Background
Generally, it is believed that standard levothyroxine (LT4) therapy is sufficient to restore euthyroidism and relieve hypothyroid symptoms in hypothyroid patients. However, a considerable proportion of treated patients remains symptomatic despite normal TSH/FT4 serum values.
Methods
Using a digital survey we investigated quality of life (QoL, ThyPRO), daily functioning (SF-36), and hypothyroid-related symptoms in hypothyroid patients and control persons without thyroid diseases. The ThyTSQ was used to measure patient satisfaction. Patients and control persons (through snowballing) were recruited through patient organizations, posters/flyers and social media.
Results
The QoL of hypothyroid patients (n=1,137) was significantly (mean 20.8%) more disrupted in all domains, as compared to controls (n=240) (p<0.001). TSH, FT4, age, gender and duration of illness did not significantly affect QoL, whereas the M3 comorbidity index (weighted sum of reported comorbidities) did to a minor extent. Hypothyroid patients had significantly (mean 20%) more impairment of daily functioning and reported significantly (mean 2,8 times) higher scores for symptoms related to hypothyroidism, as compared to control persons (all p<0.001). The majority of patients (77.8%) reported not feeling well while their blood values were within the reference range and would like to have a better treatment for hypothyroidism (74.5%, n=1,194). The median satisfaction scores for LT4 treatment, information about illness and treatment were 4 (out of 6, very satisfied). The lowest satisfaction (median 3) was experienced with the care given around diagnosis.
Conclusions
In this comprehensive study, hypothyroid patients had a worse QoL, impaired daily functioning and residual hypothyroid related symptoms, compared to control persons without thyroid diseases, despite LT4 replacement therapy and serum TSH/FT4 within the target range values. As such, we see a medical need for better treatment modalities and care in a proportion of hypothyroid patients.