The Application of ThyPRO Questionnaire in Patients With Graves’ Disease Treated With Antithyroid Medications

Abstract

Background: The ThyPRO-39 questionnaire assesses health-related QoL (HRQoL) in patients with benign thyroid disease and has been validated for use in the local setting. The aim of the study is to investigate disease specific health-related quality of life using ThyPRO-39 in patients with newly diagnosed Graves’ disease treated with antithyroid medications over one year. Methods: Patients with newly diagnosed Graves’ disease were recruited in the outpatient setting. The ThyPRO-39 questionnaire was administered at baseline, 6 and 12 months of antithyroid medication treatment. Relevant demographic and clinical information was collected at the three time points of the study. Results of clinical parameters and various ThyPRO scales were compared between baseline, 6 months and 12 months of treatment. Results: There were 32 patients with newly diagnosed Graves’ disease recruited between April 2018 and May 2019. All except 2 patients completed all 3 time points of the study. Two patients missed their 6 months questionnaire. There were 24 females (75%) and 8 males (25%) in the study. Analysis of the clinical parameters showed significant changes in weight from baseline (59.7 + 17.7kg) to 6 months (59.4 + 9.9kg) to 12 months (63.4 + 17.4Kg), all p<0.001, TSH receptor antibody level from baseline (17.3 + 12.9IU/L) to 12 months (7.1 + 10.8IU/L), NR <1.76IU/L, p<0.001, fT4 levels from baseline (49.9 + 18.1pmol/L) to 6 months (14.3 + 6.9pmol/L) and from baseline to 12 months (11.8 + 2.3pmol/L), NR 8.8-14.4pmol/L, all p<0.001 and TSH levels from baseline (0.011 + 0.009mU/L) to 6 months (1.38 + 1.74mU/L, p=0.001) and from baseline to 12 months (1.80 + 1.72mU/L, p<0.001), NR 0.65-3.70mU/L. After 6 months of treatment, 7 out of 13 ThyPRO scales improved and 9 out of 13 ThyPRO scales improved after 12 months of treatment. Large treatment effects were observed on 2 ThyPRO scales (Hyperthyroid symptoms and Anxiety) while moderate effects were seen in 5 ThyPRO scales (Tiredness, Cognitive complaints, Depressivity, Impaired daily Life and overall QoL) from baseline to 6 months. Large treatment effects were observed on 2 ThyPRO scales (Hyperthyroid symptoms and Anxiety) while moderate effects were seen in 5 ThyPRO scales (Tiredness, Depressivity, Emotional susceptibility, Impaired daily Life and overall QoL) from baseline to 12 months. Small treatment effects were observed in 2 ThyPRO scales (Goiter symptoms and Tiredness) from 6 to 12 months. Conclusion: There are significant improvements in many aspects HRQL during the first 6 months of antithyroid drug treatment, with hyperthyroid symptoms and anxiety showing the most improvements throughout the 12 month treatment period. Our results complement clinical monitoring of patients with Graves’ disease and provide realistic outcome measures of disease impact and treatment outcomes from the patient’s perspective.

Physicians' and Patients' Perceptions and Practices Concerning Antithyroid Drug-Induced Agranulocytosis

“…Previous audits of the information recalled by patients on side effects of ATDs indicated that 56 to 70% would take an appropriate action if they have any symptoms suggestive of agranulocytosis. 9,10 In general, information remains sparse in the literature, and no data exists from non-European regions. Equally important is the notion that physicians initiating medication are responsible for preventing, detecting, and managing their complications.…”