Relatively Lower FT3 Levels Are Associated with Impaired Quality of Life in Levothyroxine-Treated Patients with Hashimoto Thyroiditis.

Zhijun Cui,Yu An,Guang Wang,Jia Liu,Jiaxuan Wang,Nannan Bian,Xiaoyu Ding,Xiaona Chang,Alexander Schreiber

doi:10.1155/2022/1918674

Zhijun Cui, Yu An + Show 7 more

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https://doi.org/10.1155/2022/1918674

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Abstract

Objective Patients with Hashimoto thyroiditis (HT) frequently have some complaints despite achieving euthyroidism after levothyroxine (LT4) treatment. This study aimed to investigate the relevant factors affecting the quality of life (QoL) in euthyroid HT patients after LT4 treatment. Methods In this case-control study, 133 participants with HT were included. They were divided into two groups: 64 euthyroid HT subjects (control group) and 69 HT patients were rendered euthyroid by LT4 treatment (well-controlled group). QoL was measured with the Thyroid-Related Patient-Reported Outcome (ThyPRO-39) questionnaire. Results Both study groups were well matched with respect to gender, age, BMI, euthyroidism, and thyroid antibodies (TPOAb and TGAb). Compared with the control group, the well-controlled group had lower FT3 (P < 0.01) levels. Of note, QoL was impaired on all scales in the well-controlled group. Moreover, ThyPRO-39 scores among the well-controlled group were significantly higher (worse) than the control group in all scales. Regarding the composite scale, its score was related to FT3 (r = −0.176, P=0.043) but not to FT4 and TSH levels. Further logistic regression analysis revealed FT3 was significantly associated with elevated composite QoL [0.128 (0.029–0.577), P < 0.01] after adjustment of potential confounders. Conclusion Relatively lower FT3 concentrations, even within the normal reference range, were related to impaired QoL in HT patients treated with LT4. This finding supports the great value of FT3 in clinical decision-making on dose adequacy.

Highlights

Hashimoto thyroiditis (HT), called chronic lymphocytic thyroiditis, is a common autoimmune disease characterized by an enlarged thyroid gland, lymphocytic infiltration of the thyroid parenchyma, and increased circulating antibodies to thyroid antigens [1]
Both study groups were well matched with respect to gender, age, BMI, euthyroidism, and thyroid antibodies (TPOAb and thyroglobulin antibodies (TGAb))
In model 3, with further adjustment to thyroperoxidase antibodies (TPOAb), TGAb, FT4, and thyroid-stimulating hormone (TSH), we found FT3 levels remained independently associated with elevated composite quality of life (QoL) (0.128 (0.029–0.577), P < 0.01)

Summary

Introduction

Hashimoto thyroiditis (HT), called chronic lymphocytic thyroiditis, is a common autoimmune disease characterized by an enlarged thyroid gland, lymphocytic infiltration of the thyroid parenchyma, and increased circulating antibodies to thyroid antigens [1]. HT is considered the most common cause of primary hypothyroidism [2, 3], and its incidence has increased rapidly in recent years [4]. In daily clinical practice, we often notice that patients with hypothyroidism have discomfort and complaints, even though they have biochemical euthyroidism after LT4 treatment. Until now, these residual symptoms remain puzzling, several possible explanations have been proposed, including the presence of thyroid autoimmunity, the coexistence of other autoimmune diseases, the awareness of having a chronic disease, and the phenomenon of weight gain [9–12]. Evidence is mounting that treatment of hypothyroidism with LT4 does not normalize triiodothyronine (T3) levels in all tissues [13–15], nor does it reproduce the serum thyroid hormone profiles of native euthyroidism

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