Abstract

Background Primary hypothyroidism is characterized by reduced quality of life (QoL). Although thyrotropin (TSH) is utilized as the primary indicator of thyroid disease and treatment adequacy, no simple correlation between QoL and TSH has been shown. This study aimed to investigate changes in clinically relevant predictors during initiation of levothyroxine (L-T4) therapy and their ability to predict improvement in QoL. Method Quality of life was measured in patients with newly diagnosed hypothyroidism, during the initial 12 months of L-T4 therapy, by the thyroid-related patient-reported outcome questionnaire, ThyPRO-39. The main outcome measures were the Composite QoL scale and the Tiredness and Emotional Susceptibility subscales (0–100, higher scores worse). Clinical variables (resting energy expenditure (REE), body composition, thyroid function, L-T4 dose, and cognitive function tests) were evaluated as predictors of improvement in QoL by univariate and multiple regression analysis. Results Thirty-seven hypothyroid patients with a baseline median TSH of 30 mU/l and a median QoL score of 29 were included. After twelve months of L-T4 treatment, the ThyPRO-39 QoL score had significantly improved to a median score of 14, while REE per kg fat-free mass (FFM) increased significantly from a mean of 26.5 to 28.7 kcal/day/kg (p < 0.001). Change in ThyPRO-39 was not associated with a change in REE/FFM (unstandardized coefficient (USC): 0.09 with confidence interval (CI): −1.93 to 2.11, p=0.93) but was positively predicted by baseline body mass index (BMI) (USC: 1.54 with CI: 0.59 to 2.49, (p=0.002), without association with weight loss (USC: 0.33 with CI: −1.21 to 1.27, p=0.96). Conclusion Improvement in QoL as measured by ThyPRO-39 after initiation of L-T4 therapy for hypothyroidism was not associated with changes in REE. High baseline BMI, but not weight loss during therapy, was associated with improvement in QoL. This trail is registered with www.Clinicaltrials.gov (registration no. https://clinicaltrials.gov/ct2/show/NCT02891668).

Highlights

  • Hypothyroidism is characterized by reduced quality of life (QoL), due to a range of diverse symptoms [1, 2], with tiredness and emotional susceptibility being prominent complaints [3]. yrotropin (TSH) is considered the most sensitive marker for evaluating the severity of hypothyroidism

  • Overweight is a frequent phenomenon among patients with hypothyroidism and in the general population, and overweight is strongly associated with reduced QoL. e risk of overweight is influenced by many factors, including genetics [9]; daily calorie intake surmounting daily calorie expenditure remains the core problem [10]

  • We looked for clinically relevant predictors of improvement in QoL, as measured by the yPRO-39 Composite scale, during initiation of L-T4 treatment in patients with primary hypothyroidism

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Summary

Introduction

Hypothyroidism is characterized by reduced quality of life (QoL), due to a range of diverse symptoms [1, 2], with tiredness and emotional susceptibility being prominent complaints [3]. yrotropin (TSH) is considered the most sensitive marker for evaluating the severity of hypothyroidism. Hypothyroidism is characterized by reduced quality of life (QoL), due to a range of diverse symptoms [1, 2], with tiredness and emotional susceptibility being prominent complaints [3]. Is study aimed to investigate changes in clinically relevant predictors during initiation of levothyroxine (L-T4) therapy and their ability to predict improvement in QoL. Quality of life was measured in patients with newly diagnosed hypothyroidism, during the initial 12 months of L-T4 therapy, by the thyroid-related patient-reported outcome questionnaire, yPRO-39. Clinical variables (resting energy expenditure (REE), body composition, thyroid function, L-T4 dose, and cognitive function tests) were evaluated as predictors of improvement in QoL by univariate and multiple regression analysis. Improvement in QoL as measured by yPRO-39 after initiation of L-T4 therapy for hypothyroidism was not associated with changes in REE. High baseline BMI, but not weight loss during therapy, was associated with improvement in QoL

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