1 Division of Endocrinology and Metabolism, Rush University Medical Center , Chicago, Illinois.
2 Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
Thyroid. 2018 Jun;28(6):707-721. doi: 10.1089/thy.2017.0681. Epub 2018 Apr 5.
Approximately 15% more patients taking levothyroxine (LT4) report impaired quality of life compared to controls. This could be explained by additional diagnoses independently affecting quality of life and complicating assignment of causation. This study sought to investigate the underpinnings of reduced quality of life in hypothyroid patients and to provide data for discussion at a symposium addressing hypothyroidism.
An online survey for hypothyroid patients was posted on the American Thyroid Association Web site and forwarded to multiple groups. Respondents were asked to rank satisfaction with their treatment for hypothyroidism and their treating physician. They also ranked their perception regarding physician knowledge about hypothyroidism treatments, need for new treatments, and life impact of hypothyroidism on a scale of 1-10. Respondents reported the therapy they were taking, categorized as LT4, LT4 and liothyronine (LT4 + LT3), or desiccated thyroid extract (DTE). They also reported sex, age, cause of hypothyroidism, duration of treatment, additional diagnoses, and prevalence of symptoms.
A total of 12,146 individuals completed the survey. The overall degree of satisfaction was 5 (interquartile range [IQR] = 3-8). Among respondents without self-reported depression, stressors, or medical conditions (n = 3670), individuals taking DTE reported a higher median treatment satisfaction of 7 (IQR = 5-9) compared to other treatments. At the same time, the LT4 treatment group exhibited the lowest satisfaction of 5 (IQR = 3-7), and for the LT4 + LT3 treatment group, satisfaction was 6 (IQR = 3-8). Respondents taking DTE were also less likely to report problems with weight management, fatigue/energy levels, mood, and memory compared to those taking LT4 or LT4 + LT3.
A subset of patients with hypothyroidism are not satisfied with their current therapy or their physicians. Higher satisfaction with both treatment and physicians is reported by those patients on DTE. While the study design does not provide a mechanistic explanation for this observation, future studies should investigate whether preference for DTE is related to triiodothyronine levels or other unidentified causes.
与对照组相比，约 15%的服用左甲状腺素 (LT4) 的患者报告生活质量受损。这可能是由于其他独立影响生活质量的诊断导致，使因果关系的确定变得复杂。本研究旨在探讨甲状腺功能减退症患者生活质量下降的原因，并为探讨甲状腺功能减退症的研讨会提供数据。
在美国甲状腺协会网站上发布了针对甲状腺功能减退症患者的在线调查，并转发给多个小组。要求受访者对他们对甲状腺功能减退症治疗的满意度以及他们的治疗医生进行排名。他们还对医生对甲状腺功能减退症治疗知识的了解程度、对新治疗方法的需求以及甲状腺功能减退症对生活的影响程度进行评分（1-10 分）。受访者报告他们正在服用的治疗药物，分为 LT4、LT4 和三碘甲状腺原氨酸（LT4+LT3）或甲状腺干提取物（DTE）。他们还报告了性别、年龄、甲状腺功能减退症的病因、治疗时间、其他诊断以及症状的发生率。
共有 12146 人完成了调查。总体满意度为 5（四分位距 [IQR]=3-8）。在没有自我报告抑郁、压力或疾病的受访者（n=3670）中，服用 DTE 的人报告的治疗满意度中位数为 7（IQR=5-9），高于其他治疗方法。与此同时，LT4 治疗组的满意度最低，为 5（IQR=3-7），而 LT4+LT3 治疗组的满意度为 6（IQR=3-8）。服用 DTE 的受访者也较少报告体重管理、疲劳/能量水平、情绪和记忆力方面的问题，与服用 LT4 或 LT4+LT3 的受访者相比。
有一部分甲状腺功能减退症患者对他们目前的治疗方法或他们的医生不满意。那些服用 DTE 的患者对治疗和医生的满意度更高。虽然研究设计并未为这一观察结果提供机制解释，但未来的研究应调查对 DTE 的偏好是否与三碘甲状腺原氨酸水平或其他未确定的原因有关。
