Marlier Joke, T'Sjoen Guy, Kaufman Jean, Lapauw Bruno
Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium.
Eur Thyroid J. 2022 Nov 2;11(6). doi: 10.1530/ETJ-21-0128. Print 2022 Dec 1.
Thyroid hormone replacement in central hypothyroidism (CHT) is more difficult than in primary hypothyroidism (PHT), putting patients at risk for inappropriate substitution. In this study, we compared the dosage of thyroid hormone replacement in patients with CHT with that of patients with PHT. In addition, we explored and compared quality of life (QoL) between both groups, based on two questionnaires, the SF-36 health score and the thyroid-specific ThyPRO score.
This is a monocentric, cross-sectional study, performed at the Ghent University Hospital (Belgium). We included 82 patients in total, 41 patients with CHT and 41 patients with PHT. At the time of inclusion, all patients had to have a stable dose of levothyroxine over the past 6 months and patients with PHT needed to be euthyroid (defined as having a thyroid-stimulating hormone level within the reference range, 0.2-4.5 mU/L). All data were retrieved from medical files, and questionnaires on QoL were self-administered.
The CHT and PHT groups were comparable regarding age and BMI. There was no significant difference between both groups regarding total daily dose of levothyroxine (100 (93.75-125.00) vs 107.14 (75.00-133.93) μg in CHT and PHT, respectively; P = 0.87) or daily dose of levothyroxine per kg body weight (1.34 (1.16-1.55) vs 1.55 (1.16-1.82) μg/kg, respectively; P = 0.13). Serum levels of fT4 (P = 0.20) and fT3 (P = 0.10) also did not differ between the two groups and both were in the normal (mid)range for the two groups. Regarding QoL, patients with CHT scored worse in terms of depressive and emotional symptoms, impaired daily and social life.
We could demonstrate a difference in QoL between patients with CHT and PHT. Although patients with CHT had a somewhat lower levothyroxine substitution dose than patients with PHT, this difference was also not significant and probably does not explain the difference in QoL.
中枢性甲状腺功能减退症（CHT）的甲状腺激素替代治疗比原发性甲状腺功能减退症（PHT）更困难，这使患者面临替代不当的风险。在本研究中，我们比较了CHT患者与PHT患者的甲状腺激素替代剂量。此外，我们基于SF-36健康评分和甲状腺特异性ThyPRO评分这两份问卷，探讨并比较了两组患者的生活质量（QoL）。
这是一项在比利时根特大学医院进行的单中心横断面研究。我们共纳入了82例患者，其中41例CHT患者和41例PHT患者。纳入时，所有患者在过去6个月内必须有稳定剂量的左甲状腺素，且PHT患者需甲状腺功能正常（定义为促甲状腺激素水平在参考范围内，0.2 - 4.5 mU/L）。所有数据均从医疗档案中获取，生活质量问卷由患者自行填写。
CHT组和PHT组在年龄和体重指数方面具有可比性。两组患者左甲状腺素的每日总剂量（CHT组为100（93.75 - 125.00）μg，PHT组为107.14（75.00 - 133.93）μg；P = 0.87）或每千克体重的左甲状腺素每日剂量（分别为1.34（1.16 - 1.55）μg/kg和1.55（1.16 - 1.82）μg/kg；P = 0.13）均无显著差异。两组患者的血清游离甲状腺素（fT4）水平（P = 0.20）和游离三碘甲状腺原氨酸（fT3）水平（P = 0.10）也无差异，且两组均处于正常（中等）范围。在生活质量方面，CHT患者在抑郁和情绪症状、日常及社交生活受损方面得分更低。
我们可以证明CHT患者和PHT患者在生活质量上存在差异。尽管CHT患者的左甲状腺素替代剂量略低于PHT患者，但这种差异也不显著，可能无法解释生活质量的差异。
