Federal University of Rio de Janeiro, Endocrine Service, Av. Brigadeiro Trompowski s/n, Ilha do Fundão, Cidade Universitária, Rio de Janeiro, Brazil,
Endocrine. 2013 Oct;44(2):434-40. doi: 10.1007/s12020-013-9886-1. Epub 2013 Jan 31.
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.
本研究旨在验证左甲状腺素替代治疗对巴西原发性甲状腺功能减退症患者健康相关生活质量（HRQoL）的影响。这是一项在巴西四个转诊中心进行的 2057 例连续原发性甲状腺功能减退症患者的横断面研究（中位年龄=53 岁；25%分位数=43 岁；75%分位数=61 岁）。患者的生化数据来自病历，患者完成了一份关于社会经济问题和甲状腺功能减退症临床体征和症状的问卷。HRQoL 使用 SF-36v2 进行评估。根据 TSH 水平将患者分为三组：治疗过度组（OvT；TSH<0.4mU/L）、适当治疗组（AT；TSH 在 0.4 至 4.0mU/L 之间）和治疗不足组（UnT；TSH>4.0mU/L）。根据 TSH 和 FT4 血清水平，患者还进行了分析：治疗过度性甲亢（OHyper；TSH<0.4mU/L 且 FT4>1.9ng/dL）、亚临床甲亢（SHyper；TSH<0.4mU/L 且 FT4 0.8-1.9ng/dL）、亚临床甲状腺功能减退症（SHypo；TSH>4.0mU/L 且 FT4 0.8-1.9ng/dL）和治疗过度性甲状腺功能减退症（OHypo；TSH>4.0mU/L 且 FT4<0.8ng/dL）。共有 14.4%的患者为 OvT，其中 13.0%为 SHyper，1.4%为 OHyper。治疗不足的患病率为 25.9%，其中 21.5%为 SHypo，4.4%为 OHypo。治疗不足的患者 HRQoL 较适当治疗的患者差，尤其是在身体和情绪方面，无论是否存在 SHypo 或 OHypo 状态。甲状腺功能减退症治疗不足与患者 HRQoL 较差有关。因此，应给予适当的左甲状腺素治疗，使血清 TSH 维持在参考范围内。
