Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
British Thyroid Foundation, Harrogate, UK.
Clin Endocrinol (Oxf). 2021 Mar;94(3):513-520. doi: 10.1111/cen.14340. Epub 2020 Dec 17.
Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this.
We conducted an online survey of individuals with self-reported hypothyroidism.
Nine hundred sixty-nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L-T4) and liothyronine (L-T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L-T4 or L-T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L-T4 + L-T3 or L-T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L-T4 (P < .001) and expectations for more support from the GP (P < .001), for L-T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L-T3 independently (P = .014), negative experiences with L-T4 (P = .013), having expectations for L-T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006).
Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.
有研究报道，接受甲状腺功能减退症治疗的患者对治疗不满，生活质量受损。本研究旨在深入了解这一现象。
我们对自报甲状腺功能减退症的患者进行了在线调查。
共分析了 969 份回复。治疗满意度低（77.6%），整体生活质量评分低。患者满意度与甲状腺激素治疗类型无相关性，但联合使用左甲状腺素（L-T4）和三碘甲状腺原氨酸（L-T3）或甲状腺干提取物（DTE）治疗与 L-T4 或 L-T3 单药治疗相比，报告的生活质量显著改善（P<0.001）；然而，包括其他临床参数的多变量分析未能证实甲状腺激素治疗类型与生活质量或满意度之间的关联。多变量分析显示，满意度与年龄（P=0.026）、男性（P=0.011）、由甲状腺专家治疗（P<0.001）、家庭医生（GP）开处方 DTE 或 L-T4+L-T3 或 L-T3（P<0.001）和对甲状腺功能减退症有充分了解（P<0.001）呈正相关；满意度与 L-T4 的负面经历（P<0.001）和对 GP 更多支持的期望（P<0.001）、L-T4 解决所有症状（P=0.004）和转介给甲状腺专家（P<0.001）之间存在负相关。生活质量与男性（P=0.011）和甲状腺功能减退症的持续时间（P=0.002）呈正相关；与年龄（P=0.027）、诊断前就诊次数超过 3 次（P<0.001）、自行获取 DTE 或 L-T3（P=0.014）、L-T4 的负面经历（P=0.013）、期望 L-T4 解决所有症状（P<0.001）和 GP 提供更多支持（P=0.006）呈负相关。
包括既往医疗保健经历和期望在内的多种因素影响甲状腺功能减退症治疗的满意度和生活质量。关注改善患者体验和明确诊断时的期望，可能会提高满意度和生活质量。
