Adults with type D personality more likely to be dissatisfied with hypothyroidism care
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Key takeaways:
- Of adults with hypothyroidism, 54.2% have a type D personality with high levels of negative affectivity and social inhibition.
- Somatic symptom disorder was reported by 66.1% of those with a type D personality.
More than half of adults with hypothyroidism have self-reported high levels of negative feelings and social withdrawal, or a type D personality, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.
Researchers recruited 3,523 adults with hypothyroidism to complete the Type D Scale-14, a questionnaire that assesses for type D personality as defined by negative affectivity and social inhibition. Adults who scored at least 10 of a possible 28 points on both subscales were defined as having a type D personality. Of the study group, 54.2% had a type D personality, and those with type D personality were more likely to report dissatisfactions with hypothyroidism care and that hypothyroidism was negatively impacting their everyday life.
“People with hypothyroidism and type D personality may experience more negative treatment outcomes than those without type D personality,” Petros Perros, MD, honorary senior lecturer at Newcastle University and a consultant in endocrinology at Royal Victoria Infirmary, Newcastle upon Tyne, U.K., said in a press release. “We think that there are two likely interpretations, which may not be mutually exclusive — type D personality and hypothyroidism share similar underlying causes, or people with type D personality may perceive treatment outcomes more negatively.”
Adults from 68 countries diagnosed with hypothyroidism participated in a cross-sectional study from April 11, 2020, to Jan. 3, 2021. In addition to completing the Type D Scale-14, participants also completed the Patient Health Questionnaire-15. Adults with a score of 10 or higher on the Patient Health Questionnaire-15 were considered to have somatic symptom disorder. Participants answered questions on anxiety, mood, depression, control of hypothyroidism symptoms with medication, satisfaction with hypothyroidism treatment and care and impact of hypothyroidism on everyday living.
Of the participants, 54.2% had a type D personality with a high score on both the negative affectivity and social inhibition subscales, 20.9% had a high score for negative affectivity only, 8.5% had a high score for social inhibition only and 16.5% had low scores for both subscales.
Using chi-squares testing, adults with type D personality were more likely to report that their medication did not control hypothyroidism symptoms well, that they were dissatisfied with care and treatment and that their everyday life was negatively impacted by hypothyroidism compared with those without type D personality. Researchers said high scores for negative affectivity was a larger contributor toward those associations than high scores for social inhibition.
Somatic symptom disorder was observed in 66.1% of the type D personality group compared with 57.3% of those with only a high score for negative affectivity, 36.1% of those with only a high score for social inhibition and 33% for those with low scores on both subscales.
“Further research is needed to confirm our findings and determine if it is possible to predict how newly diagnosed patients with hypothyroidism will respond to treatment based on personality traits,” Perros said in the release. “If so, studies could be designed specifically for such patients, to determine if interventions can improve outcomes.”
Reference:
People with hypothyroidism and type D personality may be more likely to experience poor treatment outcomes. Available at: www.eurekalert.org/news-releases/1040252. Published April 9, 2024. Accessed April 9, 2024.
Perspective
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In the study by Perros and colleagues, 3,523 adults with hypothyroidism from 68 countries completed a questionnaire that evaluates for type D personality. The Type D Scale-14 questionnaire is a self-administered and validated instrument that includes subscales on negative affectivity and social inhibition.
The main study objective was to investigate the prevalence of type D personality in patients with hypothyroidism and better understand whether there is a relationship between type D personality and hypothyroidism-related patient-reported outcomes. Overall, more than half of the respondents had attributes of a type D personality, and the authors concluded that those patients were more likely to report negative outcomes regarding hypothyroidism, including dissatisfaction with treatment.
It is well-known that a subgroup of patients with hypothyroidism don’t feel well and are dissatisfied with their hypothyroidism treatment, despite reaching biochemical euthyroidism. This can significantly impact patients’ quality of life. The reasons for this remain unclear but potentially may be related to different individual thyroid-stimulating hormone setpoints for different patients or additional diagnoses that independently affect quality of life.
It has been previously shown that people with type D personality are more likely to experience psychological distress, which has been associated with perceived poor health status and increased symptom burden. Even though the current study showed that type D personality may be associated with negative outcomes among some people with hypothyroidism, findings should be cautiously interpreted as there was also a significantly higher burden of comorbidities in these patients compared to the reference population.
Interestingly, the authors reported clustering of treatment with desiccated thyroid extracts or synthetic levothyroxine/liothyronine combination therapy and non-type D personality.
Future studies with a crossover or randomized-controlled trial design may be able to better delineate whether patient satisfaction is influenced by type of thyroid treatment irrespective of personality traits. Overall, there is a critical need for high-quality future research studies in representative cohorts of hypothyroid individuals to guide intervention strategies that will improve these patients’ well-being.
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