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Hashimoto's thyroiditis (HT) is the most common endocrine disorder leading to hypothyroidism. HT is characterized by the presence of elevated circulating antibodies, especially anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg). In our study, we aimed to reveal the effects of autoimmunity on health-related quality of life of euthyroid HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic were enrolled. The medical records of the patients were surveyed and their demographical data were collected. By using communication data, the patients were invited to our clinic, to inform them about our study and to fill out the health-related quality of life questionnaire. A total of 84 euthyroid HT patients older than 18 years who completed the short form-36 questionnaire, were enrolled. As all patients were euthyroid, there was a significant negative correlation between each domain score and the antibody levels, individually. Patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores (p < 0.001). There was statistically no significant correlation between the antibody levels and thyroid function tests (p > 0.05). Additionally, all dimension scores were significantly higher both in the anti-Tg and anti-TPO negative groups, indicating a better quality of life than that in the antibody positive groups. Our study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of HT-associated symptoms, leading to a lower quality of life. Other probable contributing factors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should keep in mind.
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ORIGINAL ARTICLE
Autoimmunity affects health-related quality of
life in patients with Hashimoto’s thyroiditis
Hilal Bektas Uysal
a,
*, Mediha Ayhan
b
a
Department of Internal Medicine, Adnan Menderes University School of Medicine,
Aytepemevkii Merkez, Aydin, Turkey
b
Department of Endocrinology, Adnan Menderes University School of Medicine,
Aytepemevkii Merkez, Aydin, Turkey
Received 8 April 2016; accepted 28 June 2016
KEYWORDS
Anti-thyroglobulin;
Anti-thyroid
peroxidase;
Hashimoto’s
thyroiditis;
Health related quality
of life
Abstract Hashimoto’s thyroiditis (HT) is the most common endocrine disorder leading to hy-
pothyroidism. HT is characterized by the presence of elevated circulating antibodies, espe-
cially anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin(anti-Tg).Inourstudy,we
aimed to reveal the effects of autoimmunity on health-related quality of life of euthyroid
HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic
were enrolled. The medical records of the patients were surveyed and their demographical
data were collected. By using communication data, the patients were invited to our clinic,
to inform them about our study and to fill out the health-related quality of life questionnaire.
A total of 84 euthyroid HT patients older than 18 years who completed the short form-36 ques-
tionnaire, were enrolled. As all patients were euthyroid, there was a significant negative cor-
relation between each domain score and the antibody levels, individually. Patients who had
higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores
(p<0.001). There was statistically no significant correlation between the antibody levels
and thyroid function tests (p>0.05). Additionally, all dimension scores were significantly high-
er both in the anti-Tg and anti-TPO negative groups, indicating a better quality of life than that
in the antibody positive groups. Our study revealed that higher thyroid antibody levels were
negatively correlated with life quality scores. Thus, patients who had higher anti-TPO and
anti-Tg levels had significantly lower quality of life domain scores. We believe that apart from
hypothyroidism, a high antibody level was one of the contributing factors for the development
of HT-associated symptoms, leading to a lower quality of life. Other probable contributing fac-
tors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should
keep in mind.
Copyright ª2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).
Conflicts of interest: All authors declare no conflicts of interests.
* Corresponding author. Adnan Menderes University, School of Medicine, Department of Internal Medicine, 090100, Aytepe, Aydin, Turkey.
E-mail address: hilalbektasuysal@yahoo.com (H. Bektas Uysal).
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Please cite this article in press as: Bektas Uysal H, Ayhan M, Autoimmunity affects health-related quality of life in patients with
Hashimoto’s thyroiditis, Kaohsiung Journal of Medical Sciences (2016), http://dx.doi.org/10.1016/j.kjms.2016.06.006
http://dx.doi.org/10.1016/j.kjms.2016.06.006
1607-551X/Copyright ª2016, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Available online at www.sciencedirect.com
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journal homepage: http://www.kjms-online.com
Kaohsiung Journal of Medical Sciences (2016) xx,1e7
Introduction
Hashimoto thyroiditis (HT) is the most common endocrine
disorder leading to hypothyroidism. The disease is
considered to be the most common autoimmune disease.
HT is characterized by the presence of elevated circu-
lating antibodies to thyroid antigens, especially the anti-
thyroid peroxidase (anti-TPO) and anti-thyroglobulin
(anti-Tg) antibodies [1]. The disease is diagnosed by
clinical properties, presence of serum antibodies, and the
sonographic appearance of thyroid. Anti-TPO is consid-
ered to be the best serological marker for the diagnosis of
HT and is found positive in nearly 95% of the patients. It
has been shown that anti-TPO titers are positively corre-
lated with the number of thyroid-infiltrating lymphocytes
and with the sonographic hypoechogenicity degree of the
thyroid [2]. Anti-Tg antibodies are positive in nearly
60e70% of HT patients and are found to be positive in a
higher proportion of healthy people. They are less specific
and sensitive for HT when compared with anti-TPO anti-
bodies [3]. As the two antibodies are assessed together for
the diagnosis in daily practice, they correlate poorly. In
HT, anti-TPO levels are expected to be at higher titers
than anti-Tg levels [1].
The influence of a chronic disease on the everyday life of
a patient is very important. Health-related quality of life
(HRQoL) is ‘a general concept that implies an evaluation of
the impact of all aspects of life on the general well-being’
[4]. In other words, it is the subjective assessment of how a
medical situation affects the daily physical, emotional,
social functioning, and well-being of a person [5]. When
treating a chronic disorder such as HT, the HRQoL of the
patient may be damaged because of different contributing
factors. Concurrently with medical examinations,
measuring HRQoL in daily clinical practice may give
important information about patients with particular diffi-
culties, which may need support, and about the effects of
the treatment modalities or the patients’ emotional moods.
In the last decade especially, HRQoL has been one of the
main targets of chronic disease treatment.
The importance of HRQoL has also increasingly been
acknowledged for thyroid disorders by some recent studies
[6e9]. To date, hypothyroidism is thought to be the main
factor for the increased symptom load and decreased
quality of life. However, studies have revealed that thyroid
disorders affect HRQoL, independently of the thyroid
function status. Even in euthyroid patients HRQoL was also
found to be decreased [7]. From this point of view, we
aimed to reveal other contributing factors of decreased
quality of life.
It is known that thyroid dysfunctions and mood disor-
ders, especially depression, often exist together [10].
Autoimmunity in the thyroid gland, mostly anti-TPO, was
found to be closely linked with decreased quality of life and
a depressed mood [7,11]. However, there are conflicting
studies suggesting that there is no association [12].
In our present study, we aimed to reveal the effects of
autoimmunity on HRQoL of euthyroid HT patients.
Furthermore, to the best of our knowledge, this is the first
study assessing the impact of two antibodies, anti-TPO and
anti-Tg together on HRQoL.
Materials and methods
Study design
Patients with HT diagnosis who were admitted to Adnan
Menderes University Outpatient Clinic between December
2013 and January 2016 were enrolled in our study. The HT
diagnosis was based on histological validation or clinical
properties, presence of serum antibodies, and sonographic
findings. Among all selected participants, there were 13
patients with negative antibody but diagnosed with histo-
logical examination. The medical records of patients were
surveyed and the demographic data collected. Patients who
had thyroid function test results in the last 6 months and
thyroid antibody test results were selected. Normal ranges
in our laboratory for thyroid stimulating hormone (TSH) and
free thyroxine (fT4) were 0.35e4.94 IU/mL and
0.70e1.48 ng/dL, respectively. Patients who had hyper-
thyroidism (decreased TSH and increased fT4 levels) or
hypothyroidism (increased TSH and decreased fT4 levels)
were excluded. Patients with subclinical thyroid dysfunc-
tions were not included; only euthyroid patients were
included. Clinical variables including age, associating
chronic diseases, and treatment options were completed
during the survey. By using the communication data, pa-
tients were invited to our clinics to be informed about our
study and to fill out the HRQoL questionnaire. Written
informed consent of patients who agreed to participate in
the study was taken. Participants older than 18 years who
completed the SF-36 questionnaire were enrolled in the
study. Patients having psychiatric disorders, dementia,
pregnancy, inflammatory diseases, acute infections and
malignancy were excluded from the study. Additionally,
patients having mental or social retardation, who were
unable to complete the questionnaire, were also excluded.
This study was approved by the Ethics Committee of the
Adnan Menderes University Faculty of Medicine, Aydin,
Turkey.
HRQoL measurement
SF-36 is a self-completed questionnaire measuring eight
aspects of health status: (1) physical functioning (PF)dthe
extent of health limiting physical activity; (2) physical role
playing (RP)dthe extent of physical health interfering or
limiting the usual role activities; (3) emotional role playing
(RE)dthe extent of emotional problems interfering or
limiting the usual daily role activities; (4) social functioning
(SF)dthe extent of physical health or emotional problems
interfering with the normal social activities; (5) bodily pain
(BP)dthe intensity of pain and effects on normal activities;
(6) mental health (MH)dincludes depression and anxiety;
(7) vitality (VT)dincluding feeling full of pep versus tired
and worn-out; and (8) general health (GH)dpersonal
evaluation of health. SF-36 measures these eight health
dimensions with 36 items: PF with 10 items; RP and VT each
with four items; RE with three items; SF and BP each with
two items; and GH and MH each with five items. There is a
further unscaled single item asking respondents about
health change over the past year. For each dimension, the
2 H. Bektas Uysal, M. Ayhan
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Please cite this article in press as: Bektas Uysal H, Ayhan M, Autoimmunity affects health-related quality of life in patients with
Hashimoto’s thyroiditis, Kaohsiung Journal of Medical Sciences (2016), http://dx.doi.org/10.1016/j.kjms.2016.06.006
item scores are coded, summed, and transformed on to a
scale from 0 (worst possible health state measured by the
questionnaire) to 100 (the best possible health state) [13].
The scores represent the percentage of the total possible
score achieved. Following this, the items in the same scale
are averaged together to create the eight dimension scores.
Physical composite scores (PCS) and mental composite
scores (MCS) were calculated for the SF-36 as described by
Ware et al. [13,14]. PCS defines the general physical health
status and MCS defines the general mental health status.
The SF-36 questionnaire is widely used in chronically ill
patients and has significant correlations with other HRQoL
measures [14]. Moreover, adequate internal consistency
reliabilities (0.81e0.88) support its use [15]. The reliability
of the Turkish version of SF-36 has been proved by Koc¸yi
git
et al. [16].
Statistical analysis
All data were analyzed by using the PASW Statistics version
18 (SPSS Inc., Chicago, IL, USA) software package. The
KolmogoroveSmirnov test was used to assess the normality
of the numeric variables. Descriptive analyses were pre-
sented using the mean standard deviation or median (25
th
percentile to 75
th
percentile values) for continuous vari-
ables and percentage values were given for categorical
variables. Student tand ManneWhitney Utests were used
to compare the parametric continuous variables in the in-
dependent groups and Chi-square tests were used for the
comparison of categorical variables. The Spearman’s coef-
ficient was used to measure correlations among the quality
of life scores, the antibody levels, and thyroid function test
levels. Additionally, patients were stratified into groups
according to their serum antibody levels. Patients with
positive anti-TPO levels and negative anti-TPO levels were
assessed according to their HRQoL domain scores using the
ManneWhitney Utest. Similar assessments were performed
according to the anti-Tg levels, too. An overall 0.05 type-1
error level was used to infer the statistical significance.
Results
A total of 84 patients, 94% women and 6% men were
enrolled in our study. The mean age of the group was
41.82 12.16 years. The patient characteristics are pre-
sented in Table 1. Eighteen patients had additional
comorbidities except psychiatric disorders, dementia,
pregnancy, inflammatory diseases, acute infections, ma-
lignancy, and mental retardation. All patients had normal
fT4 and TSH levels within normal ranges. Fifty-two patients
(62% of the study population) were under thyroid hormone
supplementation. All patients with and without thyroid
hormone supplementation were euthyroid.
Overall, the HRQoL domain scores of the study population,
expressed as median (25
th
e75
th
percentile) values, were as
follows: PF 80.00 (56.25e90.00); RP 50.00 (0.00e75.00); BP
62.00 (41.00e74.00); GH 43.50 (30.00e65.00); VT 32.50
(20.00e63.75); SF 50.00(37.50e75.00); RE 33.30 (0.00e
66.70); MH 52.00 (33.00e68.00); PCS 44.40 (36.57e51.22);
and MCS 34.55 (27.85e43.75).
As shown in Table 2, there was a significant negative
correlation between each SF-36 domain score and antibody
level, individually. Patients who had higher anti-TPO and
anti-Tg levels had a significantly lower quality of life
domain scores (p<0.001). There was no statistically sig-
nificant correlation between the antibody levels and thy-
roid function tests (p>0.05). Additionally, there was no
significant correlation between the TSH or fT4 levels and
the HRQoL domain scores (p>0.05).
Patients were stratified according to their antibody
levels. When anti-TPO positive patients were compared
with those with negative anti-TPO, no difference was found
in the prevalence in female patients [62 (94%) vs. 17 (94%),
p>0.05] age and thyroid hormone supplementation [41
(62%) vs. 11 (61%), p>0.05]. There was also no significant
difference in TSH [1.89 (0.98e3.32) vs.1.87 (0.93e2.96),
p>0.05] and fT4 [1.09 (0.99e1.199 vs 1.14 (0.96e1.20),
p>0.05] levels between anti-TPO positive and negative
groups. Similarly, there were no significant differences
between anti-Tg positive and negative groups in terms of
sex [56 (93%) vs. 23 (96%), p>0.05], age, thyroid hormone
supplementation [37 (62%) vs. 15 (62%), p>0.05], TSH
[1.89 (1.00e3.40) vs. 1.88 (0.92e2.75), p>0.05] and fT4
[1.09 (0.99e1.19) vs. 1.10 (0.98e1.23), p>0.05] levels. As
mentioned above, the groups were similar in terms of some
important probable confounding factors such as age, sex,
thyroid hormone supplementation and thyroid hormone
levels. All dimension scores were significantly higher both
in anti-Tg and anti-TPO negative groups, indicating a better
quality of life than in the antibody positive groups
(p<0.001). When these groups were stratified by adjusting
the comorbidities as a confounding factor; there was also a
significant difference between both anti-TPO and anti-Tg
antibody positive and negative groups (p<0.001). SF-36
domain scores in antibody positive and negative groups,
by adjusting comorbidities, are as presented in Tables 3
and 4.
Table 1 Demographic and clinical characteristics of
patients.
Variable Value
Sex (female), n(%) 79 (94)
Patients with thyroid hormone
supplementation, n(%)
52 (62)
Patients with comorbidity,
n(%)
18 (21)
Age (y), mean standard
deviation
41.82 12.16
TSH (mU/mL), median
(25
th
e75
th
percentile)
1.89 (0.96e3.22)
fT4 (ng/dL), median
(25
th
e75
th
percentile)
1.10 (0.99e1.19)
Anti-TPO (IU/mL), median
(25
th
e75
th
percentile)
287.19 (22.72e762.20)
Anti-Tg (IU/mL), median
(25
th
e75
th
percentile)
24.82 (3.38e160.07)
Anti-Tg Zanti-thyroglobulin antibody; Anti-TPO Zanti-thyro-
peroxidase antibody; fT4 Zfree thyroxine; TSH Zthyroid
stimulating hormone.
Quality of life in Hashimoto’s thyroiditis 3
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Please cite this article in press as: Bektas Uysal H, Ayhan M, Autoimmunity affects health-related quality of life in patients with
Hashimoto’s thyroiditis, Kaohsiung Journal of Medical Sciences (2016), http://dx.doi.org/10.1016/j.kjms.2016.06.006
Discussion
It is well-known that thyroid dysfunction affects the mental
and physical dimensions of personal health and decreases
the HRQoL of patients [17]. Most of the studies point out
the presence of hypothyroidism and the related reduction
in the HRQoL of patients. However, euthyroid patients still
suffer from a general indisposition with various pre-
sentations. Our study clearly reveals that HT impacts the
perceived health status independently from the thyroid
function state. In the study by Demiral et al. [18], the
population norms of the SF-36 health survey in Turkey has
been determined. According to this Turkish norm-based SF-
36, the mean standard deviation (median) dimension
scores are: PF 83.8 20.0 (100); RP 86.3 24.9 (100); BP
82.9 18.9 (100); GH 71.6 16.1 (72); VT 64.5 12.9 (70);
SF 91.0 12.9 (100); RE 90.1 19.4 (100); MH 71.0 11.0
(76); PCS 47.9 8.9 (54); and MCS 47.7 9.4 (52). When
compared with the Turkish general population norms, all
domains are evidently lower in our study group, indicating a
poorer quality of life in HT patients. This poor HRQoL status
in euthyroid HT patients may have a few explanations. The
contributing factors may be disease awareness, subclinical
hypothyroidism, fluctuating thyroid hormone levels, and
antibody load, individually.
In some other chronic diseases such as hepatitis C, only
the awareness of the disease may lead to poorer HRQoL in
patients [19]. Therefore, solely the HT disease awareness
may be one of the contributing factors of poor HRQoL in our
patients.
The most relevant result of our study was the strong
association of both the higher anti-TPO and anti-Tg levels
with a lower HRQoL. In a few previous studies, a negative
correlation between HRQoL and anti-TPO has been
observed [7,20]. To the best of our knowledge this is the
first study demonstrating the negative correlation between
anti-Tg and HRQoL, entirely. Some researchers have
thought that if the antibody load itself is the main
impacting factor on the HRQoL, substantial reduction of the
antibody may help to improve the quality of life. It is known
Table 2 Relationship between health related quality of life scores and antibody levels by Spearman’s correlation coefficient.
PF RP BP GH VT SF RE MH PCS MCS
Anti-TPO 0.73* 0.76* 0.71* 0.69* 0.79* 0.55* 0.62* 0.68* 0.76* 0.64*
Anti-Tg 0.57* 0.65* 0.54* 0.65* 0.63* 0.51* 0.49* 0.56* 0.62* 0.56*
The Spearman’s coefficient was used to measure correlations. p<0.05 was defined as statistically significant. * Correlation is significant
at the 0.01 level (2-tailed).
Anti-Tg Zanti-thyroglobulin antibody; Anti-TPO Zanti-thyroperoxidase antibody.
Table 3 Health related quality of life (HRQoL) domain scores in comparison with anti-thyroperoxidase antibody (Anti-TPO)
levels by adjusting comorbidities.
Comorbidity HRQoL domain AntieTPO ()nZ18 AntieTPO (þ)nZ66 p*
Yes PF 92.50 (86.25e98.75) 67.50 (27.50e86.25) 0.01
RP 100.00 (100.0e100.00) 25.00 (0.00e56.25) <0.001
BP 79.00 (74.00e84.00) 41.00 (22.00e74.00) <0.001
GH 77.00 (64.50e85.75) 42.00 (30.00e52.00) <0.001
VT 82.50 (72.50e85.00) 27.50 (20.00e42.50) <0.001
SF 93.75 (78.12e100.00) 56.25 (34.37e65.62) <0.001
RE 100.00 (100.00e100.00) 0.00 (0.00e33.30) <0.001
MH 80.00 (73.00e84.00) 44.00 (32.00e56.00) <0.001
PCS 53.15 (50.15e55.70) 39.95 (28.05e47.00) 0.01
MCS 54.30 (52.15e58.25) 32.90 (27.95e38.07) <0.001
No PF 95.00 (90.00e100.00) 70.00 (55.00e80.00) <0.001
RP 100.00 (75.00e100.00) 25.00 (0.00e50.00) <0.001
BP 84.00 (74.00e100.00) 57.00 (41.00e74.00) <0.001
GH 67.00 (57.00e73.25) 40.00 (25.50e50.00) <0.001
VT 72.50 (60.00e81.25) 25.00 (15.00e40.00) <0.001
SF 75.00 (59.37e100.00) 50.00 (37.50e62.50) <0.001
RE 83.35 (58.35e100.0) 33.30 (0.00e33.30) <0.001
MH 76.00 (63.00e80.00) 46.00 (28.00e60.00) <0.001
PCS 54.05 (50.80e57.85) 40.95 (35.20e47.07) <0.001
MCS 47.00 (43.20e52.10) 32.25 (24.40e39.37) <0.001
*ManneWhitney Utest, p<0.05 was statistically significant. Data are reported as median (25
th
e75
th
percentile).
BP Zbodily pain; GH Zgeneral health; MCS Zmental composite scores; MH Zmental health; PCS Zphysical composite scores;
PF Zphysical functioning; RE Zrole emotional; RP Zrole playing; SF Zsocial functioning; VT Zvitality.
4 H. Bektas Uysal, M. Ayhan
+MODEL
Please cite this article in press as: Bektas Uysal H, Ayhan M, Autoimmunity affects health-related quality of life in patients with
Hashimoto’s thyroiditis, Kaohsiung Journal of Medical Sciences (2016), http://dx.doi.org/10.1016/j.kjms.2016.06.006
that total or near total removal of the thyroid gland by
surgery leads to the reduction in antibody loads [21].
However, it was revealed by Promberger et al. [8] that
thyroidectomy is not a convenient option for increasing
HRQoL of HT patients, who have high anti-TPO antibody
levels. Additionally, after surgery, the lifelong overt hypo-
thyroidism and impaired immunity status should be
considered, as the quality of life may be further affected by
these factors.
As an autoimmune disease, numerous organ-specific and
nonorgan-specific diseases are known to associate with HT
[22]. These associating autoimmune diseases are thought to
be the contributing factors for the lower HRQoL scores in
HT. In the serum of patients with autoimmune thyroid dis-
ease there is a polyclonal immune response against some
autoantigens [23]. In light of these data, elevated serum
thyroid antibody levels may be seen as the representatives
of altered immunity. Consequently, removal of the thyroid
gland alone cannot improve the quality of life unless the
thyroid is the major stimulating factor for autoimmunity.
Dardano et al. [24] recently accounted for the possible role
of thyroid autoimmunity in the HT-associated clinical syn-
drome. They reported fibromyalgia in one-third of their HT
patients and fibromyalgia was higher in euthyroid patients.
Additionally, an electron microscopic study of the skeletal
muscles of euthyroid HT patients revealed alterations
indicating an association with thyroid autoimmunity and
muscle symptoms. This study implies that clinical course of
HT patients may be more complicated than it appears and
systemic autoimmunity triggered by thyroid antibodies may
be the key concept. In the study by Rotondi et al. [25],it
was revealed that antibody-negative HT patients have a
milder clinical course, with less overt hypothyroidism, as
compared to antibody-positive patients. Therefore, the
poor HRQoL of euthyroid patients with a positive antibody
makes it obvious that thyroid antibodies are the markers for
the consequent systemic autoimmune disease development
with numerous symptoms.
Thyroid hormones are essential in the nervous system
development and the thyroid hormone alterations may
lead to central nervous system malfunctions, such as
mood and cognition disorders [12]. In our study, the
mental dimensions in the SF-36 questionnaire, such as the
mental health and mental composite scores, are not
significantly correlated with the thyroid function tests.
Concurrently, euthyroid HT patients have also been asso-
ciated with the increasing risk of depression, depending
on the high anti-TPO levels [11,26]. Consistent with these
results, the mental health and mental composite scores
especially were found to be negatively correlated with
both the anti-Tg and anti-TPO levels, in our study. Pa-
tients with higher antibody levels were found to have a
lower HRQoL.
Nearly, 62% of the patients were under thyroid hormone
supplementation, in both the antibody negative and pos-
itive groups. It is well known that the thyroid hormone
levels frequently fluctuate in HT patients and the adjust-
ment of hormone supplementation may often be difficult
[7]. Thus, the idea that patients with higher antibody
levels may have experienced temporary hypothyroidism
Table 4 Health-related quality of life (HRQoL) domain scores in comparison with anti-thyroglobulin antibody (Anti-Tg) levels
by adjusting comorbidities.
Comorbidity HRQoL Domain Anti-Tg ()nZ24 Anti-Tg (þ)nZ60 p*
Yes PF 90.00 (80.00e95.00) 55.00 (25.00e70.00) 0.01
RP 75.00 (50.00e100.00) 0.00 (0.00e25.00) <0.001
BP 74.00 (57.50e84.00) 41.00 (22.00e51.50) 0.01
GH 62.00 (44.50e77.00) 40.00 (30.00e48.50) 0.03
VT 70.00 (37.50e82.50) 20.00 (17.50e35.00) <0.001
SF 75.00 (62.50e93.75) 50.00 (25.00e65.50) <0.001
RE 100.00 (33.30e100.00) 0.00 (0.00e16.65) <0.001
MH 72.00 (44.00e80.00) 40.00 (30.00e52.00) 0.02
PCS 50.90 (45.20e53.65) 39.60 (27.80e41.90) <0.001
MCS 47.30 (34.95e54.30) 29.70 (25.85e36.15) <0.001
No PF 95.00 (90.00e100.00) 70.00 (55.00e80.00) <0.001
RP 100.00 (100.00e100.00) 25.00 (0.00e50.00) <0.001
BP 100.00 (74.00e100.00) 52.00 (41.00e74.00) <0.001
GH 72.00 (67.00e77.00) 40.00 (25.00e47.00) <0.001
VT 75.00 (65.00e80.00) 25.00 (15.00e40.00) <0.001
SF 75.00 (62.50e87.50) 50.00 (37.50e62.50) <0.001
RE 66.70 (33.30e100.0) 33.30 (0.00e33.30) <0.001
MH 76.00 (64.00e80.00) 48.00 (28.00e60.00) <0.001
PCS 57.70 (54.00e59.90) 40.70 (35.00e46.20) <0.001
MCS 47.40 (42.90e51.10) 32.20 (25.60e40.00) <0.001
*ManneWhitney Utest, p<0.05 was statistically significant. Data are reported as median (25
th
e75
th
percentile).
BP Zbodily pain; GH Zgeneral health; MCS Zmental composite scores; MH Zmental health; PCS Zphysical composite scores;
PF Zphysical functioning; RE Zrole emotional; RP Zrole playing; SF Zsocial functioning; VT Zvitality.
Quality of life in Hashimoto’s thyroiditis 5
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much more than antibody-negative patients cannot be
denied. This may be another contributing factor of the
lower HRQoL scores in patients with higher antibody
levels.
Selenium is another noteworthy subject in HT patients.
Selenium deficiency is known to be associated with
increased risk of cancer and infections and serious neuro-
logical diseases such as Alzheimer’s and Parkinson’s dis-
ease. Additionally, selenium deficiency has also been shown
to contribute to mood changes, behavior, and cognitive
function alterations in HT patients [27,28]. After selenium
supplementation, a decrease in anti-TPO levels was
revealed by Ga
¨rtner et al. [29]. Selenium is thought to
affect body immune responses directly by incorporation
into some selenoproteins [30]. Therefore, selenium may be
a treatment option for HT patients. However, further
studies are needed in this area.
In conclusion, our study revealed that higher antibody
levels are negatively correlated with quality of life scores.
Thus, patients who have higher anti-TPO and anti-Tg levels
have significantly lower quality of life domain scores. As all
our HT patients were euthyroid, the thyroid hormone sup-
plementation rates were similar in each group. We believe
that apart from hypothyroidism, a high antibody level is one
of the contributing factors for the development of HT-
associated symptoms leading to a lower quality of life.
Other probable contributing factors such as selenium defi-
ciency, thyroid hormone fluctuation, and disease awareness
must also be kept in mind. Further studies are needed to
pave the way for new approaches and treatment strategies
for HT patients.
Acknowledgments
We want to thank to Associate Professor Filiz Ergin for her
precious contributions to the statistical analysis of this
study.
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Hashimoto’s thyroiditis, Kaohsiung Journal of Medical Sciences (2016), http://dx.doi.org/10.1016/j.kjms.2016.06.006
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Quality of life in Hashimoto’s thyroiditis 7
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... 9 Symptom distress is the degree of physical or mental upset experienced by a particular disease. [9][10][11][12] The phenomenon of increased SD in clinical euthyroidism has been linked to decreased quality of life (QoL) in patients with HT. 9,[13][14][15][16] The etiology of SD in individuals with HT is poorly understood. 5 It has been speculated that the autoimmune component of HT may be the culprit for persistent symptoms. ...
... 5 It has been speculated that the autoimmune component of HT may be the culprit for persistent symptoms. 5,15 Some have suggested that aTA may be the confounding factor in the inability to resolve the symptoms of adequately treated patients with HT. 5,15 Recently, researchers have hypothesized that aTA may induce oxidative stress and may act as a cytotoxin to thyroid cells in individuals with HT. [17][18][19] One study found physical and psychological health to be worse in the presence of aTA compared to patients without circulating aTA. 9 Moreover, some have theorized that the aTA concentrations are directly related to the severity of SD a person experiences. 12 A group of researchers noted that patients perceived their mental and physical health to be worse when aTA levels were double the reference range. ...
... 5 It has been speculated that the autoimmune component of HT may be the culprit for persistent symptoms. 5,15 Some have suggested that aTA may be the confounding factor in the inability to resolve the symptoms of adequately treated patients with HT. 5,15 Recently, researchers have hypothesized that aTA may induce oxidative stress and may act as a cytotoxin to thyroid cells in individuals with HT. [17][18][19] One study found physical and psychological health to be worse in the presence of aTA compared to patients without circulating aTA. 9 Moreover, some have theorized that the aTA concentrations are directly related to the severity of SD a person experiences. 12 A group of researchers noted that patients perceived their mental and physical health to be worse when aTA levels were double the reference range. ...
Article
Objective: The aim of this review was to evaluate the association between anti-thyroid antibodies and quality of life in people with euthyroid Hashimoto's thyroiditis. Introduction: Patients with Hashimoto's report symptom distress more often than those with non-autoimmune thyroid disorders. Therefore, anti-thyroid antibodies may be related to decreased quality of life in persons with Hashimoto's. The etiology of lingering symptoms, even in euthyroidism, remains unknown. The relationship between anti-thyroid antibodies and quality of life for people with Hashimoto's has not been evaluated in a systematic review. Inclusion criteria: The participants were males and females at least 12 years old with Hashimoto's. Participants not in a euthyroid state were excluded from this review. In this review, the exposure was the presence of anti-thyroid antibodies and the primary outcome was quality of life. Methods: A three-step search strategy was implemented with an initial search of PubMed and CINAHL. A comprehensive database search using all identified keywords and index terms was undertaken in March 2019 for relevant published literature, gray literature, and clinical trial registries. The final updates to the search strategies were conducted in December 2019. The search was limited to studies published in English after 1956. Two independent reviewers completed screening for inclusion and utilized the recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis. The findings are presented in a meta-analysis and in a narrative synthesis, which includes tables and figures. Results: All 13 studies had high methodological quality. Four studies found a significant correlation (P < 0.05) between antibodies and quality of life. A fifth study found a significant correlation (P < 0.001) between higher antibody levels and quality of life. A meta-analysis was conducted using two cross-sectional studies, which revealed that the summative small effect size is statistically significant and suggests a lower quality of life in antibody-positive patients. Due to the heterogeneity of the studies, a narrative synthesis was conducted for the three secondary outcomes: symptom distress, executive function, and mental health. Three studies found a statistically significant (P < 0.05) correlation between symptom distress and antibodies, two studies found a statistically significant (P < 0.05) association between executive function and antibodies, and all but one study found a statistically significant (P < 0.05) relationship between mental health and antibodies. Conclusions: The findings in this review did not reveal a definitive relationship between antibodies and quality of life. However, our meta-analysis suggested a link between anti-thyroid antibodies and decreased quality of life in euthyroid children and adults. Though not conclusive, poor mental health and symptom distress may be associated with anti-thyroid antibodies. Therefore, it may be beneficial to periodically evaluate the quality of life and mental health in euthyroid patients with positive antibodies. It is unlikely that antibodies and executive functions are related. The studies and our review's limitations require replication of findings to confirm a connection between antibodies, quality of life, and the secondary outcomes. Future research should continue to evaluate the relationship between anti-thyroid antibodies and the quality of life in individuals with euthyroid Hashimoto's thyroiditis. Systematic review registration number: PROSPERO CRD42018084663.
... HT is portrayed by the manifestation of antibodies that attack the thyroid cells and it is affecting mostly women. Patients with HT experience persistent complaints such as impairments in cognitive functioning and physical and psychological symptoms, have a higher chance to develop other autoimmune diseases, and as consequence experience a decreased quality of life (Boelaert et al., 2010;Gulseren et al., 2006;Uysal & Ayhan, 2016). Because HT can provoke changes in body appearance and anatomy such as skin dryness, hair loss, weight gain, and hoarseness, feelings of shame may occur. ...
... Because HT can provoke changes in body appearance and anatomy such as skin dryness, hair loss, weight gain, and hoarseness, feelings of shame may occur. Patients' quality of life is inversely related to the level of circulating antibodies against thyroid cells (Uysal & Ayhan, 2016) while psychological symptoms such as fatigue, irritability, nervousness, and depression increase with higher antibody levels (Müssig et al., 2012;Ott et al., 2011). In some instances, the psychological symptoms experienced by patients with HT lead to a mental health disorder as diagnosed with DSM-5 (Bauer et al., 2008;Müssig et al., 2012). ...
Article
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Objectives Patients with Hashimoto thyroiditis (HT) experience mental health complaints due to the immune system dysregulation. Preliminary evidence suggests that psychological interventions could improve patients’ quality of life. Compassionate mind training (CMT) is part of compassion-focused therapy (CFT) and can be used to help individuals address physical and mental health difculties. The present study sought to assess the acceptability and preliminary efcacy of Reset Your Immune System, a 6-week CMT-based online intervention, in patients with HT. Methods Nine women were randomly selected from a wider sample that undertook the online intervention. Upon completion, they were interviewed with nine standard open-ended questions. Additionally, pre- and post-intervention questionnaires were flled out. Results Qualitative analysis indicated that participants observed improvements in symptoms, sleep quality, self-awareness, stress-management, and self-regulation skills. Participants did experience some difculties in undertaking compassion-related exercises. Quantitative analyses showed that negative afect, social/role limitations, and HT symptoms indicated a reliable change from pre- to post intervention. Conclusions Overall, Reset Your Immune System showed benefcial efects on patients with HT, suggesting that including psychological care as part of the standard treatment of HT might have added value. It is important to assess long-term efects in a larger sample through a randomized control trial.
... The risk of miscarriage and infertility increased in the young women with HT, and thyroid hormone supplementation is not effective in relieving this situation [10]. It was found that HT patients with normal thyroid function may suffer from various clinical symptoms which reduce the quality of life and this may be positively correlated with high thyroid antibody concentrations [11,12]. ...
... Some studies use the SF-36 to reflect the quality of life of HT patients. It is found that when the thyroid function is normal, the quality of life of HT patients is negatively correlated with antibody levels [11,12]. Therefore, in this study, SF-36 is also used as an observation indicator to evaluate the influence of acupuncture on HT patients. ...
Article
Full-text available
Background The incidence rate of Hashimoto thyroiditis (HT) has gradually increased in recent years. There has been no specific etiological treatment for HT. Even though with normal level of thyroid hormone, the patients may still suffer from various clinical symptoms, such as anterior neck discomfort, fatigue, and mood swings, which seriously impair their quality of life. Acupuncture has long been used in the treatment of thyroid diseases, but there has been no related standardized clinical study as of today. This study aims to assess the feasibility, efficacy, and safety of acupuncture for HT. Methods This is a randomized, black-controlled assessor-blinded pilot trial. A total of 60 patients will be recruited and divided into the experimental group ( n = 30) or the control group ( n = 30). The experimental group will undergo acupuncture therapy (penetration needling of Hand-Yangming meridian, PNHM) for 16 weeks, followed by a 16-week follow-up period, and the control group will first go through an observation period for 16 weeks, followed by a 16-week compensation PNHM therapy. The primary outcome will be the change of the concentrations of anti-thyroperoxidase antibodies (TPOAb), antithyroglobulin antibodies (TgAb), and thyroid hormone, including total thyroxine (FT 4 ), free thyroxine (FT 3 ), and thyroid-stimulating hormone (TSH). The secondary outcome measurements include the thyroid-related quality of life questionnaire short-form (ThyPRO-39), The Mos 36-item Short Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HAD). Data collection will be performed before the start of the study (the baseline assessment) and at weeks 8, 16, 24, and 32. Discussion The study is designed to assess the feasibility and effectiveness of PNHM in reducing the thyroid antibody level and improving the quality of life of HT patients with hypothyroidism or subclinical hypothyroidism. Results of this trial will assist further analyses on whether the acupuncture treatment can alleviate symptoms for patients with HT. Trial registration Acupuncture-Moxibustion Clinical Trial Registry AMCTR-IOR-19000308 ( ChiCTR1900026830 ). Registered on 23 October 2019.
... Women are exposed up to 8 times more often in comparison to the risk of disease among men [27]. Carta et al. in their studies prove even six times higher risk of depressive disorders in the group of patients with Hashimoto's disease, regardless of thyroid dysfunction assessed by routine serological tests [28,29]. ...
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Introduction. Numerous authors have undertaken research on the coexistence of mental health disorders and thyroid disease. They have not been able to clearly demonstrate which illness came first. Aim. The main purpose of this work is to asses the coexistence of thyroid disease with mental health conditions and disorders in behaviour. This work is based on a retrospective study and has shown frequent coexistence of thyroid disease with mental health or behaviour disorders. Material and methods. The research method was a retrospective study carried out on the basis of medical records of patients of primary care clinics in the city of Lublin. The criterion for qualifying patients for the study was having a diagnosis, according to ICD 10, from at least one of the following groups: thyroid diseases E03-E07, mental health conditions F00-F 99 and behavioral disorders R44-R46. Results. In total, 243 patients were qualified for the study. In this group 193 people are women and the remaining 50 are men. Among patients with isolated diseases, 28% of them have only diagnosed thyroid disease; every third patient (30%) has diagnosed mental health illness or behavioural disorders. The Fisher test showed a relationship between thyroid diseases and mental health conditions including behavioural disorders (p=0.0000). A group of people with hypothyroidism in the course of Hashimoto’s disease has been identified. The results of the prevalence of the disease were observed dividing by gender and age. Hashimoto’s disease occurs in the group of 15% women and 4% men. Pearson’s Chi ² test showed a relationship between the incidence of Hashimoto’s disease and gender (p=0.037). The quota coefficient showed that this relationship is weak (0.13). The disease is more common in women. Conclusions. There is a close relationship between the incidence of thyroid disease and mental health illness, including behavioural disorders. Patients with co-morbidity are significantly more likely to present mental illnesses and disorders. The dominance of mental illnesses and disorders is three times higher compared to thyroid diseases.
... Moreover, a correlation was observed between the scale outcomes and TRAb levels. Previous studies have shown a negative correlation between TPOAb, TgAb, and QoL [34][35][36] . In addition, TSH concentration was identified to be an important factor affecting the QoL of GO patients 37,38 . ...
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Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.
... Previous research has indicated that various factors, such as age, sex, tumor size, bilaterality, multifocality, extracapsular invasion, and angiolymphatic invasion, are significantly associated with CLNM, whereas a TC tumor location in the upper one-third of the thyroid and lymphocytic thyroiditis are believe to be protective factors agains CLNM [12]. Elevated serum thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) levels are serological characteristics of Hashimoto's thyroiditis (HT) [13,14], and research has shown that the concentrations of thyroid autoantibodies induced in HT are positively correlated with the degree of thyroid tissue destruction, thyroid lymphocyte infiltration, and hypothyroidism [15]. A later study found only the TPOAb concentration to be positively correlated with the degree of thyroid lymphocyte infiltration and thyroid hypothyroidism [16]. ...
Article
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Background To investigate the influence of different risk factors on central lymph node metastasis (CLNM) in the cervical region in patients with papillary thyroid carcinoma (PTC). Methods This retrospective study included 2586 PTC patients. Potential risk factors were identified by univariate analysis, and the relationships between these factors and CLNM were ascertained by multivariable analysis. A scoring system was constructed, and the optimal cut-off value was determined. Results On univariate analysis, sex, age, tumor diameter, multifocality, capsule invasion, vascular invasion, total number of lymph nodes in the central region, and serum thyroid peroxidase antibody (TPOAb) concentration were identified as potential risk factors for CLNM in the cervical region, whereas nerve invasion, thyroid-stimulating hormone concentration, and thyroglobulin antibody (TgAb) concentration were not. Multivariable analysis indicated that male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were significant risk factors. From these factors, a preoperative CLNM risk assessment scale was constructed for predicting CLNM in the cervical region for PTC patients. Conclusion Male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were positively correlated with CLNM in the cervical region in PTC patients. The preoperative CLNM risk assessment scale based on these risk factors is expected to offer accurate preoperative assessment of central lymph node status in PTC patients.
... High levels of thyroid autoantibodies not only cause hypothyroidism but also are an essential factor in HT disease progression. Studying euthyroid HT patients revealed that high levels of thyroid autoantibodies can lead to a lower quality of life score and vestibular dysfunction [5,6]. Given that euthyroid HT patients already bear the above burden, early diagnosis and intervention are particularly important. ...
Article
Full-text available
Background Omega-3 polyunsaturated fatty acids (PUFAs) produce lipid mediators with both anti-inflammatory and pro-resolution properties, including resolvins. The purpose of this study was to detect serum resolvin E1 (RVE1) levels in Hashimoto’s thyroiditis (HT) patients and healthy controls (HCs) and to evaluate the relationship of RVE1 with thyroid autoimmunity. Methods A total of 57 participants were recruited, including 30 untreated HT patients and 27 age- and sex‐matched HCs. The levels of RVE1 in serum were measured via enzyme-linked immunosorbent assay (ELISA). An electrochemiluminescence immunoassay was used for the measurement of thyroid-stimulating hormone (TSH), total T4 (TT4), TT3, free T4 (FT4), FT3, anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb) levels. Hemogram tests and routine biochemical analyses were performed on each sample. Results The serum level of RVE1 of HT patients (24.09, 15.76–34.38 pg/mL) was significantly lower than that of healthy controls (28.51, 20.76–51.23 pg/mL) (P = 0.027). RVE1 levels showed a downward trend with increasing TgAb levels (P for trend = 0.001). Multivariable ordinal logistic regression analysis showed that RVE1 levels were negatively correlated with increasing TgAb levels in both the unadjusted (OR = 0.9446, 95 % CI = 0.9111–0.9782, P = 0.002) and adjusted models (OR = 0.9380, 95 % CI = 0.8967–0.9811, P = 0.005). Conclusions Decreased RVE1 levels might be a sign that HT is associated with inflammatory resolution dysfunction. RVE1 may serve as a protective factor against increased TgAb levels.
... Two recent studies have added to this evidence. In the first, thyroglobulin and TPO antibody levels showed a negative correlation with quality of life scores in HT patients but there was no correlation between autoantibody levels and thyroid function tests [39]. In the second, both autoantibodies showed a correlation with a symptom score comprising 16 symptoms of hypothyroidism, but again no correlation was found with thyroid hormone levels; thyroglobulin antibodies were associated with particular symptoms in a logistical regression model [40]. ...
Article
Full-text available
It is 70 years since Noel Rose embarked on his pioneering studies that lead to the discovery of autoimmune thyroiditis and the elucidation of Hashimoto’s thyroiditis. This short review to honour his passing focuses on the developments in our understanding of the causes and pathogenesis of HT over the last five years. Recent genetic studies have reported heritability estimates for HT and associated diseases for the first time, and emphasised the complexity of the genetic factors involved, including monogenic forms of HT. Environmental factors continue to be elucidated, especially as a side effect of drugs which modulate the immune system therapeutically. Regarding pathogenetic mechanisms, multiple cytokine networks have been identified which involve the thyroid cells in a circuit of escalating proinflammatory effects, such as the expression of inflammasome components, and an array of different defects in T regulatory cells may underlie the loss of self-tolerance to thyroid autoantigens. Finally, a number of studies have revealed fresh insights into disease associations with HT which may have both pathological and clinical significance, the most intriguing of which is a possible direct role of the autoimmune process itself in causing some of the persistent symptoms reported by a minority of patients with levothyroxine-treated HT.
Article
Background Hashimoto’s thyroiditis (HT) may cause salivary dysfunction in patients resulting in xerostomia, but little is known about changes in salivary function in patients with no obvious dry mouth symptoms. In this study we assessed salivary function in women with HT, who had not experienced xerostomia and, for the first time, evaluated the effects of thyroid auto-antibodies on this function. Methods Sixty consecutive subjects were included, comprising 32 women (mean age, 36 ± 12 years) diagnosed with HT accompanied by differentiated thyroid cancer (DTC) in the study group (HT group), along with a control group (DTC group) of 28 women (mean age, 40 ± 12 years) diagnosed with DTC only. Salivary gland scintigraphy was used to assess salivary function with the semi-quantitative parameters of maximum absorption ratio and maximum secretion ratio, the decrease of which indicate impaired salivary function. Moreover, the HT and DTC groups were divided into four subgroups (Anti– HT, Anti+ HT, Anti– DTC, and Anti+ DTC), based on the presence of anti-thyroid peroxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). Finally, salivary gland semi-quantitative parameters were correlated with levels of thyroid-stimulating hormone (TSH), TGAb, and TPOAb in the HT and DTC groups. Results None of the semi-quantitative parameters examined in parotid or submandibular glands differed significantly between the HT and DTC groups. However, the maximum secretion ratio for the parotid and submandibular glands were significantly different in the subgroup comparison (p < 0.05). Furthermore, the TgAb, TPOAb, and TSH values correlated significantly with salivary excretive function (p ≤ 0.05). Conclusion Women with HT without xerostomia may not have salivary functional impairment during hypothyroidism. Serum thyroid autoantibody and TSH levels may mainly influence salivary excretive function but not uptake function.
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Health-related quality of life (HRQoL) assessments are increasingly used to evaluate treatment effects and to shape the delivery of value based care. Valid generic and disease specific tools are available for quantifying HRQoL in patients with non-toxic goitre. However, few studies have applied these validated instruments to assess HRQoL in patients with benign non-toxic goitre. Limited evidence suggests that patients with non-toxic goitre have HRQoL impairments in multiple HRQoL domains. While the HRQoL-impact of non-toxic goitre may be small relative to other severely disabling medical conditions, treatment is almost exclusively elected for HRQoL indications. Thus better quantification of HRQoL, particularly at better (or more favorable) levels where many patients score, is essential. Web and mobile technologies have eased the ability to deliver surveys to patients. Routine consideration of HRQoL provides the opportunity to monitor the impact of treatment on the outcomes most meaningful for patients and the opportunity to help shape the delivery of value based health care.
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To evaluate the association between mood and anxiety disorders and thyroid autoimmunity in a community sample. Methods: A community based sample of 222 subjects was examined. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified (CIDIS), according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO). 16.6% of the overall sample had an anti-TPO value above the normal cut-off. Subjects with at least one diagnosis of anxiety disorders (OR = 4.2, C.L. 95% 1.9-38.8) or mood disorders (OR = 2.9, Cl 95% 1.4-6.6, P < 0.011) were positive for serum anti-TPO more frequently than subjects without mood or anxiety disorders. A statistically significant association with anti-TPO+ was found in Anxiety Disorder Not Otherwise Specified (OR = 4.0, CL 95% 1.1-15.5), in Major Depressive Episode (OR = 2.7, CL 95% 1.1-6.7) and Depressive Disorder Not Otherwise Specified (OR = 4.4, S CL 95% 1-19.3). The study seems to suggest that individuals in the community with thyroid autoimmunity may be at high risk for mood and anxiety disorders. The psychiatric disorders and the autoimmune reaction seem to be rooted in a same (and not easy correctable) aberrancy in the immuno-endocrine system. Should our results be confirmed, the findings may be of great interest for future preventive and case finding projects.
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To evaluate the relationship between thyroid variables and health-related quality of life (QoL) in patients with autoimmune hypothyroidism, using the thyroid-specific QoL questionnaire ThyPRO. In a cross-sectional study, responses to the ThyPRO from 199 outpatients with autoimmune hypothyroidism were analyzed in relation to thyroid volume, thyroid function and markers of thyroid autoimmunity. Based on a classical QoL framework, we hypothesized that physiological dysfunction caused specific physical and psychological symptoms, which affected functioning and well-being, and consequently participation in life and QoL. These hypotheses were tested through multiple regression and multivariate path analysis models. None of the thyroid function tests were associated with QoL scores. However, in the pairwise regression, the thyroid peroxidase antibody (TPOAb) level was associated with several QoL outcomes: Goitre Symptoms (p = 0.024), Depressivity (p = 0.004), Anxiety (p = 0.004), Emotional Susceptibility (p = 0.005) and Impaired Social Life (p = 0.047). In the multivariate model, the TPOAb level was related to Goitre Symptoms (r = 0.17, p = 0.019), Depressivity (r = 0.24, p = 0.001), and Anxiety (r = 0.23, p = 0.002), but no longer to Emotional Susceptibility or Impaired Social Life, indicating that the effect on these were mediated through an effect on the symptom scales (i.e. Goitre Symptoms, Depressivity and Anxiety). Health-related QoL, evaluated with state-of-the-art QoL methodology, was related to TPOAb level but not to thyroid function. This raises the hypothesis that autoimmunity, independent of thyroid function, impacts on QoL in patients with autoimmune hypothyroidism, especially in terms of psychological symptoms. Longitudinal studies, in initially untreated patients, are needed to test this hypothesis.
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Despite high sensitivity of current assays for autoantibodies to thyroperoxidase (TPO) and to thyroglobulin (Tg), some hypothyroid patients still present with negative tests for circulating anti-thyroid Ab. These patients usually referred to as having seronegative-autoimmune-thyroiditis (seronegative-CAT) have not been characterized and definite proof that their clinical phenotype is similar to that of patients with classic-chronic-autoimmune-thyroiditis (CAT) is lacking. To compare the clinical phenotype of seronegative-CAT and CAT as diagnosed according to a raised serum level of TSH with negative and positive tests for anti-thyroid Ab, respectively. A case-control retrospective study enrolling 55 patients with seronegative-CAT and 110 patients with CAT was performed. Serum FT3, FT4, TSH, Tg-Ab, TPO-Ab were measured in all patients. Patients with seronegative-CAT displayed significantly lower mean levels of TSH (6.6±3.4 µU/ml vs. 10.2±9.8 µU/ml; p=0.009), higher mean FT4 levels (1.1±0.2 ng/dl vs. 0.9±0.2 ng/dl; p=0.0002) and similar FT3 levels as compared to patients with CAT. Mean thyroid volume, was significantly greater in patients with CAT as compared with seronegative-CAT (11.2±6.5 ml vs. 8.1±3.7 ml; p=0.001). Logistic regression demonstrated that FT4 [0.123 (0.019-0.775); (p= 0.026)] and thyroid volume [1.243 (1.108-1.394); (p=0.0002)] were significantly and independently related to the diagnosis (CAT/ seronegative-CAT). Patients with seronegative-CAT had similar prevalence of thyroid nodules and of female gender but lower prevalence of overt hypothyroidism (5.4% vs. 20.9%; p=0.012) as opposed to patients with CAT. These results suggest an autoimmune aetiology of seronegative-CAT, which however seems to have a milder clinical course as compared to CAT.
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Objective: To evaluate the association between depressive symptoms and thyroid autoimmunity, and the effect of thyroid hormone on the risk of depression. Methods: We included 3138 individuals from SardiNIA project, none of whom was taking thyroid medication and antidepressants. Thyrotropin (TSH), free thyroxine (FT4), and antibodies against thyroperoxidase (TPOAb) were measured in all the sample. Depressive symptoms were assessed with Center for Epidemiologic Studies Depression Scale (CES-D). Results: We found no association between TPOAb and depressive symptoms and no linear association between TSH or FT4 levels and depressive symptoms. However, individuals in the lowest and highest FT4 quintiles showed a higher CES-D score compared to individuals in the middle quintile. In addition, participants in the lowest and highest FT4 quintiles had an increased risk of CES-D≥16 with odds ratios of 1.44 (95% CI=1.09-1.89) and 1.33 (95% CI=1.01-1.77), respectively. Limitations: Cross-sectional design of the study. Conclusions: A U-shaped relation was found between FT4 and depressive symptoms: compared to average FT4 values, both high and low thyroid function was associated with more depressive symptoms. Further studies are necessary to determine the exact cause-effect relation of this association.
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Hashimoto thyroiditis (HT) and other benign goiters (BG) might influence patients' quality of life (QoL). The objective of this study was to analyze influence of surgery on these patients' QoL. A prospective cohort study was conducted. The ThyPRO questionnaire was used in the QoL assessment. The HT patients experienced significantly worse hypothyroid symptoms and sex life than the BG patients. The improvement in QoL in the BG patients was significant after surgery in all ThyPRO domains. In the HT patients, the improvement was significant in all but two domains, eye symptoms and cognitive impairment. The best improvement in both groups was in overall QoL. None of the patients developed permanent consequences. The QoL of HT and BG patients is impaired and improves significantly after surgical treatment. Thyroidectomy should be considered as a treatment option in the HT patients more often as in the BG patients. Copyright © 2015. Published by Elsevier Ltd.
Book
Quality, as exemplified by Quality-of-life (QoL) assessment, is frequently discussed among health care professionals and often invoked as a goal for improvement, but somehow rarely defined, even as it is regularly assessed. It is understood that some medical patients have a better QoL than others, but should the QoL achieved be compared to an ideal state, or is it too personal and subjective to gauge? Can a better understanding of the concept help health care systems deliver services more effectively? Is QoL worth measuring at all? Integrating concepts from psychology, philosophy, neurocognition, and linguistics, this book attempts to answer these complex questions. It also breaks down the cognitive-linguistic components that comprise the judgment of quality, including description, evaluation, and valuations, and applies them to issues specific to individuals with chronic medical illness. In this context, quality/QoL assessment becomes an essential contributor to ethical practice, a critical step towards improving the nature of social interactions. The author considers linear, non-linear, and complexity-based models in analyzing key methodology and content issues in health-related QoL assessment.This book is certain to stimulate debate in the research and scientific communities. Its forward-looking perspective takes great strides toward promoting a common cognitive-linguistic model of how the judgment of quality occurs, thereby contributing important conceptual and empirical tools to its varied applications, including QoL assessment. © Springer Science+Business Media, LLC 2012. All rights reserved.