No Effect of Thyroid Dysfunction and Autoimmunity on Health-Related Quality of Life and Mental Health in Children and Adolescents: Results From a Nationwide Cross-Sectional Study.

Raphael Hirtz,Heike Hölling,Anke Hinney,Anne Keesen,Berthold P Hauffa,Corinna Grasemann

doi:10.3389/fendo.2020.00454

Abstract

Background: In adults, a significant impact of thyroid dysfunction and autoimmunity on health-related quality of life (HRQoL) and mental health is described. However, studies in children and adolescents are sparse, underpowered, and findings are ambiguous.Methods: Data from 759 German children and adolescents affected by thyroid disease [subclinical hypothyroidism: 331; subclinical hyperthyroidism: 276; overt hypothyroidism: 20; overt hyperthyroidism: 28; Hashimoto's thyroiditis (HT): 68; thyroid-peroxidase antibody (TPO)-AB positivity without apparent thyroid dysfunction: 61] and 7,293 healthy controls from a nationwide cross-sectional study (“The German Health Interview and Examination Survey for Children and Adolescents”) were available. Self-assessed HRQoL (KINDL-R) and mental health (SDQ) were compared for each subgroup with healthy controls by analysis of covariance considering questionnaire-specific confounding factors. Thyroid parameters (TSH, fT4, fT3, TPO-AB levels, thyroid volume as well as urinary iodine excretion) were correlated with KINDL-R and SDQ scores employing multiple regression, likewise accounting for confounding factors.Results: The subsample of participants affected by overt hypothyroidism evidenced impaired mental health in comparison to healthy controls, but SDQ scores were within the normal range of normative data. Moreover, in no other subgroup, HRQoL or mental health were affected by thyroid disorders. Also, there was neither a significant relationship between any single biochemical parameter of thyroid function and HRQoL or mental health, nor did the combined thyroid parameters account for a significant proportion of variance in either outcome measure. Importantly, the present study was sufficiently powered to identify even small effects in children and adolescents affected by HT, subclinical hypothyroidism, and hyperthyroidism.Conclusions: In contrast to findings in adults, and especially in HT, there was no significant impairment of HRQoL or mental health in children and adolescents from the general pediatric population affected by thyroid disease. Moreover, mechanisms proposed to explain impaired mental health in thyroid dysfunction in adults do not pertain to children and adolescents in the present study.

Highlights

Up to 30 percent of adult patients affected by thyroid dysfunction have been reported to suffer from psychological impairments despite proper medical treatment (1), and up to 20 percent are affected by depression (2)
Neither transformed KINDL-R scores (p = 0.114; see Table 1B and Table S2 for detailed statistics regarding the analysis of KINDL-R and SDQ-TD scores) nor transformed SDQ-TD scores (p = 0.308) did significantly differ between participants with thyroid autoimmunity and healthy controls considering the via correlation analysis identified covariates age [KINDL: r(7,295) = −0.354, p < 0.001; SDQ: r(7,396) = −0.170, p < 0.001] and social status [SDQ: r(7,229) = −0.132, p < 0.001; s
H5 and H6 could not be confirmed since there was no significant effect of overt thyroid dysfunction on

Summary

Introduction

Up to 30 percent of adult patients affected by thyroid dysfunction have been reported to suffer from psychological impairments despite proper medical treatment (1), and up to 20 percent are affected by depression (2). Whether children and adolescents with thyroid disease are likewise affected by impaired healthrelated quality of life (HRQoL) or mental health has not yet been rigorously investigated, despite thyroid disorders being a common endocrine disease in this age group. Subclinical hypothyroidism (HYPOSC), defined by an elevated thyrotropin (TSH) level above the age-specific reference range despite a normal free T4 (fT4), is a common finding in children and adolescents with an estimated prevalence of 1.7 to 2.9% (5, 6). Studies investigating HRQoL and mental health in pediatric HYPOSC are rare, and findings are ambiguous. While Holtmann et al (7) found significantly higher TSH levels in children and adolescents affected by impaired mental health, neither Cerbone et al (8) nor Zepf et al (9) could relate HYPOSC to affective and behavioral dysregulation. Studies in children and adolescents are sparse, underpowered, and findings are ambiguous

Methods

Results

Discussion

Conclusion