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Heald AH, Taylor P, Premawardhana L, Stedman M, Dayan C. Natural desiccated thyroid for the treatment of hypothyroidism? Front Endocrinol (Lausanne) 2024; 14:1309159. [PMID: 38260143 PMCID: PMC10801060 DOI: 10.3389/fendo.2023.1309159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Primary hypothyroidism affects about 3% of the general population in Europe. Early treatments in the late 19th Century involved subcutaneous as well as oral administration of thyroid extract. Until the early 1970s, the majority of people across the world with hypothyroidism were treated with natural desiccated thyroid (NDT) (derived from pig thyroid glands) in various formulations, with the majority of people since then being treated with levothyroxine (L-thyroxine). There is emerging evidence that may account for the efficacy of liothyronine (NDT contains a mixture of levothyroxine and liothyronine) in people who are symptomatically unresponsive to levothyroxine. While this is a highly selected group of people, the severity and chronicity of their symptoms and the fact that many patients have found their symptoms to be alleviated, can be viewed as valid evidence for the potential benefit of NDT when given after careful consideration of other differential diagnoses and other treatment options.
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Affiliation(s)
- Adrian H. Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, United Kingdom
| | - Peter Taylor
- Thyroid Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Lakdasa Premawardhana
- Thyroid Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - Colin Dayan
- Thyroid Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
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Brigante G, Santi D, Boselli G, Margiotta G, Corleto R, Monzani ML, Craparo A, Locaso M, Sperduti S, Roy N, Casarini L, Trenti T, Tagliavini S, De Santis MC, Roli L, Rochira V, Simoni M. Randomized double-blind placebo-controlled trial on levothyroxine and liothyronine combination therapy in totally thyroidectomized subjects: the LEVOLIO study. Eur J Endocrinol 2024; 190:12-22. [PMID: 38124252 DOI: 10.1093/ejendo/lvad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Despite having normal thyroid-stimulating hormone levels, many hypothyroid patients are dissatisfied with the treatment. The primary aim of this study was to evaluate the effect of twice-daily, combination therapy with levothyroxine (LT4) and liothyronine (LT3), at doses adapted according to TSH-level, on peripheral tissues as reflected by sex hormone binding globulin (SHBG) levels in totally thyroidectomized patients. Changes in other tissue markers and quality of life considering DIO2-rs225014 and MCT10-rs17606253 genetic variants were also assessed. DESIGN Double-blind, randomized, placebo-controlled. METHODS One hundred and forty-one subjects were randomized to LT4 + LT3 group (LT4 + LT3 in the morning and LT3 in the evening; n = 70) or placebo group (LT4 in the morning and placebo in the evening; n = 71). Pituitary-thyroid axis compensation was assessed after 6, 12, and 24 weeks. Clinical parameters, quality of life, and tissue markers (sex hormone binding globulin, serum lipids, bone markers) were evaluated at 12 and 24 weeks. DIO2 and MCT10 single nucleotide polymorphisms were genotyped. RESULTS The LT4 + LT3 group was treated with mean daily LT3 doses of 5.00 µg, with a mean daily LT4 reduction of 15 µg. After 6 months of treatment, neither SHBG and other tissue markers nor quality of life differed significantly between groups. Combination treatment required greater dose adjustments than placebo (25% vs 54%, P < .001), due to thyroid-stimulating hormone reduction, without hyperthyroidism signs or symptoms. At the end of treatment, the LT4 + placebo group had significantly lower fT3/fT4 compared to the LT4 + LT3 group (0.26 ± 0.05 vs 0.32 ± 0.08, P < .001). No preference for combination therapy was found. Genetic variants did not influence any outcomes. CONCLUSIONS Six months of combination therapy with twice-daily LT3 dose adapted according to TSH-level do not significantly change peripheral tissue response or quality of life, despite an increase in the fT3/fT4 ratio.
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Affiliation(s)
- Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Gisella Boselli
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Gianluca Margiotta
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Rossella Corleto
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Andrea Craparo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Michela Locaso
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Samantha Sperduti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Neena Roy
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, 41126 Modena, Italy
| | - Tommaso Trenti
- Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, 41126 Modena, Italy
| | - Simonetta Tagliavini
- Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, 41126 Modena, Italy
| | - Maria Cristina De Santis
- Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, 41126 Modena, Italy
| | - Laura Roli
- Department of Laboratory Medicine and Anatomy Pathology, Azienda USL Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, 41126 Modena, Italy
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Larsen CB, Winther KH, Cramon PK, Rasmussen ÅK, Feldt-Rasmussen U, Groenvold M, Bjorner JB, Hegedüs L, Watt T, Bonnema SJ. Severity of hypothyroidism is inversely associated with impaired quality of life in patients referred to an endocrine clinic. Thyroid Res 2023; 16:37. [PMID: 37658415 PMCID: PMC10472621 DOI: 10.1186/s13044-023-00178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE We investigated the association between health-related quality of life (HRQL) and the severity of hypothyroidism at diagnosis in patients referred to a secondary hospital clinic. METHODS Sixty-seven adult patients referred from primary care were enrolled. All patients had newly diagnosed hypothyroidism due to autoimmune thyroiditis and were treated with levothyroxine (LT4). The dose was adjusted according to thyroid function tests aiming at a normal plasma thyrotropin. Patients were stratified according to the severity of hypothyroidism in two different ways: the conventional approach (subclinical or overt hypothyroidism) and a novel approach according to the change (decrease or increase) in plasma level of free triiodothyronine index (FT3I) following LT4 treatment. The ThyPRO-39 questionnaire was used for measurement of HRQL at referral to the Endocrine Outpatient Clinic (higher score corresponds to worse HRQL). RESULTS Free thyroxine index (FT4I) at diagnosis correlated positively with the scores on the Hypothyroid Symptoms and Tiredness scales (p = 0.018 for both). In accordance, patients with subclinical hypothyroidism (n = 36) scored higher on Hypothyroid Symptoms (p = 0.029) than patients with overt hypothyroidism (n = 31). The difference in HRQL was more pronounced if patients were stratified according to the dynamics in FT3I following LT4 treatment. Thus, patients who showed a decrease in FT3I following treatment (n = 24) scored significantly worse for Anxiety (p = 0.032) and Emotional Susceptibility (p = 0.035) than patients with an increase in FT3I (n = 43). CONCLUSION Patients referred to an endocrine clinic with mild hypothyroidism had an impaired HRQL, compared to patients with more severe hypothyroidism. The most likely explanation of this finding is a lower threshold for seeking medical consultation and secondary care referral if HRQL is deteriorated. The dynamics in plasma FT3I following treatment may be more sensitive for such a discrimination in HRQL than a stratification according to the thyroid function tests at diagnosis.
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Affiliation(s)
- Camilla B Larsen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000, Odense C, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Kristian Hillert Winther
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Karkov Cramon
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Mogens Groenvold
- Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torquil Watt
- Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, DK-5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Rigó A, Malkov K, Szabó A, Bognár VK, Urbán R. Adaptation and validation of the Hungarian version of Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire: testing factor structure, known-group validity with the comparison of quality of life in Hashimoto's thyroiditis and Graves' disease. J Patient Rep Outcomes 2023; 7:60. [PMID: 37368126 DOI: 10.1186/s41687-023-00606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Living with autoimmune thyroid disease is a longstanding challenge and can seriously affect the quality of life. We aimed to adapt and validate the Hungarian version of the Thyroid-Related Patient-Reported Outcome-39 (ThyPro-39) questionnaire, test its factor structure, and compare two frequent autoimmune thyroid diseases, Hashimoto's thyroiditis, and Graves' disease. We tested the factor structure of ThyPro-39 with a series of confirmatory factor analyses (CFAs). To examine the validity of ThyPro-39 and to compare the quality of life of the two groups - Hashimoto's thyroiditis (N = 240), Graves' disease (N = 51) - CFA with covariates were used. RESULTS Our results supported a bifactor model with psychosocial and somatic symptoms as general factors, and 12 symptom-specific factors. Based on the analysis of omega hierarchical indices ranging between 0.22 and 0.66, the specific scales also carry information besides the composite scores and should be used when a more detailed analysis is required. In the multivariate analysis, perceived stress was significantly associated with the general psychosocial factor (β = 0.80), symptom factors (β = 0.34), anxiety (β = 0.43), depressivity (β = 0.37), and emotional susceptibility (β = 0.38) specific factors. Graves' patients reported more eye symptoms (d = 0.45) and cosmetic complaints (d = 0.40), while Hashimoto patients had more cognitive problems (d = 0.36) and more severe hypothyroid symptoms (d = 0.35). These group differences confirm the known-group validity of the questionnaire. CONCLUSIONS The validity of the Hungarian version of ThyPRO-39 is supported. We recommend using two composite scores of psychosocial and somatic symptoms and the specific symptoms scores to measure the quality of life in clinical practice and research.
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Affiliation(s)
- Adrien Rigó
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, H-1064, Hungary.
| | - Katalin Malkov
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, H-1064, Hungary
| | - Alexandra Szabó
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, H-1064, Hungary
| | - Virág Katalin Bognár
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, H-1064, Hungary
- Institute of Behavioural Sciences, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, H-1064, Hungary
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Monzani ML, Piccinini F, Boselli G, Corleto R, Margiotta G, Peeters RP, Simoni M, Brigante G. Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine. J Endocrinol Invest 2023; 46:319-326. [PMID: 35988109 DOI: 10.1007/s40618-022-01903-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Previous studies demonstrated decreased quality of life (QoL) in differentiated thyroid cancer (DTC) survivors and suggested QoL variability related to time from thyroidectomy and levothyroxine dosage. The aims of this study were to evaluate QoL in thyroidectomized subjects in different levothyroxine states and to evaluate the association between TSH and thyroid hormones and QoL. METHODS Prospective 5-year study enrolling 208 patients thyroidectomized for DTC, studied in one to four times according to levothyroxine dosage: withdrawal (WITHD), complete (C-SUPP) and mild TSH-suppression (M-SUPP), replacement (REPL). Each patient was allowed to participate into the study more than one time. A total of 300 evaluations were collected, consisting of detailed thyroid hormone profile and QoL assessment through the ThyPRO questionnaire. RESULTS Comparing the four groups, significant differences were found for anxiety, impaired social and daily life and item 12 (overall impact of thyroid disease) domains (p < 0.05). Interestingly, C-SUPP subjects reported the best scores in almost all ThyPRO scales. Significant correlations were found between QoL and pituitary-thyroid axis function, as well as between QoL and gender, being females more affected. At multiple regression analyses fT3 demonstrated to be the best explanatory factor for overall impact of thyroid disease on the patient's life, followed by gender. CONCLUSIONS TSH-suppressive doses of levothyroxine are more effective in improving QoL in DTC patients after thyroidectomy. These results confirm the urgent need of further studies aimed to define the best treatment of hypothyroidism, effective on well-being and harmless for patients.
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Affiliation(s)
- M L Monzani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - F Piccinini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Boselli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - R Corleto
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Margiotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - R P Peeters
- Department of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy
| | - G Brigante
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy.
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Tzelnick S, Tsur N, Amir I, Mizrachi A, Watt T, Rabinovics N, Mamun Y, Yaniv D, Bachar G, Najjar E. Quality of Life Following Robotic Transaxillary Versus Conventional Hemithyroidectomy: A Comparative Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:8-14. [PMID: 36322881 DOI: 10.1089/lap.2022.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Robotic technology has proven safe and effective for thyroidectomy procedures. Few studies have addressed the quality-of-life outcomes of robotic thyroidectomy compared with conventional thyroidectomy. Materials and Methods: The database of a tertiary medical center was retrospectively reviewed for all patients with thyroid disease who had undergone robotic hemithyroidectomy in 2012-2020. All patients treated by transaxillary robotic surgery and a similar number of randomly selected patients treated by conventional cervical surgery completed a standardized self-administered thyroid disease-specific quality-of-life (QOL) questionnaire (ThyPRO). Clinical data were derived from the medical files. The results were compared using mean comparison tests and multivariate logistic regression models. Results: The cohort consisted of 131 patients: 63 after robotic thyroidectomy and 68 after conventional thyroidectomy. The mean age was 38.87 ± 14.11 and 58.85 ± 14.1 years, respectively (P < .0001). The robotic hemithyroidectomy group reported better QOL outcomes in physical and mental health parameters, including decreased anxiety, depression, lower sex life impairment, and cognitive impairment scores (P < .0001). Furthermore, after adjusting for age, gender, malignancy status, and surgical approach, we found that patients undergoing robotic hemithyroidectomy had a lower probability of experiencing depressive symptoms than the conventional hemithyroidectomy group (odds ratio = 0.31; 95% confidence interval, 0.11-0.88). Of interest, no significant difference in cosmetic outcomes was found. Conclusions: Patients who underwent robotic thyroidectomy report better postoperative QOL after surgery than patients operated by the conventional approach in terms of anxiety, depression, cognitive and sex-life scores.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Tsur
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Torquil Watt
- Department of Endocrinology, National University Hospital, Copenhagen, Denmark
| | - Naomi Rabinovics
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology-Head and Neck Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
| | - Yaakov Mamun
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Dan Yaniv
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Esmat Najjar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pitt SC, Zanocco K, Sturgeon C. The Patient Experience of Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:761-780. [PMID: 36244692 DOI: 10.1016/j.ecl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 3 phases of thyroid cancer care are discussed: diagnosis, management, and survivorship. Drivers of quality of life (QOL) in each phase are described, and suggestions are made for mitigating the risk of poor QOL. Active surveillance is another emerging management strategy that has the potential to improve QOL by eliminating upfront surgical morbidity but will need to be studied prospectively.
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Affiliation(s)
- Susan C Pitt
- Department of Surgery, University of Michigan Taubman 2920F, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kyle Zanocco
- Department of Surgery, University of California Los Angeles, CHS 72-222, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern University, 676 North Saint Claire Street, Suite 650, Chicago, IL 60611, USA.
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Uslar V, Becker C, Weyhe D, Tabriz N. Thyroid disease-specific quality of life questionnaires - A systematic review. Endocrinol Diabetes Metab 2022; 5:e357. [PMID: 35856310 PMCID: PMC9471597 DOI: 10.1002/edm2.357] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Thyroid diseases are very common and rarely life-threatening. One of the main therapeutic goals is an improvement in quality of life, making it important to measure in clinical and research settings. The aim of this systematic review is to provide an overview of the currently available thyroid-specific quality of life questionnaires with regard to their validation quality in order to make recommendations for clinical use with a special focus on German questionnaires. METHODS A systematic literature search was performed in Pubmed, Google Scholar and the Cochrane Library. A total of 904 studies were identified. After excluding duplicates, non-English- or German-language texts, full texts that were not freely available and studies with irrelevant content, 64 studies reporting on 16 different questionnaires were included in the analysis. RESULTS Four questionnaires concerned benign thyroid diseases (ThyPRO, ThyPRO-39, Thy-R-HRQoL and Thy-D-QOL), six malignant thyroid diseases (THYCA-QoL, ThyCa-HRLQOL, EORTC-Thy34, MADSI-Thy, QOL-Thyroid and ThyCAT), and six endocrine orbitopathy (GO-QOL, GO-QLS, TED-QOL, STED-QOL, TAO-QoL and Ox-TED). Only five questionnaires were at least developed, if not validated, in German, and five were developed in more than two languages. CONCLUSIONS ThyPRO and the ThyPRO-39 are the best-evaluated questionnaires for benign thyroid diseases. Alternatively, in hypothyroid patients, the adequately validated Thy-D-QoL can be used. For malignant thyroid diseases, the choice should be made individually, as all six questionnaires (THYCA-QoL, ThyCA-HRQOL, EORTC-Thy34, MDASI-Thy, QOL-Thyroid and ThyCAT) have different strengths and weaknesses. The GO-QOL is the best-validated questionnaire in endocrine orbitopathy. However, the TED-QOL is also suitable as a short-screening questionnaire for these patients.
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Affiliation(s)
- Verena Uslar
- University Hospital for Visceral SurgeryCarl von Ossietzky University OldenburgOldenburgGermany
| | - Caroline Becker
- University Hospital for Visceral SurgeryCarl von Ossietzky University OldenburgOldenburgGermany
| | - Dirk Weyhe
- University Hospital for Visceral SurgeryCarl von Ossietzky University OldenburgOldenburgGermany
| | - Navid Tabriz
- University Hospital for Visceral SurgeryCarl von Ossietzky University OldenburgOldenburgGermany
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de Koster EJ, Husson O, van Dam EWCM, Mijnhout GS, Netea-Maier RT, Oyen WJG, Snel M, de Geus-Oei LF, Vriens D. Health-related quality of life following FDG-PET/CT for cytological indeterminate thyroid nodules. Endocr Connect 2022; 11:e220014. [PMID: 35731242 PMCID: PMC9346328 DOI: 10.1530/ec-22-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
Objective This study assessed the health-related quality of life (HRQoL) in patients undergoing 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT for an indeterminate (Bethesda III/IV) thyroid nodule. FDG-PET/CT accurately rules out malignancy and prevents 40% of futile diagnostic surgeries in these nodules. Design Secondary analyses of HRQoL data from a randomised controlled multicentre trial (NCT02208544) in 126 patients from 15 hospitals in the Netherlands were done. Methods Longitudinal HRQoL assessment was performed using the EuroQol 5-dimension 5-level (EQ-5D-5L), the RAND 36-item Health Survey v2.0 (RAND-36), and the Thyroid Patient-Reported Outcome (ThyPRO) questionnaire on baseline, 3, 6, and 12 months, relative to the date of the FDG-PET/CT scan. Results Patients who were randomised to active surveillance following an FDG-negative nodule instead of diagnostic surgery reported stable HRQoL scores throughout the year. Univariate analysis indicated better HRQoL for patients undergoing surveillance than surgical patients with benign histopathology on multiple physical and psychosocial domains. Univariate within-group analysis suggested both temporary and continued HRQoL deteriorations in patients with benign histopathology over time. Multivariate within-group analysis demonstrated no significant longitudinal HRQoL changes in patients undergoing active surveillance. In contrast, in patients with benign histopathology, worse HRQoL was observed with regard to ThyPRO cognitive impairment (P = 0.01) and cosmetic complaints (P = 0.02), whereas goitre symptoms (P < 0.001) and anxiety (P = 0.04) improved over time. In patients with malignant histopathology, anxiety also decreased (P = 0.05). Conclusions The reassurance of a negative FDG-PET/CT resulted in sustained HRQoL throughout the first year of active surveillance. Diagnostic surgery for a nodule with benign histopathology resulted in more cognitive impairment and physical problems including cosmetic complaints, but improved goitre symptoms and anxiety. Anxiety was also reduced in patients with malignant histopathology.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Husson
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Eveline W C M van Dam
- Department of Internal Medicine, Division of Endocrinology, location VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G Sophie Mijnhout
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
| | - Marieke Snel
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - for the EfFECTS trial study group
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Division of Clinical Studies, Institute of Cancer Research, London, UK
- Department of Internal Medicine, Division of Endocrinology, location VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
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The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial. World J Surg 2022; 46:2212-2222. [PMID: 35637354 PMCID: PMC9150879 DOI: 10.1007/s00268-022-06610-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
Background Methods Results Conclusions
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11
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Abstract
Hypothyroidism is the common clinical condition of thyroid hormone deficiency and, if left untreated, can lead to serious adverse health effects on multiple organ systems, with the cardiovascular system as the most robustly studied target. Overt primary hypothyroidism is defined as elevated thyroid-stimulating hormone (TSH) concentration in combination with free thyroxine (fT4) concentration below the reference range. Subclinical hypothyroidism, commonly considered an early sign of thyroid failure, is defined by elevated TSH concentrations but fT4 concentrations within the reference range. Hypothyroidism is classified as primary, central or peripheral based on pathology in the thyroid, the pituitary or hypothalamus, or peripheral tissue, respectively. Acquired primary hypothyroidism is the most prevalent form and can be caused by severe iodine deficiency but is more frequently caused by chronic autoimmune thyroiditis in iodine-replete areas. The onset of hypothyroidism is insidious in most cases and symptoms may present relatively late in the disease process. There is a large variation in clinical presentation and the presence of hypothyroid symptoms, especially in pregnancy and in children. Levothyroxine (LT4) is the mainstay of treatment and is one of the most commonly prescribed drugs worldwide. After normalization of TSH and fT4 concentrations, a considerable proportion of patients treated with LT4 continue to have persistent complaints, compromising quality of life. Further research is needed regarding the appropriateness of currently applied reference ranges and treatment thresholds, particularly in pregnancy, and the potential benefit of LT4/liothyronine combination therapy for thyroid-related symptom relief, patient satisfaction and long-term adverse effects.
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Romero-Velez G, Burneikis T, Zolin SJ, Noureldine SI, Jin J, Berber E, Krishnamurthy VD, Shin J, Siperstein A. Quantifying disease-specific symptom improvement after parathyroid and thyroid surgery using patient-reported outcome measures. Am J Surg 2022; 224:923-927. [DOI: 10.1016/j.amjsurg.2022.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
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Ettleson MD, Raine A, Batistuzzo A, Batista SP, McAninch E, Teixeira MCT, Jonklaas J, Laiteerapong N, Ribeiro MO, Bianco AC. Brain Fog in Hypothyroidism: Understanding the Patient's Perspective. Endocr Pract 2022; 28:257-264. [PMID: 34890786 PMCID: PMC8901556 DOI: 10.1016/j.eprac.2021.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Patient-centered studies have shown that several patients on thyroid hormone replacement therapy for hypothyroidism exhibit persistent symptoms, including "brain fog." Here, we aimed to determine which of these specific symptoms are associated with brain fog, identify patient-reported factors that modify these symptoms, and identify patient concerns related to brain fog not included in thyroid-specific questionnaires. METHODS A survey on brain fog symptoms adapted from thyroid-specific patient-reported outcome was distributed online. Textual data analysis was performed to identify common areas of concern from open-ended survey responses. RESULTS A total of 5170 participants reporting brain fog while being treated for hypothyroidism were included in the analysis. Of these, 2409 (46.6%) participants reported symptom onset prior to the diagnosis of hypothyroidism, and 4096 (79.2%) participants experienced brain fog symptoms frequently. Of the symptoms listed, participants associated fatigue and forgetfulness most frequently with brain fog. More rest was the most common factor provided for improving symptoms. The textual data analysis identified areas of concern that are not often included in thyroid-specific quality of life questionnaires, including a focus on the diagnosis of hypothyroidism, the types and doses of medications, and the patient-doctor relationship. CONCLUSION Brain fog in patients treated for hypothyroidism was associated most frequently with fatigue and cognitive symptoms. Several additional areas of patient concern were found to be associated with brain fog, which are not typically addressed in thyroid-specific questionnaires.
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Affiliation(s)
- Matthew D. Ettleson
- University of Chicago, Section of Endocrinology, Diabetes, and Metabolism, Chicago, Illinois,Address correspondence to Dr Matthew D. Ettleson, University of Chicago, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, 5841 S. Maryland Ave. MC1027, Chicago, IL 60637. (M.D. Ettleson)
| | - Ava Raine
- Carleton College, Northfield, Minnesota
| | - Alice Batistuzzo
- Developmental Disorders Program, Center for Biological Sciences and Health, Mackenzie Presbyterian University, Sao Paulo SP, Brazil
| | - Samuel P. Batista
- Developmental Disorders Program, Center for Biological Sciences and Health, Mackenzie Presbyterian University, Sao Paulo SP, Brazil
| | - Elizabeth McAninch
- Stanford University Medical Center, Division of Endocrinolgoy, Gerontology, and Metabolism, Stanford Hospital, Stanford, California
| | - Maria Cristina T.V. Teixeira
- Developmental Disorders Program, Center for Biological Sciences and Health, Mackenzie Presbyterian University, Sao Paulo SP, Brazil
| | - Jacqueline Jonklaas
- Georgetown University Medical Center, Division of Endocrinology, Washington, DC
| | - Neda Laiteerapong
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois
| | - Miriam O. Ribeiro
- Developmental Disorders Program, Center for Biological Sciences and Health, Mackenzie Presbyterian University, Sao Paulo SP, Brazil
| | - Antonio C. Bianco
- University of Chicago, Section of Endocrinology, Diabetes, and Metabolism, Chicago, Illinois
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Chen DW, Papaleontiou M. Clearing Up the Fog: Insights Into Brain Fog Experienced by Patients With Hypothyroidism. Endocr Pract 2022; 28:349-350. [PMID: 35077905 PMCID: PMC10080712 DOI: 10.1016/j.eprac.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute of Gerontology, University of Michigan, Ann Arbor, Michigan.
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Cramon PK, Bjorner JB, Groenvold M, Boesen VB, Bonnema SJ, Hegedüs L, Feldt-Rasmussen U, Rasmussen ÅK, Watt T. Implementation of thyroid-related patient-reported outcomes in routine clinical practice. Front Endocrinol (Lausanne) 2022; 13:1000682. [PMID: 36246917 PMCID: PMC9554589 DOI: 10.3389/fendo.2022.1000682] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Patient-reported outcomes (PROs) are increasingly used in clinical practice to improve clinical care. Multiple studies show that systematic use of PROs can enhance communication with patients and improve patient satisfaction, symptom management and quality of life. Further, such data can be aggregated to examine health levels for patient groups, improve quality of care, and compare patient outcomes at the institutional, regional or national level. However, there are barriers and challenges that should be handled appropriately to achieve successful implementation of PROs in routine clinical practice. This paper briefly overviews thyroid-related PROs, describes unsolved quality of life issues in benign thyroid diseases, provides examples of routine collection of PROs, and summarizes key points facilitating successful implementation of thyroid-related PROs in routine clinical practice. Finally, the paper touches upon future directions of PRO research.
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Affiliation(s)
- Per Karkov Cramon
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- QualityMetric Incorporated, LLC, Johnston, RI, United States
| | - Mogens Groenvold
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Palliative Care Research Unit, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Victor Brun Boesen
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Torquil Watt
- Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Torquil Watt,
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Bjerkreim BA, Hammerstad SS, Gulseth HL, Berg T, Omdal LJ, Lee-Ødegård S, Eriksen EF. Effect of Liothyronine Treatment on Quality of Life in Female Hypothyroid Patients With Residual Symptoms on Levothyroxine Therapy: A Randomized Crossover Study. Front Endocrinol (Lausanne) 2022; 13:816566. [PMID: 35273566 PMCID: PMC8902821 DOI: 10.3389/fendo.2022.816566] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The effects of levothyroxine (LT4)/liothyronine (LT3) combination therapy on quality of life (QoL) in hypothyroid patients former on LT4 monotherapy have been disappointing. We therefore wanted to test the effects of LT3 monotherapy on QoL in hypothyroid patients with residual symptoms despite thyroid stimulating hormone (TSH) values within the reference range. DESIGN Female hypothyroid patients with residual symptoms on LT4 monotherapy or combination LT4/LT3 therapy received LT3 and LT4 monotherapy, respectively for 12 weeks in a non-blinded randomized crossover study. METHODS Fifty-nine patients aged 18-65 years were included. QoL was assessed using one disease-specific questionnaire (ThyPRO) and two generic questionnaires (Fatigue Questionnaire and SF-36) at baseline and at the end of the two treatment periods. Clinical indices of cardiovascular health (resting heart rate and blood pressure), as well as thyroid tests, were assessed at baseline and at the end of the two treatment periods. RESULTS After 12 weeks of LT3 treatment, 12 of the 13 domains of the ThyPRO questionnaire (physical, mental and social domains) showed significant improvements. The most pronounced improvements were less tiredness (mean -21 ± 26; P<0.0001) and cognitive complaints (mean -20 ± 20; P<0.0001). LT4 monotherapy exerted minor effects on two domains only (cognitive complaints and impaired daily life). All three dimensions' scores in the Fatigue Questionnaire (physical, mental and total fatigue) improved after LT3 treatment compared to baseline (P<0.001), and in the SF-36 questionnaire 7 of 8 scales showed significantly better scores after LT3 treatment compared to baseline. There were no differences in blood pressure or resting heart rate between the two treatment groups. TSH in patients on LT3 was slightly higher (median 1.33 mU/L (interquartile range (IQR) 0.47-2.26)) than in patients on LT4 (median 0.61 mU/L (IQR 0.25-1.20; P<0.018). Five patients on LT3 dropped out of the study due to subjectively reported side effects, compared to only one on LT4. CONCLUSIONS LT3 treatment improved QoL in women with residual hypothyroid symptoms on LT4 monotherapy or LT4/LT3 combination therapy. Short-term LT3 treatment did not induce biochemical or clinical hyperthyroidism, and no cardiovascular adverse effects were recorded. Further studies are needed to assess the long-term safety and efficacy of LT3 monotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT03627611.
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Affiliation(s)
- Betty Ann Bjerkreim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Betty Ann Bjerkreim,
| | - Sara Salehi Hammerstad
- Department of Endocrinology, Pilestredet Park Specialist Center, Oslo, Norway
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Hanne Løvdal Gulseth
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Tore Julsrud Berg
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Erik Fink Eriksen
- Department of Endocrinology, Pilestredet Park Specialist Center, Oslo, Norway
- The Faculty of Dentistry, University of Oslo, Oslo, Norway
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Ettleson MD, Papaleontiou M. Evaluating health outcomes in the treatment of hypothyroidism. Front Endocrinol (Lausanne) 2022; 13:1026262. [PMID: 36329885 PMCID: PMC9623066 DOI: 10.3389/fendo.2022.1026262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Clinical hypothyroidism is defined by the inadequate production of thyroid hormone from the thyroid gland to maintain normal organ system functions. For nearly all patients with clinical hypothyroidism, lifelong treatment with thyroid hormone replacement is required. The primary goal of treatment is to provide the appropriate daily dose of thyroid hormone to restore normal thyroid function for each individual patient. In current clinical practice, normalization of thyrotropin (TSH) level is the primary measure of effectiveness of treatment, however the use of a single biomarker to define adequate thyroid hormone replacement is being reevaluated. The assessment of clinical health outcomes and patient-reported outcomes (PROs), often within the context of intensity of treatment as defined by thyroid function tests (i.e., undertreatment, appropriate treatment, or overtreatment), may play a role in evaluating the effectiveness of treatment. The purpose of this narrative review is to summarize the prominent health outcomes literature in patients with treated hypothyroidism. To date, overall mortality, cardiovascular morbidity and mortality, bone health and cognitive function have been evaluated as endpoints in clinical outcomes studies in patients with treated hypothyroidism. More recent investigations have sought to establish the relationships between these end results and thyroid function during the treatment course. In addition to clinical event outcomes, patient-reported quality of life (QoL) has also been considered in the assessment of adequacy of hypothyroidism treatment. From a health care quality perspective, treatment of hypothyroidism should be evaluated not just on its effectiveness for the individual patients but also to the extent to which patients of different sociodemographic groups are treated equally. Ultimately, more research is needed to explore differences in health outcomes between different sociodemographic groups with hypothyroidism. Future prospective studies of treated hypothyroidism that integrate biochemical testing, PROs, and end result clinical outcomes could provide a more complete picture into the effectiveness of treatment of hypothyroidism.
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Affiliation(s)
- Matthew D. Ettleson
- Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, Chicago, IL, United States
- *Correspondence: Matthew D. Ettleson,
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes and Institute of Gerontology, University of Michigan, Ann Arbor, MI, United States
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Heald AH, Premawardhana L, Taylor P, Okosieme O, Bangi T, Devine H, Livingston M, Javed A, Moreno GYC, Watt T, Stedman M, Dayan C, Hughes DA. Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series. Int J Clin Pract 2021; 75:e14967. [PMID: 34626513 DOI: 10.1111/ijcp.14967] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/19/2021] [Accepted: 10/06/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a natural desiccated thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid® . These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. METHODS The ThyPRO39 (thyroid symptomatology) and EQ-5D-5L-related QoL/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. RESULTS There were 28 women and 3 men. The dose range of NDT was 60-180 mg daily. Age range was 26-77 years with length of time since diagnosis with hypothyroidism ranging from 2 to 40 years. One person discontinued the NDT because of lack of response; two because of cardiac symptoms. EQ-5D-5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241-0.542), t = 6.82, P < .001. EQ-VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95% CI 25.2-50.2), t = -4.9, P < .001. ThyPRO scores showed consistent fall across all domains with the composite QoL-impact Score improving from 68.3 (95% CI 60.9-75.7) to 25.2 (95% CI 18.7-31.7), a difference of 43.1 (95% CI 33-53.2) (t = 5.6, P < .001). CONCLUSION Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.
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Affiliation(s)
- Adrian H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Lakdasa Premawardhana
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Peter Taylor
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Onyebuchi Okosieme
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Tasneem Bangi
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Holly Devine
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Mark Livingston
- Department of Clinical Biochemistry, Black Country Pathology Services, Walsall Manor Hospital, Walsall, UK
| | - Ahmed Javed
- Department of Endocrinology and Diabetes, Salford Royal Hospital, Salford, UK
| | - Gabriela Y C Moreno
- Coordinación Nacional de Investigación, Subdirección de Servicios de Salud, Petróleos Mexicanos, Ciudad de México, México
| | - Torquil Watt
- Department of Internal Medicine, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | | | - Colin Dayan
- Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, UK
| | - Dyfrig A Hughes
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
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Teliti M, Monti E, Comina M, Conte L, Vera L, Gay S, Saccomani G, Ferone D, Giusti M. A comparative cross-sectional study on sleep quality in patients with a history of differentiated thyroid carcinoma and its correlation with quality of life. Endocrine 2021; 73:347-357. [PMID: 33537955 PMCID: PMC8263451 DOI: 10.1007/s12020-020-02591-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate sleep quality in differentiated thyroid carcinoma (DTC) patients and correlate sleep disturbances with quality of life (QoL). METHODS 119 DTC patients were enrolled (DTC group). The Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) inventories were administered. The Thyroid-specific Patient-Reported Outcome (ThyPRO) questionnaire, the Billewicz scale (BS) and an ad-hoc visual analogic scale (VAS) were used to measure QoL and subjective therapy-related complaints. The same examinations were conducted in 53 subjects (control group) who had undergone surgery for benign thyroid pathology. RESULTS L-T4 dosages and TSH levels differed between the groups. BS and VAS scores were comparable. PSQI documented a similar percentage of poor sleepers in the DTC (74%) and control (62%) groups. ISI showed no difference in subjects without clinically significant insomnia: DTC (43%) and controls (48%). ThyPRO showed significantly worse scores in DTC than control subjects. In DTC patients, PSQI (P = 0.002) and ISI (P = 0.04) correlated significantly with age. In control subjects, TSH displayed a significant positive association with PSQI (P = 0.02) and ISI (P < 0.05). The ThyPRO general score correlated significantly with PSQI in DTC patients. In both groups, ISI correlated significantly with several ThyPRO scales and the ThyPRO general score. "Anxiety" and "emotional susceptibility" were the scales most significantly related with PSQI and ISI. CONCLUSION In disease-free DTC patients and subjects who undergo thyroid surgery for benign pathology, abnormal sleep components and insomnia are similar. The ThyPRO questionnaire closely reflects sleep disturbances in all subjects. Recognising and treating sleep disturbances might improve QoL.
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Affiliation(s)
- Marsida Teliti
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Monti
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Martina Comina
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Conte
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lara Vera
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Gay
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Saccomani
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), University of Genoa, Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), University of Genoa, Genoa, Italy.
| | - Massimo Giusti
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), University of Genoa, Genoa, Italy
- Centro Diagnostico Priamar, Savona, Italy
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20
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Liew H, Watt T, Nan L, Tan AWK, Chan YH, Chew DEK, Dalan R. Psychometric properties of the thyroid-specific quality of life questionnaire ThyPRO in Singaporean patients with Graves' disease. J Patient Rep Outcomes 2021; 5:54. [PMID: 34236563 PMCID: PMC8266927 DOI: 10.1186/s41687-021-00309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Graves' disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves' hyperthyroidism. METHODS Forty-seven consecutive Graves' hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach's alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen's effect size. RESULTS Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21-0.64 (p < 0.05). There was high internal consistency between the items in this instrument, Cronbach's alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20-0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). CONCLUSION This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves' disease patients in Singapore population with the potential to complement clinical care.
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Affiliation(s)
- Huiling Liew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin W K Tan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniel Ek Kwang Chew
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rinkoo Dalan
- Department of Diabetes and Endocrinology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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21
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Martino G, Caputo A, Vicario CM, Feldt-Rasmussen U, Watt T, Quattropani MC, Benvenga S, Vita R. Alexithymia, Emotional Distress, and Perceived Quality of Life in Patients With Hashimoto's Thyroiditis. Front Psychol 2021; 12:667237. [PMID: 34045997 PMCID: PMC8144453 DOI: 10.3389/fpsyg.2021.667237] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Emotion-processing impairment represents a risk factor for the development of somatic illness, affecting negatively both health-related quality of life (HRQoL) and disease management in several chronic diseases. The present pilot study aims at (i) investigating the associations between alexithymia and depression, anxiety, and HRQoL in patients with Hashimoto's thyroiditis (HT); (ii) examining the association between these three psychological conditions together with HRQoL, and thyroid autoantibodies status as well as thyroid echotexture in patients with HT; and (iii) comparing the intensity of all these clinical psychological features in patients with HT versus controls. Twenty-one patients with serologically or ultrasonographically verified HT and 16 controls with non-toxic goiter or postsurgical hypothyroidism were recruited for this study. Serum thyrotropin (TSH) and free thyroxine, as well as thyroid autoantibodies (thyroglobulin antibodies and thyroid peroxidase antibodies), were assayed. Alexithymia, depression, anxiety, and HRQoL were assessed with Toronto Alexithymia Scale; Beck Depression Inventory, second edition; Hamilton Anxiety Rating Scale; and Health Survey Short-Form 36, respectively. A negative relationship between the difficulty to describe feelings and the cognitive component of depression was found (r = -0.46, p = 0.04). Besides, patients with seronegative HT had lower somatic anxiety than patients with HT who tested positive (r = -0.68, p = 0.01 and r = -0.59, p = 0.04, respectively). Besides, no statistically significant difference was found between patients with HT and controls with regard to somatic anxiety. The present study suggests the relevance of alexithymia in patients suffering from HT, which may be intertwined with a possible state of underreported depression that is mainly expressed through physical complaints. Promoting the capability to describe and communicate feelings could contribute to psychological elaboration and coping with the disease and, consequently, to the improvement of self-management and perceived HRQoL.
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Affiliation(s)
- Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Caputo
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Carmelo M. Vicario
- Department of Cognitive Sciences, Psychological, Pedagogical and Cultural Studies, University of Messina, Messina, Italy
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria C. Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular and Clinical Endocrinology and Women’s Endocrine Health, University Hospital, AOU Policlinico “G. Martino,” Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, McAninch EA, Moeller LC, Nygaard B, Sawka AM, Watt T, Dayan CM. Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Eur Thyroid J 2021; 10:10-38. [PMID: 33777817 PMCID: PMC7983670 DOI: 10.1159/000512970] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. METHODS The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. RESULTS Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 µg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. DISCUSSION This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
- *Jacqueline Jonklaas, Division of Endocrinology, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007 (USA),
| | - Antonio C. Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesco S. Celi
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Heike Heuer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | | | - Lars C. Moeller
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Colin M. Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
- **Colin M. Dayan, Thyroid Research Group, School of Medicine, Cardiff University, C2 Link, Heath Park, Cardiff CF14 4XN (UK),
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Piromchai P, Chaiudomsom S, Wijakkanalan P, Watt T. Validity and Reliability of the Thai Version of the Thyroid-Related Patient-Reported Outcome-A Thyroid-specific Quality of Life Questionnaire. Int Arch Otorhinolaryngol 2021; 25:e92-e97. [PMID: 33542758 PMCID: PMC7851362 DOI: 10.1055/s-0040-1701270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/03/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction
The Thyroid-Related Patient-Reported Outcome (ThyPRO) is a new thyroid-specific quality of life patient-reported outcome measure for benign thyroid disorders.
Objective
The objective of this study was to investigate the face validity, internal consistency, and test-retest reliability of the Thai version of the ThyPRO (ThyPROth).
Methods
The translation of the ThyPRO questionnaire was performed using double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Five thyroid patients evaluated the face validity. The internal consistency and test-retest reliability were evaluated in 30 patients with thyroid diseases.
Results
The overall validity score was 3.75 (range 0–4). The Cronbach α coefficient ranged from 0.76 to 0.95, with a total coefficient of 0.97 (95% CI 0.962–0.959), indicating excellent internal consistency. The test-retest reliability coefficient ranged from 0.70 to 0.97. All values were 0.70 and above. The total reliability coefficient was 0.86 (95% CI 0.724–0.932), indicating excellent reliability.
Conclusion
The ThyPROth was found to be valid and to exhibit good internal consistency and test-retest reliability. The questionnaire is ready for implementation in the assessment of health-related quality of life in Thai patients with benign thyroid diseases.
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Affiliation(s)
- Patorn Piromchai
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supachat Chaiudomsom
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pattaramon Wijakkanalan
- Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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24
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Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, McAninch EA, Moeller LC, Nygaard B, Sawka AM, Watt T, Dayan CM. Evidence-Based Use of Levothyroxine/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Thyroid 2021; 31:156-182. [PMID: 33276704 PMCID: PMC8035928 DOI: 10.1089/thy.2020.0720] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Fourteen clinical trials have not shown a consistent benefit of combination therapy with levothyroxine (LT4) and liothyronine (LT3). Despite the publication of these trials, combination therapy is widely used and patients reporting benefit continue to generate patient and physician interest in this area. Recent scientific developments may provide insight into this inconsistency and guide future studies. Methods: The American Thyroid Association (ATA), British Thyroid Association (BTA), and European Thyroid Association (ETA) held a joint conference on November 3, 2019 (live-streamed between Chicago and London) to review new basic science and clinical evidence regarding combination therapy with presentations and input from 12 content experts. After the presentations, the material was synthesized and used to develop Summary Statements of the current state of knowledge. After review and revision of the material and Summary Statements, there was agreement that there was equipoise for a new clinical trial of combination therapy. Consensus Statements encapsulating the implications of the material discussed with respect to the design of future clinical trials of LT4/LT3 combination therapy were generated. Authors voted upon the Consensus Statements. Iterative changes were made in several rounds of voting and after comments from ATA/BTA/ETA members. Results: Of 34 Consensus Statements available for voting, 28 received at least 75% agreement, with 13 receiving 100% agreement. Those with 100% agreement included studies being powered to study the effect of deiodinase and thyroid hormone transporter polymorphisms on study outcomes, inclusion of patients dissatisfied with their current therapy and requiring at least 1.2 μg/kg of LT4 daily, use of twice daily LT3 or preferably a slow-release preparation if available, use of patient-reported outcomes as a primary outcome (measured by a tool with both relevant content validity and responsiveness) and patient preference as a secondary outcome, and utilization of a randomized placebo-controlled adequately powered double-blinded parallel design. The remaining statements are presented as potential additional considerations. Discussion: This article summarizes the areas discussed and presents Consensus Statements to guide development of future clinical trials of LT4/LT3 combination therapy. The results of such redesigned trials are expected to be of benefit to patients and of value to inform future thyroid hormone replacement clinical practice guidelines treatment recommendations.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
- Address correspondence to: Jacqueline Jonklaas, MD, PhD, Division of Endocrinology, Georgetown University, 4000 Reservoir Road, NW, Washington, DC 20007, USA
| | - Antonio C. Bianco
- Section of Adult and Pediatric Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Anne R. Cappola
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesco S. Celi
- Division of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, Netherlands
| | - Heike Heuer
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | | | - Lars C. Moeller
- Department of Endocrinology, Diabetes and Metabolism, University Duisburg-Essen, Essen, Germany
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Canada
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Colin M. Dayan
- Thyroid Research Group, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Address correspondence to: Colin M. Dayan, MD, PhD, Thyroid Research Group, School of Medicine, Cardiff University, C2 Link, Heath Park, Cardiff CF14 4XN, UK
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25
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Bartalena L, Wiersinga WM. Proposal for Standardization of Primary and Secondary Outcomes in Patients with Active, Moderate-to-Severe Graves' Orbitopathy. Eur Thyroid J 2020; 9:3-16. [PMID: 33511081 PMCID: PMC7802435 DOI: 10.1159/000510700] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/04/2020] [Indexed: 01/02/2023] Open
Abstract
Standardization of treatment outcomes in randomized clinical trials (RCTs) for active, moderate-to-severe Graves' orbitopathy (GO) is needed to make results of different RCTs comparable and to draw sound conclusions on the efficacy of a given treatment. Both subjective patient-reported outcome (PRO) and objective clinician-reported outcome (CRO) are important in this regard. In this paper, it is proposed that primary PRO should be the evaluation of treatment-related changes in the quality of life by the use of a validated and disease-specific questionnaire (GO-QoL). The proposed primary CRO is a revised composite index, which includes only objective items and provides an overall assessment of the effects of treatment. Secondary outcomes should also be provided in RCTs to show the effects of treatment on individual features of GO, as well on persistence of activity (by the 7-item Clinical Activity Score), safety, relapses of GO, need for subsequent medical and/or surgical treatments, and other indicators (orbital volume, cytokines, TSH receptor antibody levels). Assessment of the overall response to treatment by primary and secondary outcomes should be made 3 months after treatment completion.
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Affiliation(s)
- Luigi Bartalena
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- *Luigi Bartalena, Endocrine Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Viale Borri, 57, IT–21100 Varese (Italy), , or, Wilmar M. Wiersinga, Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Meibergdreef 9, NL–1105AZ Amsterdam (The Netherlands),
| | - Wilmar M. Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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26
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Chew CR, Chin SL, Lam T, Drosdowsky A, Chan STF, Chin-Lenn L. How does thyroidectomy for benign thyroid disease impact upon quality of life? A prospective study. ANZ J Surg 2020; 90:E177-E182. [PMID: 32975031 DOI: 10.1111/ans.16342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Choosing which patients to recommend surgery for benign thyroid conditions can be difficult due to the subjective nature of compressive thyroid and hormonal symptoms. The aim of this prospective study was to analyse changes in quality of life (QOL) following thyroid surgery using a validated disease-specific assessment tool, the thyroid-related patient-reported outcome (ThyPRO) questionnaire. METHODS Participants undergoing elective thyroid surgery for benign conditions were recruited. Patient demographics and clinical data were collected. ThyPRO consists of 85 questions grouped into 13 physical, mental and social symptom domains. Patients completed a ThyPRO questionnaire pre-operatively and at 6 weeks and 6 months post-operatively. ThyPRO items were scored according to protocol to produce 13 subscales. Repeated measures linear models with no random effects were performed using data for each outcome. RESULTS Results were available for a total of 72 patients. The sample was predominately female (n = 63, 88%) with average age 49.8 years. The majority of patients underwent surgery for multi-nodular goitre. At 6 weeks post-operatively, significant improvement was demonstrated in the goitre, hypothyroid, hyperthyroid and anxiety symptom domains. At 6 months post-operatively, significant improvement was demonstrated in all but four domains. No domains demonstrated significant increase in impairment post-operatively. CONCLUSION Patients had significant improvement in nine of 13 symptom domains following surgery. Patients did not experience a negative impact on QOL following surgery. Further studies with larger patient cohorts may be able to identify potential pre-operative predictive factors for a post-operative improvement in QOL for benign thyroid disease.
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Affiliation(s)
- Carolyn R Chew
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Synn Lynn Chin
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Tracey Lam
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steven T F Chan
- Department of Surgery, North West Academic Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura Chin-Lenn
- Endocrine Surgery, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia
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Giusti M, Gay S, Conte L, Cecoli F, Mortara L, Vera L, Monti E. Evaluation of Quality of Life in Patients with Differentiated Thyroid Cancer by Means of the Thyroid-Specific Patient-Reported Outcome Questionnaire: A 5-Year Longitudinal Study. Eur Thyroid J 2020; 9:247-255. [PMID: 33088793 PMCID: PMC7548839 DOI: 10.1159/000501201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with malignancy suffer impairment of their quality of life (QoL). QoL has been evaluated in thyroid cancer patients. Since 2010, a new inventory, the thyroid-specific patient-reported outcome (ThyPRO) measure for benign thyroid disorders, has been available. AIM This study evaluated QoL longitudinally in patients with a history of differentiated thyroid cancer (DTC) by means of the ThyPRO questionnaire. Methods : From 2012 to 2016, QoL was evaluated yearly in 123 adult DTC patients by means of ThyPRO. The ThyPRO questionnaire consists of 13 scales on which higher scores represent greater impact on QoL in areas affected by thyroid pathology. Disease-specific morbidity due to possible inadequate L-T4 treatment was evaluated by means of the Billewicz scale (BS). The same examinations were conducted in 192 control subjects who had undergone surgery for benign thyroid pathology. RESULTS DTC and control subjects had similar scores on all but one scale; scores on the hyperthyroid symptoms scale were significantly higher in DTC patients than in controls. Over the 5 years, scores did not change significantly in the DTC group. Overall, QoL and BS scores showed a slight, but not significant, improvement during the study period in DTC patients. BMI impacted on several ThyPRO scales. No significant differences between genders were noted in DTC. CONCLUSIONS The ThyPRO questionnaire indicates that illness perception is similar after thyroidectomy for malign and benign pathology. Only a marginal improvement in QoL was noted in DTC subjects over the 5-year study period. In both groups, females showed a greater perception of illness than males.
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Affiliation(s)
- Massimo Giusti
- Endocrine Unit, San Martino Polyclinic Hospital, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
- *Massimo Giusti, MD, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, IT–16100 Genoa (Italy), E-Mail
| | - Stefano Gay
- Endocrine Unit, San Martino Polyclinic Hospital, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Lucia Conte
- Endocrine Unit, San Martino Polyclinic Hospital, Genoa, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Lorenzo Mortara
- Endocrine Unit, San Martino Polyclinic Hospital, Genoa, Italy
| | - Lara Vera
- Endocrine Unit, San Martino Polyclinic Hospital, Genoa, Italy
| | - Eleonora Monti
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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28
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Endoscopic versus Conventional Thyroid Surgery: A Comparison of Quality of Life, Cosmetic Outcomes and Overall Patient Satisfaction with Treatment. World J Surg 2020; 44:4118-4126. [DOI: 10.1007/s00268-020-05732-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 02/07/2023]
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29
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Davies TF, Andersen S, Latif R, Nagayama Y, Barbesino G, Brito M, Eckstein AK, Stagnaro-Green A, Kahaly GJ. Graves' disease. Nat Rev Dis Primers 2020; 6:52. [PMID: 32616746 DOI: 10.1038/s41572-020-0184-y] [Citation(s) in RCA: 168] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 02/08/2023]
Abstract
Graves' disease (GD) is an autoimmune disease that primarily affects the thyroid gland. It is the most common cause of hyperthyroidism and occurs at all ages but especially in women of reproductive age. Graves' hyperthyroidism is caused by autoantibodies to the thyroid-stimulating hormone receptor (TSHR) that act as agonists and induce excessive thyroid hormone secretion, releasing the thyroid gland from pituitary control. TSHR autoantibodies also underlie Graves' orbitopathy (GO) and pretibial myxoedema. Additionally, the pathophysiology of GO (and likely pretibial myxoedema) involves the synergism of insulin-like growth factor 1 receptor (IGF1R) with TSHR autoantibodies, causing retro-orbital tissue expansion and inflammation. Although the aetiology of GD remains unknown, evidence indicates a strong genetic component combined with random potential environmental insults in an immunologically susceptible individual. The treatment of GD has not changed substantially for many years and remains a choice between antithyroid drugs, radioiodine or surgery. However, antithyroid drug use can cause drug-induced embryopathy in pregnancy, radioiodine therapy can exacerbate GO and surgery can result in hypoparathyroidism or laryngeal nerve damage. Therefore, future studies should focus on improved drug management, and a number of important advances are on the horizon.
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Affiliation(s)
- Terry F Davies
- Thyroid Research Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,James J. Peters VA Medical Center, New York, NY, USA. .,Mount Sinai Thyroid Center, Mount Sinai Downtown at Union Sq, New York, NY, USA.
| | - Stig Andersen
- Department of Geriatric and Internal Medicine and Arctic Health Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Rauf Latif
- Thyroid Research Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J. Peters VA Medical Center, New York, NY, USA
| | - Yuji Nagayama
- Department of Molecular Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Giuseppe Barbesino
- Thyroid Unit, Division of Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria Brito
- Mount Sinai Thyroid Center, Mount Sinai Downtown at Union Sq, New York, NY, USA
| | - Anja K Eckstein
- Department of Ophthalmology, University Duisburg Essen, Essen, Germany
| | - Alex Stagnaro-Green
- Departments of Medicine, Obstetrics and Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, Rockford, IL, USA
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Centre, Mainz, Germany
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Boesen VB, Bjorner JB, Groenvold M, Cramon PK, Rasmussen AK, Watt T, Feldt-Rasmussen U. Ecological momentary assessments (EMAs) did not improve responsiveness of patient-reported outcomes on quality of life. J Clin Epidemiol 2020; 125:138-147. [PMID: 32525086 DOI: 10.1016/j.jclinepi.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Clinical practice guidelines recommend questionnaires with short recall. We compare responsiveness of ecological momentary assessments (EMAs) and retrospective assessments of thyroid-related quality of life. STUDY DESIGN AND SETTING Patients with newly diagnosed thyrotoxicosis completed retrospective Thyroid-related Patient-Reported Outcome measures (ThyPROs) with 4-week and 1-week recall, respectively, and three daily EMAs for 4 weeks at time of inclusion and again after treatment (N = 115). Magnitude of change and statistical power (F-test statistics) were compared. Two designs were applied to the same data: Design 1 mimicked the practical realities of clinical trials by comparing 4-week recall ThyPRO administered at time of inclusion with EMA initiated at time of inclusion and collected prospectively for 1 week, thus not covering the same time frame or duration. Design 2 compared assessments covering the same 4 weeks after inclusion. RESULTS Design 1: the estimated change and statistical power were significantly larger for 4-week ThyPRO compared with EMAs. Design 2: retrospective assessments and EMAs had comparable change and power. Repeated 1-week ThyPRO administrations increased the statistical power. CONCLUSION Selecting the optimal time frame for evaluation proved crucial for responsiveness. EMAs did not provide higher responsiveness than retrospective measures in either design. Repeated 1-week ThyPRO administrations increased statistical power.
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Affiliation(s)
- Victor Brun Boesen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark; Optum Patient Insights, Johnston, RI, USA
| | - Morgens Groenvold
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark; Department of Palliative Medicine, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23B, Copenhagen, Denmark
| | - Per Karkov Cramon
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Denmark
| | - Aase Krogh Rasmussen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Denmark
| | - Torquil Watt
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Denmark; Department of Internal Medicine, Copenhagen University Hospital Herlev-Gentofte, Gentofte Hospitalsvej 1, Gentofte, Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Denmark; Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark.
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de Montmollin M, Feller M, Beglinger S, McConnachie A, Aujesky D, Collet TH, Ford I, Gussekloo J, Kearney PM, McCarthy VJC, Mooijaart S, Poortvliet RKE, Quinn T, Stott DJ, Watt T, Westendorp R, Rodondi N, Bauer DC. L-Thyroxine Therapy for Older Adults With Subclinical Hypothyroidism and Hypothyroid Symptoms: Secondary Analysis of a Randomized Trial. Ann Intern Med 2020; 172:709-716. [PMID: 32365355 DOI: 10.7326/m19-3193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND L-thyroxine does not improve hypothyroid symptoms among adults with subclinical hypothyroidism (SCH). However, those with greater symptom burden before treatment may still benefit. OBJECTIVE To determine whether L-thyroxine improves hypothyroid symptoms and tiredness among older adults with SCH and greater symptom burden. DESIGN Secondary analysis of the randomized, placebo-controlled trial TRUST (Thyroid Hormone Replacement for Untreated Older Adults with Subclinical Hypothyroidism Trial). (ClinicalTrials.gov: NCT01660126). SETTING Switzerland, Ireland, the Netherlands, and Scotland. PARTICIPANTS 638 persons aged 65 years or older with persistent SCH (thyroid-stimulating hormone level of 4.60 to 19.9 mIU/L for >3 months and normal free thyroxine level) and complete outcome data. INTERVENTION L-thyroxine or matching placebo with mock dose titration. MEASUREMENTS 1-year change in Hypothyroid Symptoms and Tiredness scores (range, 0 to 100; higher scores indicate more symptoms) on the Thyroid-Related Quality-of-Life Patient-Reported Outcome Questionnaire among participants with high symptom burden (baseline Hypothyroid Symptoms score >30 or Tiredness score >40) versus lower symptom burden. RESULTS 132 participants had Hypothyroid Symptoms scores greater than 30, and 133 had Tiredness scores greater than 40. Among the group with high symptom burden, the Hypothyroid Symptoms score improved similarly between those receiving L-thyroxine (mean within-group change, -12.3 [95% CI, -16.6 to -8.0]) and those receiving placebo (mean within-group change, -10.4 [CI, -15.3 to -5.4]) at 1 year; the adjusted between-group difference was -2.0 (CI, -5.5 to 1.5; P = 0.27). Improvements in Tiredness scores were also similar between those receiving L-thyroxine (mean within-group change, -8.9 [CI, -14.5 to -3.3]) and those receiving placebo (mean within-group change, -10.9 [CI, -16.0 to -5.8]); the adjusted between-group difference was 0.0 (CI, -4.1 to 4.0; P = 0.99). There was no evidence that baseline Hypothyroid Symptoms score or Tiredness score modified the effects of L-thyroxine versus placebo (P for interaction = 0.20 and 0.82, respectively). LIMITATION Post hoc analysis, small sample size, and examination of only patients with 1-year outcome data. CONCLUSION In older adults with SCH and high symptom burden at baseline, L-thyroxine did not improve hypothyroid symptoms or tiredness compared with placebo. PRIMARY FUNDING SOURCE European Union FP7.
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Affiliation(s)
- Maria de Montmollin
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Martin Feller
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Shanthi Beglinger
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (A.M., I.F.)
| | - Drahomir Aujesky
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (D.A.)
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, and University of Lausanne, Lausanne, Switzerland (T.C.)
| | - Ian Ford
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland (A.M., I.F.)
| | - Jacobijn Gussekloo
- Leiden University Medical Center, Leiden, the Netherlands (J.G., R.K.P.)
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland (P.M.K.)
| | - Vera J C McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland (V.J.M.)
| | - Simon Mooijaart
- Institute for Evidence-based Medicine in Old Age, Leiden University Medical Center, Leiden, the Netherlands (S.M.)
| | | | - Terence Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.Q., D.J.S.)
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland (T.Q., D.J.S.)
| | - Torquil Watt
- Copenhagen University Hospital Herlev, Herlev, Denmark, and University of Copenhagen, Copenhagen, Denmark (T.W., R.W.)
| | - Rudi Westendorp
- Copenhagen University Hospital Herlev, Herlev, Denmark, and University of Copenhagen, Copenhagen, Denmark (T.W., R.W.)
| | - Nicolas Rodondi
- Inselspital, Bern University Hospital, and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (M.D., M.F., S.B., N.R.)
| | - Douglas C Bauer
- University of Copenhagen, Copenhagen, Denmark; and University of California, San Francisco, San Francisco, California (D.C.B.)
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Đanić Hadžibegović A, Hergešić F, Babić E, Slipac J, Prstačić R. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Acta Clin Croat 2020; 59:38-49. [PMID: 34219883 PMCID: PMC8212616 DOI: 10.20471/acc.2020.59.s1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
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Affiliation(s)
| | - Filip Hergešić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ema Babić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Juraj Slipac
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ratko Prstačić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
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Madan R, Celi FS. Combination Therapy for Hypothyroidism: Rationale, Therapeutic Goals, and Design. Front Endocrinol (Lausanne) 2020; 11:371. [PMID: 32733377 PMCID: PMC7360670 DOI: 10.3389/fendo.2020.00371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Hypothyroidism is a common condition with a wide spectrum of etiologies and clinical manifestations. While the majority of patients affected by hypothyroidism respond well to levothyroxine, some patients do not and complain of symptoms despite adequate replacement. There is evidence in experimental models of hypothyroidism that levothyroxine alone may not be able to deliver an adequate amount of T3 to all the tissues targeted by the hormonal action, while liothyronine/levothyroxine combination therapy can. The results of clinical studies directed to assess the effectiveness of liothyronine/levothyroxine combination therapy on the amelioration of hypothyroid symptoms have been disappointing. Most of the trials have been short and underpowered, with several shortcomings in the study design. There is consensus that an adequately powered clinical trial should be developed to prove or disprove the efficacy and effectiveness of therapies other than LT4 alone for the treatment of hypothyroidism, and to assess which group of patients would benefit from them. Here we present some considerations on the technical aspects and necessary tradeoffs in designing such a study with a particular focus on study population selection, choice of endpoints, and study drugs formulation and regimen.
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Abstract
Patients who take levothyroxine monotherapy to treat hypothyroidism frequently experience residual symptoms despite TSH testing at target levels. Trials have been conducted to evaluate the potential benefit of combination therapy with levothyroxine and liothyronine, though results have not consistently demonstrated benefit. In addition to randomization, placebo-control, and masking, four additional design choices to consider include the study population, dosing strategy for levothyroxine and liothyronine, primary and secondary outcome selection, and statistical power. A thoughtful design that considers these features will increase the likelihood that a combination trial will be considered definitive and finally resolve the important question of whether combination therapy with levothyroxine and liothyronine is a better thyroid replacement strategy than levothyroxine monotherapy.
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Critical internal organization’s forces influencing sustainability of post ERP in UAE service industry. INTERNATIONAL JOURNAL OF ORGANIZATIONAL ANALYSIS 2019. [DOI: 10.1108/ijoa-03-2018-1375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Despite the wide recognition of enterprise resource planning’s (ERP’s) multiple uses, little research has examined the internal forces that influence success after ERP implementation in the service industry. This study aims to identify the factors influencing post-implementation ERP capabilities (PERPC) and improving post-implementation sustainability and user satisfaction (PERPSUS). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) are used for this, with advance managed outsourced solutions (AMOS) and an entanglement view of all firm ERP users.
Design/methodology/approach
A theoretical model is created to explain internal organizational factors impacting post-implementation ERP sustainability and user satisfaction. Data were collected from 152 executive ERP users in two organizations in the UAE. Two CFA models were created.
Findings
The results show that adoption by internal organizational forces leads to more sustainable post-implementation ERP. A 69 per cent variance in user satisfaction and post-implementation ERP sustainability was found through a PERPC model and its dimensions, which are significantly highly correlated.
Research limitations/implications
ERP professionals and stakeholders believe that identification of ERP capabilities (ERPCs) and user satisfaction must be multi-dimensional.
Practical implications
CIOs and ERP professionals could use these results to increase the success of ERP in the service industry, and they can support the inclusion of post-implementation ERP practices.
Originality/value
Using AMOS, this paper explores the role of ERPCs in system sustainability and user satisfaction in the service sector, utilizing stakeholder perspectives and an entanglement view of ERP users in the service industry.
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Törring O, Watt T, Sjölin G, Byström K, Abraham-Nordling M, Calissendorff J, Cramon PK, Filipsson Nyström H, Hallengren B, Holmberg M, Khamisi S, Lantz M, Wallin G. Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves' Hyperthyroidism: A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey. Thyroid 2019; 29:322-331. [PMID: 30667296 DOI: 10.1089/thy.2018.0315] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hyperthyroidism is known to have a significant impact on quality of life (QoL), at least in the short term. The purpose of the present study was to assess QoL in patients 6-10 years after treatment for Graves' disease (GD) with radioiodine (RAI) compared to those treated with thyroidectomy or antithyroid drugs (ATD) as assessed with both thyroid-specific Thyroid-Related Patient-Reported Outcome (ThyPRO) questionnaire and general (36-item Short Form Health Status) QoL survey. METHODS The study evaluated 1186 GD patients in a sub-cohort from an incidence study 2003-2005 who had been treated according to routine clinical practice at seven participating centers. Patients were included if they had returned the ThyPRO (n = 975) and/or the 36-item Short Form Health Status survey questionnaire (n = 964) and informed consent at follow-up. Scores from ThyPRO were compared to scores from a general population sample (n = 712) using multiple linear regression adjusting for age and sex as well as multiple testing. Treatment-related QoL outcome for ATD, RAI, and surgery were compared, including adjustment for the number of treatments received, sex, age, and comorbidity. RESULTS Regardless of treatment modality, patients with GD had worse thyroid-related QoL 6-10 years after diagnosis compared to the general population. Patients treated with RAI had worse thyroid-related and general QoL than patients treated with ATD or thyroidectomy on the majority of QoL scales. Sensitivity analyses supported the relative negative comparative effects of RAI treatment on QoL in patients with hyperthyroidism. CONCLUSIONS GD is associated with a lower QoL many years after treatment compared to the general population. In a previous small randomized controlled trial, no difference was found in patient satisfaction years after ATD, RAI, or surgery. Now, it is reported that in a large non-randomized cohort, patients who received RAI had adverse scores on ThyPRO and 36-item Short Form Health Status survey. These findings in a Swedish population are limited by comparison to normative data from Denmark, older age, and possibly a more prolonged course in those patients who received RAI, and a lack of information regarding thyroid status at the time of evaluation. The way RAI may adversely affect QoL is unknown, but since the results may be important for future considerations regarding treatment options for GD, they need to be substantiated in further studies.
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Affiliation(s)
- Ove Törring
- 1 Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- 2 Division of Endocrinology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Torquil Watt
- 3 Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark
- 4 Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gabriel Sjölin
- 5 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristina Byström
- 6 Department of Medicine, University Hospital and Örebro University, Örebro, Sweden
| | - Mirna Abraham-Nordling
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Calissendorff
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- 8 Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Per Karkov Cramon
- 3 Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark
- 4 Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helena Filipsson Nyström
- 9 Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- 10 Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bengt Hallengren
- 11 Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- 12 Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mats Holmberg
- 9 Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- 13 ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Selwan Khamisi
- 14 Department of Endocrinology, Uppsala University Hospital, Uppsala, Sweden
- 15 Institution of Internal Medicine, Uppsala University, Uppsala, Sweden
| | - Mikael Lantz
- 11 Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- 12 Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Göran Wallin
- 5 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Boesen VB, Feldt-Rasmussen U, Bjorner JB, Cramon P, Groenvold M, Nygaard B, Rasmussen ÅK, Vilsbøll T, Watt T. How Should Thyroid-Related Quality of Life Be Assessed? Recalled Patient-Reported Outcomes Compared to Here-and-Now Measures. Thyroid 2018; 28:1561-1570. [PMID: 30369298 DOI: 10.1089/thy.2018.0210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of thyroid disease on quality of life is an important disease aspect that is best investigated by patient-reported outcomes. Recent patient-reported outcomes research has raised concern about the validity of traditional retrospective questionnaires. Therefore, ecological momentary assessments of patients' subjective well-being have been introduced to avoid recall bias and improve contextual validity. Despite theoretical advantages, the measurement properties remain unsubstantiated. This study examines the relationship between the retrospective thyroid-related quality of life patient-reported outcome measure (ThyPRO) and a momentary (here-and-now) version of ThyPRO. METHODS Eighty-three newly diagnosed hyperthyroid patients expected to undergo treatment completed questions on their thyroid-related quality of life. Head-to-head comparison was performed between 12 momentary items from four multi-item ThyPRO scales administered three times daily via a smartphone application during 28 days and the original retrospective ThyPRO on day 28. The measurement difference between recalled and momentary ratings was quantified for all four scales. Furthermore, correlations between the measures were investigated, and their agreement was explored using Bland-Altman plots. Finally, the study examined whether retrospective ratings were influenced by two forms of recall bias (the peak effect and the end effect). RESULTS Retrospective and mean momentary ThyPRO ratings were highly correlated (Pearson's correlations: 0.74-0.88). However, retrospective ratings provided significantly higher scores (i.e., worse quality of life) on all scales. Bland-Altman plots showed a skewed distribution, indicating low levels of agreement. Results supported a peak effect for retrospective ratings on tiredness but not for the remaining scales. Further, results supported end effects for retrospective ratings of emotional susceptibility and anxiety. CONCLUSIONS Retrospective and mean momentary ThyPRO ratings correlated strongly, but retrospective ratings were higher, indicating more disease impact. The differences were of magnitudes normally deemed clinically relevant. Limited evidence supported peak and end effect bias for retrospective assessments. The two measurement modalities did not appear congruent and thus cannot be used interchangeably. When designing clinical studies, whether to use a momentary or retrospective measurement method may depend on the aim of measurement. Further prospective analyses are needed to compare any beneficial effects, for example in terms of higher precision or sensitivity to clinical change, of momentary assessments.
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Affiliation(s)
- Victor Brun Boesen
- 1 Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- 1 Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences; Copenhagen, Denmark
| | - Jakob Bue Bjorner
- 3 Department of Public Health; University of Copenhagen, Copenhagen, Denmark
- 4 Optum Patient Insights, Johnston, Rhode Island
| | - Per Cramon
- 1 Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mogens Groenvold
- 3 Department of Public Health; University of Copenhagen, Copenhagen, Denmark
- 5 Department of Palliative Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Birte Nygaard
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences; Copenhagen, Denmark
- 6 Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Åse Krogh Rasmussen
- 1 Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tina Vilsbøll
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences; Copenhagen, Denmark
- 7 Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, University of Copenhagen, Gentofte, Denmark
| | - Torquil Watt
- 1 Department of Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- 6 Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
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Burneikis T, Colvin J, Jin J, Berber E, Krishnamurthy VD, Shin J, Siperstein A. Validation of a novel patient-reported outcome measure for parathyroid and thyroid disease (PROMPT). Surgery 2018; 165:232-239. [PMID: 30401480 DOI: 10.1016/j.surg.2018.04.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient-reported outcome measures are being used increasingly to assess disease severity and response to surgery. The purpose of this study was to create and validate a patient-reported outcome measure for symptoms of thyroid enlargement and hyperparathyroidism, 2 conditions where the presence of preoperative symptoms and response to surgery is often questioned. METHODS A questionnaire reviewing common symptoms was developed from a literature review and expert opinion. Internal validity, reliability, and initial responsiveness to surgery were evaluated. RESULTS Patient-Reported Outcome Measure for Parathyroid and Thyroid Disease (PROMPT) consists of 30 items: 10 compressive items and 20 hyperparathyroidism items; we evaluated 302 surveys collected over 10 months. PROMPT showed high internal consistency for compressive and hyperparathyroid constructs (Cronbach's α 0.84 and 0.95). Constructs were scored from 0-100, with greater scores corresponding to increased severity of symptoms. Preoperatively, patients with a goiter demonstrated greater compressive scores compared with other thyroid patients and hyperparathyroid patients (goiter, 47.5; nodule/other, 38.4; hyperparathyroid, 29.8; P < .0001). PROMPT demonstrated high test-retest reliability with acceptable intraclass correlation coefficients for both compressive score and hyperparathyroid score (0.840 and 0.646). Hyperparathyroid scores improved 2 weeks after (48.6 postop, 44.0 preop, P = .0470). CONCLUSION We validated a novel measure for symptoms of hyperparathyroidism and goiter. PROMPT demonstrates high internal consistency, test-retest reliability, and preliminary analysis, which suggests that it is sensitive to change after surgery.
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Boronat M, González-Lleó A, Rodríguez-Pérez C, Feldt-Rasmussen U, López-Plasencia Y, Rasmussen ÅK, Alberiche-Ruano MP, Hegedüs L, Alvarado-Martel D, Bonnema SJ, Marrero-Arencibia D, Groenvold M, Bjorner JB, Watt T. Adaptation and cross-cultural validation of the Spanish version of the Thyroid-Related Quality-of-Life Patient-Reported Outcome questionnaire. ENDOCRINOL DIAB NUTR 2018; 65:500-507. [DOI: 10.1016/j.endinu.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
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Sawicka-Gutaj N, Ruchala M, Feldt-Rasmussen U, Rasmussen ÅK, Hegedüs L, Bonnema SJ, Groenvold M, Bjorner JB, Watt T. Patients with Benign Thyroid Diseases Experience an Impaired Sex Life. Thyroid 2018; 28:1261-1269. [PMID: 30039748 DOI: 10.1089/thy.2017.0602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study aimed to characterize the frequency of self-reported thyroid-related impaired sex life in patients with thyroid diseases, to examine its clinical correlates and relationship with overall quality of life (QOL), and to investigate the effect of treatment. PATIENTS AND METHODS Two separate patient samples with benign thyroid diseases were investigated: a cross-sectional sample (759 women and 118 men) treated at two Danish university hospital outpatient clinics, in 2007-2008, and a longitudinal sample (358 women and 74 men) undergoing treatment at the abovementioned centers, during 2008-2012, evaluated before and 6 months after therapy. The thyroid-specific QOL questionnaire ThyPRO was used to measure patient-evaluated thyroid-related sex life impairment. Biochemical and clinical variables were analyzed (i.e., age, education, degree of thyroid dysfunction, comorbidity, serum thyrotropin, total thyroxine, and triiodothyronine, as well as thyroperoxidase and thyrotropin receptor antibody concentrations). The SF-36 Health Survey was used to analyze the effect of impaired sex life on overall QOL. RESULTS In the cross-sectional sample, 36% of women and 31% of men reported what they perceived to be thyroid-attributable impaired sex life. Women with autoimmune thyroid diseases reported more impairment than those with non-autoimmune thyroid diseases. In patients with Graves' disease lower levels of educational attainment and in patients with toxic nodular goiter comorbidities were associated with impaired sex life. Overall QOL was lower in patients with thyroid-related sex life impairment. In the longitudinal sample, 42% of women and 33% of men had impaired sex life at baseline, which improved at 6 months follow-up only in women and, when analyzing individual diagnoses separately, statistically significantly among those with autoimmune hypothyroidism. Sexual impairment was associated with low education in patients with toxic nodular goiter and with high plasma triiodothyronine concentrations in patients with Graves' disease. In autoimmune hypothyroidism, a younger age was associated with sex life impairment. CONCLUSION We found a high frequency of self-reported, thyroid-related sex life impairment in patients with benign thyroid diseases, especially in young women with autoimmune thyroid diseases. Self-perceived impaired sex life persisted in women treated for Graves' disease, suggesting that normalization of thyroid function was not sufficient to restore sexual function.
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Affiliation(s)
- Nadia Sawicka-Gutaj
- 1 Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences , Poznan, Poland
| | - Marek Ruchala
- 1 Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences , Poznan, Poland
| | - Ulla Feldt-Rasmussen
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
| | - Laszlo Hegedüs
- 3 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Steen Joop Bonnema
- 3 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark
| | - Mogens Groenvold
- 4 Department of Public Health, University of Copenhagen , Copenhagen, Denmark
| | - Jakob Bue Bjorner
- 4 Department of Public Health, University of Copenhagen , Copenhagen, Denmark
- 5 Optum Patient Insights , Johnston, Rhode Island
| | - Torquil Watt
- 2 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark
- 6 Department of Internal Medicine, Copenhagen University Hospital Herlev Gentofte , Herlev, Denmark
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Conaglen HM, Tamatea JAU, Conaglen JV, Elston MS. Treatment choice, satisfaction and quality of life in patients with Graves' disease. Clin Endocrinol (Oxf) 2018; 88:977-984. [PMID: 29633307 DOI: 10.1111/cen.13611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/14/2018] [Accepted: 03/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thyrotoxicosis, most often caused by Graves' disease (GD), when treated inadequately may result in premature mortality. There is little consensus as to which of the 3 treatment options available - antithyroid drugs (ATD), radioactive iodine (RAI) and surgery, is better. AIMS (i) To assess factors involved in treatment choice and treatment satisfaction in patients treated for Graves' disease; (ii) To assess quality of life (QoL) following treatment of Graves' disease. METHOD Participants were selected from a prospective study cohort assessing thyrotoxicosis incidence and severity. Of the 172 eligible patients with Graves' disease, 123 treated patients participated (64% had received ATD only, 11% RAI and 25% total thyroidectomy, the latter 2 usually after a period of ATD), along with 18 untreated patients with newly diagnosed Graves' disease (overall participation rate, 73%). Consented patients completed a questionnaire detailing factors involved in treatment choice, QoL and satisfaction with treatment. RESULTS Participants reported that the most important factors in choosing a treatment were the following: the effects on activities of daily living, concern about use of radioiodine, possibility of depression or anxiety, and doctor's recommendations. Satisfaction levels were high across all 3 treatment types. QoL 1-year following treatment was higher than in untreated patients, and comparable with other international studies. CONCLUSIONS Patient satisfaction with therapy and QoL does not differ by treatment type. Therefore, clinical and social factors, in combination with patient choice and resource availability, should determine which treatment modality patients with Graves' disease should receive.
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Affiliation(s)
- Helen M Conaglen
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
| | - Jade A U Tamatea
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
| | - John V Conaglen
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
| | - Marianne S Elston
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
- Department of Endocrinology, Waikato Hospital, Hamilton, New Zealand
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Wong CKH, Choi EPH, Woo YC, Lang BHH. Measurement properties of ThyPRO short-form (ThyPRO-39) for use in Chinese patients with benign thyroid diseases. Qual Life Res 2018; 27:2177-2187. [PMID: 29671250 DOI: 10.1007/s11136-018-1857-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the validity and reliability of a newly-translated Thyroid-specific Patient-Reported Outcome short-form (ThyPRO-39) instrument for ethnic-Chinese patients suffering from benign thyroid diseases. METHODS The translation and cross-cultural adaptation of the English ThyPRO-39 were performed using the double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Cross-sectional data of 308 patients with benign thyroid diseases were utilized for this psychometric evaluation of ThyPRO-39 instrument. Convergent validity between similar construct in the ThyPRO-39, SF-6D, and SF-12v2 was assessed using Spearman correlations. The internal construct validity was assessed by corrected item-total correlations. Sensitivity of the ThyPRO-39 domain scores was determined by performing known group comparisons by independent t test. The internal consistency reliability was assessed by Cronbach's alpha coefficient. RESULTS Significant floor effects were observed in 9 out of 13 domains of the ThyPRO-39. The hypothesized correlations between similar constructs in the ThyPRO-39 and the SF-12v2 and SF-6D were generally observed, supporting convergent validity. The internal construct validity was supported in most items, except eight items in six scales. Scale score of hyperthyroid symptoms of the ThyPRO-39 was significantly higher in the group with Graves' disease or hyperthyroid disease than the group without Graves' disease nor hyperthyroid disease. Scale scores of eye symptoms and impaired daily life were significantly higher in the incidental group than the non-incidental group. For six domains (hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, depressivity, and emotional susceptibility), Cronbach's alpha did not reach the recommended standard of 0.7. CONCLUSIONS This was the first psychometric study to translate and adapt the ThyPRO-39 instrument for non-Caucasian patients, and report its validity and reliability for use in Chinese patients with benign thyroid diseases. Given the low item-total correlations in eight items and low internal consistency reliability in respective scales of the ThyPRO-39, we suggest that the improvement of those eight items should produce a more valid and reliable ThyPRO-39 instrument.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Edmond P H Choi
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Y C Woo
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Brian H H Lang
- Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
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Zahan A, Watt T, Pascanu I, Rasmussen A, Hegedüs L, Bonnema S, Feldt-Rasmussen U, Bjorner J, Nadasan V, Boila A, Merlan I, Borda A. THE ROMANIAN VERSION OF THE THYROID-RELATED PATIENT-REPORTED OUTCOMES THYPRO AND THYPRO-39. TRANSLATION AND ASSESSMENT OF RELIABILITY AND CROSS-CULTURAL VALIDITY. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:192-200. [PMID: 31149257 PMCID: PMC6516517 DOI: 10.4183/aeb.2018.192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND ThyPRO is a recently developed thyroid-specific quality of life (QoL) questionnaire applicable to patients with benign thyroid disorders(BTD). The aim of the present study was to translate ThyPRO and ThyPRO-39 into Romanian, and to evaluate reliability and cross-cultural validity. METHODS Standard methodology for translation and linguistic validation of patient-reported outcomes (PRO) was applied. The questionnaire was completed by 130 patients with benign thyroid diseases seen at Department of Endocrinology in the Emergency County Hospital, Tîrgu Mureş, Romania, between October 2015 and March 2016. Internal reliability of the Romanian version of the ThyPRO (ThyPROro) scales was assessed for multi-item scales using Cronbach's alpha coefficient. An efficient method for testing cross-cultural validity is analysis of differential item functioning (DIF). Uniform DIF between the Romanian and the original Danish sample was investigated using ordinal logistic regression. The translation process proceeded without difficulties, and any disagreements were revised by one of the developers and the language coordinator. RESULTS Internal reliability for ThyPRO was satisfactory. Cronbach`s alpha coefficients for the 13 scales ranged from 0.78 to 0.93 for the ThyPROro and 0.78 to 0.87 for the ThyPROro-39. In the 85-item ThyPRO, nine instances of DIF were found. Most were minor, explaining <3% of the variation in scale score, but DIF in positively worded items were larger, with explained variance (R2's) around 10-15%. CONCLUSION The ThyPROro questionnaire is ready for assessment of health-related quality of life in Romanian patients with benign thyroid diseases.
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Affiliation(s)
- A.E. Zahan
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - T. Watt
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - I. Pascanu
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - A.K. Rasmussen
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - L. Hegedüs
- Odense Universitetshospital, Odense, Denmark
| | | | - U. Feldt-Rasmussen
- Copenhagen University Hospital Rigshospitalet, Dept. of Medical Endocrinology, Odense, Denmark
| | - J.B. Bjorner
- Institute of Public Health, University of Copenhagen, Copenhagen,Denmark
| | - V. Nadasan
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Hygiene, Tirgu Mures, Romania
| | - A. Boila
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
| | - I. Merlan
- University of Medicine and Pharmacy of Tîrgu Mures, Emergency County Hospital, Tîrgu Mures, Dept. of Endocrinology, Tirgu Mures, Romania
| | - A. Borda
- University of Medicine and Pharmacy of Tîrgu Mures, Dept. of Histology, Tirgu Mures, Romania
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Mintziori G, Watt T, Veneti S, Panagiotou A, Pournaras DJ, Feldt-Rasmussen U, Rasmussen ÅK, Hegedüs L, Bonnema SJ, Bjorner JB, Kita M, Goulis DG. ThyPROgr: the Greek edition of the ThyPRO questionnaires for patients with benign thyroid diseases. Hormones (Athens) 2018; 17:107-112. [PMID: 29858865 DOI: 10.1007/s42000-018-0015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
The thyroid-related patient-reported outcome measure ThyPRO is currently the most reliable and valid instrument for the measurement of thyroid-related quality of life. The objective of the current study was to translate the original (85 items) and short (39 items) versions of ThyPRO into the Greek language as well as to validate and culturally adapt ThyPRO among the Greek population. Translation of patient-reported outcomes was done according to standard methodology. Following the translation process, the Greek version of ThyPRO (ThyPROgr) was validated in consecutive patients with thyroid diseases who visited the outpatient clinics of the Department of Endocrinology, "Hippokration" General Hospital, Thessaloniki, Greece, between September and December 2016. To test cross-cultural validity, analysis of differential item functioning (DIF) between the original Danish and the new Greek version, using ordinal logistic regression, was applied. Cross-cultural validity of the Greek translation was evaluated for both versions of ThyPRO. The ThyPRO questionnaire was validated in 143 consecutive patients (131 women and 12 men) with thyroid diseases, with a mean age of 62 ± 6 (SD) years. In the 85-item ThyPRO, 17 instances of DIF were detected, most of which were minor, this accounting for the ~ 5% of the variation in scale score. Two instances of DIF among positively worded items were larger, with 8-10% of variance explained. For ThyPRO-39, five minor instances of DIF were found. As judged by the linguistic validation as well as the DIF analyses, ThyPROgr has good cross-cultural validity when compared with the original Danish version. The two versions of ThyPROgr can now be used to assess thyroid-specific quality of life in the Greek population.
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Affiliation(s)
- Gesthimani Mintziori
- Department of Endocrinology, Diabetes and Metabolism, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, 54601 Nea Efkarpia, Thessaloniki, Greece.
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Stavroula Veneti
- Department of Endocrinology, Diabetes and Metabolism, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Panagiotou
- Department of Endocrinology, Diabetes and Metabolism, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitri J Pournaras
- North Bristol Centre for Weight Loss, Metabolic and Bariatric Surgery, Southmead Hospital, Bristol, UK
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laszlo Hegedüs
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Jakob Bue Bjorner
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marina Kita
- Department of Endocrinology, Diabetes and Metabolism, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, 54601 Nea Efkarpia, Thessaloniki, Greece
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Cramon P, Rasmussen ÅK, Bonnema SJ, Bjorner JB, Feldt-Rasmussen U, Groenvold M, Hegedüs L, Watt T. Development and implementation of PROgmatic: A clinical trial management system for pragmatic multi-centre trials, optimised for electronic data capture and patient-reported outcomes. Clin Trials 2018; 11:344-354. [PMID: 24519964 DOI: 10.1177/1740774513517778] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Many clinical trials are conducted as explanatory trials, but the applicability of results from explanatory trials to clinical practice may be questioned. Pragmatic trials elucidate both benefits and harms of an intervention under conditions close to daily clinical practice. We have planned a pragmatic multi-centre trial in patients with Graves' hyperthyroidism. However, trial management is a complicated task in pragmatic trials, due to limited interaction between participants and trial personnel. Purpose The aim of this project was to develop and implement PROgmatic, a fully integrated trial management system for pragmatic multi-centre trials, optimised for electronic data capture and patient-reported outcomes (PROs). Methods Necessary tasks and logistical challenges that should be handled by PROgmatic were identified, and the system was designed and developed to handle these tasks. A combination of generic applications and custom coding was applied to develop an integrated system that met the required needs. PROgmatic features include secure web-based data entry; electronic case report forms (eCRFs); central participant registration and randomisation; automated emails linking to electronic PROs; automated reminders to participants; automated notifications to trial personnel regarding booking of trial visits, safety and compliance alerts; and monitoring of trial progress. PROgmatic underwent rigorous pilot testing, including data verification and validation, before it was released for trial management. Results PROgmatic was successfully implemented in the GRAves' Selenium Supplementation (GRASS) trial (ClinicalTrials.gov: NCT01611896) December 2012. The feedback from trial personnel on usability and utility has been positive, and PROgmatic has handled all intended tasks properly. Limitations Implementation of PROgmatic in future studies requires adaptation of the custom coding. Not all email systems accept emails with active links, and participants who use these systems therefore need to complete paper surveys. Conclusions PROgmatic facilitated the complex task of conducting a pragmatic multi-centre trial. The automated electronic capture of PRO data is time saving and reduces the risk of erroneous data entry. Email notifications to trial personnel combined with serially activated eCRFs that logically lead patient flow through the trial have helped making the pragmatic trial feasible. PROgmatic provides a template for other pragmatic multi-centre trials with patient-reported measures as high-priority outcomes.
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Affiliation(s)
- Per Cramon
- a Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Åse Krogh Rasmussen
- a Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Steen Joop Bonnema
- b Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Jakob Bue Bjorner
- c National Research Centre for the Working Environment, Copenhagen, Denmark.,d Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- a Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mogens Groenvold
- d Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Laszlo Hegedüs
- b Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Torquil Watt
- a Department of Medical Endocrinology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Kaniuka-Jakubowska S, Lewczuk A, Majkowicz M, Piskunowicz M, Mizan-Gross K, Zapaśnik A, Kaszubowski M, Lass P, Sworczak K. Nontoxic Goiter (NTG) and Radioiodine: What Do Patients Think About It? Quality of Life in Patients with NTG Before and After 131-I Therapy. Front Endocrinol (Lausanne) 2018; 9:114. [PMID: 29713309 PMCID: PMC5912045 DOI: 10.3389/fendo.2018.00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Despite numerous publications regarding nontoxic goiter (NTG) treatment and an increasing interest in patients' quality of life, few studies present the outcome of 131-I treatment from the patients' perspective. Our study's main aim was to verify whether there is any improvement in life quality following 131-I treatment. MATERIALS AND METHODS Thirty-five patients with NTG qualified to participate in the study. All patients completed a Thyroid-Related Health-Related Quality of Life (Thy-R-HRQoL) questionnaire created by us and the Medical Outcomes Study 36-item Short Form (SF-36), right before and 1 year after 131-I. RESULTS We observed an improvement in six out of eight SF-36 and three out of seven Thy-R-HRQoL domains. In comparison with the control group, we observed worse results in two out of eight, prior to treatment, and one out of eight SF-36 afterward, as well as in all Thy-R-HRQoL domains. We did not find any correlation between improvement of Thy-R-HRQoL and SF-36 and goiter size reduction, except for Bodily Pain. There was also no correlation between improvement of SF-36 and Thy-R-HRQoL domains, and goiter size before treatment. The older the patient, the less noticeable improvement was observed in Physical and Social Functioning, and Vitality in SF-36, but age had no influence on the assessment by Thy-R-HRQoL. CONCLUSION Radioiodine treatment improves life quality in patients with NTG. Use of the Health-Related Quality of Life questionnaire should be taken into consideration when evaluating life quality of patients with NTG. Relentless pursuit of maximal goiter size reduction in 131-I treatment is worth consideration. In our study, life quality improvement did not depend directly on the goiter size reduction. Life quality improvement after 131-I might not depend on initial goiter size, and for certain domains of SF-36 might be less clearly expressed in older patients.
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Affiliation(s)
- Sonia Kaniuka-Jakubowska
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
- *Correspondence: Sonia Kaniuka-Jakubowska,
| | - Anna Lewczuk
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Mikołaj Majkowicz
- Department for Quality of Life Research, Medical University of Gdansk, Gdansk, Poland
- Department of Public Health, Pomeranian University in Slupsk, Slupsk, Poland
| | | | | | - Adam Zapaśnik
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk, Poland
- Institute of Experimental Physics, University of Gdansk, Gdansk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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Conversion of standard retrospective patient-reported outcomes to momentary versions: cognitive interviewing reveals varying degrees of momentary compatibility. Qual Life Res 2017; 27:1065-1076. [DOI: 10.1007/s11136-017-1762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 01/23/2023]
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Sorensen JR, Lauridsen JF, Døssing H, Nguyen N, Hegedüs L, Bonnema SJ, Godballe C. Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study. Eur Thyroid J 2017; 6:307-314. [PMID: 29234624 PMCID: PMC5704720 DOI: 10.1159/000480348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. METHODS Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen's effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2-0.5 were defined as small, 0.5-0.8 as moderate, and values >0.8 as large. RESULTS Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14-642 mL) before surgery with surgical removal of a median of 43 g (range, 8-607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. CONCLUSIONS In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.
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Affiliation(s)
- Jesper Roed Sorensen
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- *Jesper Roed Sorensen, MD, Department of ORL Head and Neck Surgery, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C (Denmark), E-Mail
| | | | - Helle Døssing
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
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Abstract
PURPOSE OF REVIEW A subset of patients being treated for hypothyroidism do not feel well while taking levothyroxine (LT4) replacement therapy, despite having a normal serum thyroid stimulating hormone level. Pursuing a relative triiodothyronine deficiency as a potential explanation for patient dissatisfaction, has led to trials of combination therapy with liothyronine (LT3), with largely negative outcomes. This review attempts to reconcile these diverse findings, consider potential explanations, and identify areas for future research. RECENT FINDINGS Patients being treated with LT4 often have lower triiodothyronine levels than patients with endogenous thyroid function. Linking patient dissatisfaction with low triiodothyronine levels has fueled multiple combination therapy trials that have generally not shown improvement in patient quality of life, mood, or cognitive performance. Some trials, however, suggest patient preference for combination therapy. There continues, moreover, to be anecdotal evidence that patients have fewer unresolved symptoms while taking combination therapy. SUMMARY The 14 trials completed to date have suffered from employing doses of LT3 that do not result in steady triiodothyronine levels, and having insufficient power to analyze results based on baseline dissatisfaction with therapy and patient genotype. Future trials that are able to incorporate such features may provide insight into what thyroid hormone preparations will most improve patient satisfaction with therapy.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, District of Columbia, USA
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Sorensen JR, Watt T, Cramon P, Døssing H, Hegedüs L, Bonnema SJ, Godballe C. Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study. Head Neck 2017; 39:2232-2240. [PMID: 28872214 DOI: 10.1002/hed.24886] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/18/2017] [Accepted: 06/15/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters. METHOD Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests. RESULTS Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population. CONCLUSION Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.
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Affiliation(s)
- Jesper Roed Sorensen
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Per Cramon
- Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Helle Døssing
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
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