Endocrine

, Volume 44, Issue 2, pp 434–440

Inadequate levothyroxine replacement for primary hypothyroidism is associated with poor health-related quality of life–a Brazilian multicentre study

  • Patrícia dos Santos Vigário
  • Fernanda Vaisman
  • Cláudia Medina Coeli
  • Laura Ward
  • Hans Graf
  • Gisah Carvalho
  • Renan Montenegro Júnior
  • Mário Vaisman
Original Article

DOI: 10.1007/s12020-013-9886-1

Cite this article as:
Vigário, P..S., Vaisman, F., Coeli, C.M. et al. Endocrine (2013) 44: 434. doi:10.1007/s12020-013-9886-1

Abstract

This study aimed to verify the impact of levothyroxine replacement on health-related quality of life (HRQoL) in a Brazilian sample of primary hypothyroidism patients. A cross-sectional study was performed with 2,057 consecutive primary hypothyroidism patients on levothyroxine (LT4) replacement at four referral centers in Brazil (median age = 53; 25th percentile = 43; 75th percentile = 61 years). Patient biochemical data were acquired from medical records, and patients completed a questionnaire on socioeconomic issues and clinical signs and symptoms of hypothyroidism. HRQoL was assessed using the SF-36v2. Patients were divided into three groups according to TSH levels: overtreated (OvT; TSH < 0.4 mU/L), appropriately treated (AT; TSH between 0.4 and 4.0 mU/L), and undertreated (UnT; TSH > 4.0 mU/L). Patients were also analyzed by TSH and FT4 serum levels: overt hyperthyroidism (OHyper; TSH < 0.4 mU/L and FT4 > 1.9 ng/dL), subclinical hyperthyroidism (SHyper; TSH < 0.4 mU/L and FT4 0.8–1.9 ng/dL), subclinical hypothyroidism (SHypo; TSH > 4.0 mU/L and FT4 0.8–1.9 ng/dL), and overt hypothyroidism (OHypo; TSH > 4.0 mU/L and FT4 < 0.8 ng/dL). A total of 14.4 % of patients were OvT, with 13.0 % SHyper and 1.4 % OHyper. The prevalence of UnT was 25.9 %, with 21.5 % SHypo and 4.4 % OHypo. Overtreatment was not associated with HRQoL impairment. UnT patients had worse HRQoL than AT patients, especially for physical and emotional aspects, independent of SHypo or OHypo status. Hypothyroidism undertreatment is associated with poor patient HRQoL. Therefore, adequate LT4 therapy should be given to maintain serum TSH within the reference range.

Keywords

HypothyroidismThyrotropinDrug therapyQuality of life

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Patrícia dos Santos Vigário
    • 1
    • 2
  • Fernanda Vaisman
    • 1
    • 3
  • Cláudia Medina Coeli
    • 4
  • Laura Ward
    • 5
  • Hans Graf
    • 6
  • Gisah Carvalho
    • 6
  • Renan Montenegro Júnior
    • 7
  • Mário Vaisman
    • 1
  1. 1.Federal University of Rio de Janeiro, Endocrine ServiceRio de JaneiroBrazil
  2. 2.Augusto Motta University Center–UNISUAM, Rehabilitation Science Graduate ProgramRio de JaneiroBrazil
  3. 3.Instituto Nacional do CâncerRio de JaneiroBrazil
  4. 4.Federal University of Rio de Janeiro, Public Health InstituteRio de JaneiroBrazil
  5. 5.University of Campinas, Medical ClinicSão PauloBrazil
  6. 6.Federal University of Paraná, Endocrine ServiceCuritibaBrazil
  7. 7.Federal University of Ceará, Endocrine ServiceCearáBrazil