A QoL foi avaliada pelo questionário SF-36. Medidas da força de quadríceps (QS) e inspiratória (IS) foram obtidas por um dinamômetro de cadeira e um manovacuômetro. Resultados: O tratamento melhorou a IS (+11,5 ± 17,2; p = 0,041), assim como os domínios "Dor" e "Aspectos Físicos" da QoL (+19,7 ± 15,2, 0,039 e +22,1 ± 47,5, p = 0,054, respectivamente). Sintomas clínicos e psiquiátricos demonstraram respostas similares a ambas as formas de intervenção. Conclusões: Tratamento do sHT melhorou IS e aspectos físicos da QoL, apesar de não ter impacto em outros parâmetros musculares. Escore clínico, sintomas psiquiátricos e domínios do SF-36 que focam em dimensões mentais podem ser mais suscetíveis ao "efeito placebo" em pacientes com sHT.

Influence of a Medium-Impact Exercise Program on Health-Related Quality of Life and Cardiorespiratory Fitness in Females with Subclinical Hypothyroidism: An Open-Label Pilot Study

“…Neurobiological evidence seems to corroborate the hypothesis of an organic basis of the effects of thyroid hormone on the brain and on psychiatric symptoms [9]. …”

“…There are very few studies that evaluated HRQoL in sHT [9, 10], and none included cardiorespiratory fitness and health status in the same study. It is believed that some psychological aspects of thyroid hypofunction, when present in sHT, may be influenced by physical findings, as suggested by the association between physical aspects of quality of life, in the SF-12 evaluation and cardiorespiratory fitness, specially VO 2max⁡ , in the present study.…”

“…On the other hand, the evidence for improvement of psychiatric symptoms with hormonal treatment (levothyroxine) of OH and the use of triiodothyronine (T3) to potentiate the response to treatment of depressive disorders suggests a direct relationship between thyroid hormones and psychiatric symptoms [8, 9]. Neurobiological evidence seems to corroborate the hypothesis of an organic basis of the effects of thyroid hormone on the brain and on psychiatric symptoms [9].…”

Multiple Hormonal Dysregulation as Determinant of Low Physical Performance and Mobility in Older Persons

“…Simonsick and co-workers [147], in a small sample of patients found no difference in gait speed decline between patients with Shypot undergoing replacement therapy or without any treatment. Recently, Reuters and colleagues [217] performed a randomized double-blind study, in which adults with Shypot were assigned either to treatment (n=35) or placebo (n=36). The Authors showed an improvement of inspiratory muscle strength in the treatment arm, along with an improved quality of life.…”

Aging and Subclinical Thyroid Dysfunction

“…Symptoms and signs of hypothyroidism have been frequently found in subclinical hypothyroidism patients, as reported by many authors. In fact, Reuters et al described an improvement in some physical aspects of quality of life after L-T4 treatment in patients with subclinical hypothyroidism [50].…”