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Hypothyroidism only partially responsible for decreased quality of life in Hashimoto's thyroiditis
Ott J. Thyroid. 2011;21:161-167.
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New data suggest that hypothyroidism may only be partially responsible for decreased quality of life and increased symptom load among women with Hashimoto’s thyroiditis.
To investigate a potential connection between Hashimoto’s thyroiditis and the presence of symptoms in women with normal thyroid function, researchers in Austria conducted a prospective cohort study involving 426 women aged 19 years or older who were undergoing surgery for benign thyroid disease. Antithyroperoxidase (anti-TPO) antibody levels of more than 121 IU/mL served as indicators of Hashimoto’s thyroiditis, and questionnaires were used to collect information on patients’ symptoms, reproductive health and quality of life.
More than 6% of the women had Hashimoto’s thyroiditis (sensitivity, 93.3%; specificity, 94.7%), based on histological analysis.
At 6.7, the mean number of reported symptoms was higher among women with anti-TPO levels exceeding 121 IU/mL compared with women who had lower anti-TPO levels (4.1; P<.001), according to the results. Chronic fatigue, dry hair, dysphagia, irritability and nervousness were all considerably more prevalent among those with elevated anti-TPO levels. Similarly, history of breast cancer and early pregnancy loss were more common among women with anti-TPO levels exceeding the cutoff point. Quality of life also appeared significantly lower in these women, particularly regarding general health, physical activity, vitality, social functioning and mental health.
The researchers said there were comparable results among patients not receiving thyroid hormone supplementation.
“Typically, symptoms, complications and other diseases associated with [Hashimoto’s thyroiditis] are considered to be caused by hypothyroidism and, thus, it might be argued that hypothyroidism would account for the increased rates of symptoms and the lower quality-of-life scores in women with higher anti-TPO levels in our study, as well,” the researchers wrote. “However, at the time of inclusion, all patients were euthyroid, indicating that overt hypothyroidism was not the cause for the higher symptom load and the lower quality-of-life scores in the group of patients with increased anti-TPO levels.”
Charles H. Emerson, MD, editor in chief of the journal Thyroid, in which the study was published, said these data raise important clinical issues.
“Although the authors did not study thyroid hormone treatment for Hashimoto’s thyroiditis, it raises the possibility that optimal doses of thyroid hormone will not completely ameliorate all symptoms,” Emerson, who is also professor emeritus of medicine at the University of Massachusetts School of Medicine, said in a press release. “Further studies are required to confirm the findings of Ott et al and to determine if patients with hypothyroidism due to Hashimoto’s thyroiditis still have residual symptoms despite achieving an ideal biochemical response to thyroid hormone replacement therapy.”
Disclosure: The researchers report no relevant financial disclosures.
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