Patients on levothyroxine replacement in the community: association between hypothyroidism symptoms, co-morbidities and their quality of life

Tan, Ngiap Chuan; Chew, Rong Quan; Subramanian, Reena Chandhini; Sankari, Usha; Koh, Yi Ling Eileen; Cho, Li Wei

doi:10.1093/fampra/cmy064

Cited by 13 publications

(12 citation statements)

References 13 publications

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“…Patients taking desiccated thyroid extract (DTE) reported a higher median treatment satisfaction of 7 (IQR, 5-9) compared to other treatments. Patients receiving LT4 treatment reported a lower satisfaction score of 5 (IQR 3-7), while those receiving LT4 + LT3 reported a higher satisfaction score of 6 (IQR, [3][4][5][6][7][8]. Patients taking DTE were less likely to report problems related to weight management, fatigue/energy levels, mood, and memory compared to patients taking other agents.…”

Section: Discussionmentioning

confidence: 99%

“…5 Furthermore, Tan and colleagues evaluated Asian patients receiving levothyroxine replacement therapy in the community setting and found that a decreased quality of life (QOL) score was associated with hypothyroid patients with a single persistent symptom, including weight gain (adjusted OR [95% CI], 3.12 [1.71-5.68]), feeling weak (2.12 [1.09-4.11], and having dry or coarse skin (2.27 [1.24-4.14]), but decreased QOL was not associated with TSH or free thyroxine levels. 8 Thyroid related symptoms may be subtle and challenging to quantify yet serial measures of such symptoms in patients do support the utility of this approach to patient care. 2,9-13 A previously reported ten Symptom Scale Instrument (Hypothyroid Symptom Scale, HSS) has shown its ability to quantify persistent symptoms in levothyroxine treated patients.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypothyroid Symptoms in Levothyroxine-Treated Patients

et al. 2019

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Purpose: Approximately 15% of patients with hypothyroidism are dissatisfied with their treatment due to persistence of residual symptoms associated with hypothyroidism. The purpose of this study was to compare thyroid symptoms using the hypothyroid symptom scale (HSS) in patients receiving stable thyroid therapy for 6 months to patients without hypothyroidism. The HSS was used to identify the percentage of levothyroxine-treated hypothyroid patients with residual or persistent hypothyroid symptoms. Methods: Patients included in the study had hypothyroidism and were receiving a stable/maintenance dose of levothyroxine sodium therapy, unchanged for at least 6 months. A control group of patients were included if they did not have an active prescription for thyroid hormone therapy. The HSS was administered via phone or face-to-face interactions. Patients were asked to score 10 symptoms over the past month on a scale of 0 to 4 (e.g., 0, absence of, to 4, severe symptoms). Results were analyzed using descriptive and inferential statistics. T-tests and chi-squared analysis were used to assess differences in continuous and categorical variables. Results: A total of 68% of the contacted patients responded to the survey. A total of 302 patients were in the intervention group and 273 were in the control group. The mean total HSS scores between groups were significantly higher in the treatment compared to the control group (13.92 ± 10.91 vs.10.07 ± 7.85; P < 0.001). Conclusion: Significantly more patients receiving thyroid hormone therapy experienced residual thyroid symptoms compared to control patients. Attempts should be made to offer alternatives for hypothyroid patients with persistent symptoms. Article Type: Original Research

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypothyroid Symptoms in Levothyroxine-Treated Patients

et al. 2019

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“…Body weight is probably the most widely recognized proxy for thyroid hormone action, even if the association between weight gain and hypothyroidism is at best tenuous. Importantly, weight gain is one of the most important drivers of dissatisfaction among patients affected by hypothyroidism ( 3 , 4 , 17 , 45 , 48 ) and conversely, weight loss was the greatest reason to declare satisfaction with the treatments among patients who preferred combination therapy or DTE on clinical trials ( 9 , 10 , 18 , 22 , 25 ). Moreover, a crossover study indicated that therapy with LT3 alone was associated with significant weight loss ( 49 ).…”

Section: Endpointsmentioning

confidence: 99%

Combination Therapy for Hypothyroidism: Rationale, Therapeutic Goals, and Design

Madan

Celi

2020

Front. Endocrinol.

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Hypothyroidism is a common condition with a wide spectrum of etiologies and clinical manifestations. While the majority of patients affected by hypothyroidism respond well to levothyroxine, some patients do not and complain of symptoms despite adequate replacement. There is evidence in experimental models of hypothyroidism that levothyroxine alone may not be able to deliver an adequate amount of T3 to all the tissues targeted by the hormonal action, while liothyronine/levothyroxine combination therapy can. The results of clinical studies directed to assess the effectiveness of liothyronine/levothyroxine combination therapy on the amelioration of hypothyroid symptoms have been disappointing. Most of the trials have been short and underpowered, with several shortcomings in the study design. There is consensus that an adequately powered clinical trial should be developed to prove or disprove the efficacy and effectiveness of therapies other than LT4 alone for the treatment of hypothyroidism, and to assess which group of patients would benefit from them. Here we present some considerations on the technical aspects and necessary tradeoffs in designing such a study with a particular focus on study population selection, choice of endpoints, and study drugs formulation and regimen.

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“…Thyroid autoimmunity per se may also lead to symptoms through chronic inflammation, 16,17 though not all studies have confirmed this 18 . At least four possible hypotheses may explain persistent symptoms and dissatisfaction with treatment in patients with hypothyroidism who appear to be adequately replaced with L‐T4 on biochemical grounds: lack of efficacy of L‐T4 in restoring euthyroidism at tissue level 11,15 ; autoimmunity, rather than hypothyroidism being the culprit 16,17 ; pre‐existing non‐thyroidal morbidity and/or post‐thyroid diagnosis comorbidities 19‐23 ; negative experiences with healthcare professionals and other psychosocial factors unrelated to hypothyroidism being the cause of persistent symptoms 1 …”

Section: Introductionmentioning

confidence: 99%

Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation

Mitchell

Hegedűs

Žarković

et al. 2020

Clinical Endocrinology

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Objective Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. Design and patients We conducted an online survey of individuals with self‐reported hypothyroidism. Results Nine hundred sixty‐nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L‐T4) and liothyronine (L‐T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L‐T4 or L‐T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L‐T4 + L‐T3 or L‐T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L‐T4 (P < .001) and expectations for more support from the GP (P < .001), for L‐T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L‐T3 independently (P = .014), negative experiences with L‐T4 (P = .013), having expectations for L‐T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006). Conclusions Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.

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Patients on levothyroxine replacement in the community: association between hypothyroidism symptoms, co-morbidities and their quality of life

Abstract: In Asian patients with hypothyroidism, weight gain, feeling tired, feeling weak, having dry or coarse skin, leg swelling and increased number of co-morbidities and symptoms were significantly associated with poorer QOL.

Cited by 13 publications

References 13 publications

Hypothyroid Symptoms in Levothyroxine-Treated Patients

Hypothyroid Symptoms in Levothyroxine-Treated Patients

Combination Therapy for Hypothyroidism: Rationale, Therapeutic Goals, and Design

Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation

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