Predictors of Improvement in Quality of Life When Treating Hypothyroidism

Effect of physical exercise in people with hypothyroidism: systematic review and meta-analysis

This study aimed to systematically revise the available evidence on the effects of physical exercise training programmes on people with hypothyroidism. Comparative studies were searched in six electronic databases until April 2023. The Physiotherapy Evidence Database and the Methodological Index for Non-Randomized Studies were used to determine the methodological quality of the randomized controlled trials and comparative studies respectively. A total of 10 studies were found showing a low to moderate methodological quality. Most of them were performed in women with subclinical hypothyroidism. Exercise seemed to be safe, with aerobic and resistance training leading to improvements in outcomes related to physical and mental health. The performed meta-analysis with data from 120 participants indicated that exercise showed a non-significant trend towards reducing thyroid-stimulating hormone levels (Hedges'g -0.96; 95% CI -2.71; 0.79, p = 0.160; I2 = 92%). When the analysis was performed by comparing the experimental, and control groups with data from 180 participants the results remained non-significant (SMD -1.09; CI 95% -2.88; 0.70, p = 0.23; I2 = 95%). Similar findings were obtained when pooling data for FT3 and FT4 levels. Exercise does not have a significant impact on thyroid function, although its practice can lead to secondary outcomes related to physical and mental health.

The Impact of Hypothyroidism on the Quality of Life of Adults in Riyadh, Saudi Arabia

Background and objective Hypothyroidism is extremely common and associated with far-reaching health consequences. The negative effects of hypothyroidism on patients' quality of life (QoL) are well-documented. It is said to be common in the countries of the Arabian Gulf, although it is often misdiagnosed and treated in an inconsistent manner. Hence, understanding how an illness like this affects a patient's life might help us enhance their QoL and get us closer to the healthcare transformation goals of Saudi Arabia's Vision 2030. Methodology This cross-sectional study was conducted in Riyadh, Saudi Arabia, between June 2022 and February 2023. A convenience non-probability sampling method was used. The WHO Quality of Life (WHOQOL)-BREF questionnaire in Arabic was used to compile the data. Data were collected using a standardized form, refined using Google Forms, and then documented in an Excel spreadsheet. The descriptive statistics were shown as means and standard deviations (SD). To assess the numerical data, a t-test was used, while the chi-square test was employed to examine the relationship between the qualitative factors. Results A total of 394 adults from the general population with hypothyroidism were surveyed, including 105 men and 289 women. Of them, 151 (38.3%) patients had not sought therapy for their hypothyroidism, while 243 (61.7%) patients had. When asked about the QoL, a significant segment (37.6%) of patients reported that it was high, and 29.7% reported being totally satisfied with their health. The WHOQOL-BREF domain scores revealed that environmental health had the highest value (24.04 ±4.62), followed by physical health (22.24 ±3.23), and then psychological health (18.08 ±2.82), and the lowest scores were reported for the rate of QoL and satisfaction with health (2.64 ±1.36 and 2.80 ±1.68), respectively. Each domain of the WHOQOL-BREF had its own set of variables that differed from one another in a statistically significant manner (p<0.001). Conclusions  Based on our findings, we recommend expert physician monitoring and implementing educational programs as well as placing a greater emphasis on patients' QoL in the management of hypothyroidism.

Quality of life outcomes in two phase 3 trials of setmelanotide in patients with obesity due to LEPR or POMC deficiency

Introduction

Individuals with proopiomelanocortin (POMC) or leptin receptor (LEPR) deficiency are young and experience severe obesity, hyperphagia, and comorbidities, which can impair quality of life (QOL).

Methods

Two pivotal Phase 3 trials explored the effect of setmelanotide on body weight and hunger in individuals with obesity due to POMC (NCT02896192) or LEPR (NCT03287960) deficiency. QOL and depression were investigated in parallel using the disease-specific, age-appropriate Impact of Weight on Quality of Life-Lite (IWQOL-Lite), Pediatric Quality of Life Inventory (PedsQL), and Patient Health Questionnaire-9 (PHQ-9).

Results

In total, the POMC and LEPR trials enrolled 21 patients. Adults (≥ 18 years old; n = 7) had moderate-to-severe impairment in QOL at baseline, with mean (standard deviation [SD]) IWQOL-Lite total score 60.3 (13.2; maximum IWQOL-Lite total score = 100). The effect of setmelanotide on IWQOL-Lite total score was observed as soon as Week 5. Among those with scores at Week 52, 5 of 6 adults experienced a clinically meaningful improvement, with mean (SD) total scores increased from baseline by 24.2 (12.1) points. Children (6–12 years old; n = 2) and adolescents (13–17 years old; n = 4) had impaired QOL at baseline, with mean (SD) self-reported PedsQL total scores 53.3 (6.2) and 63.3 (29.1), respectively (maximum PedsQL total score = 100). Three of 5 patients experienced clinically meaningful improvement in PedsQL, with 2 children whose PedsQL total score increased by 28.3 and 3.3 points and 3 adolescents whose mean (SD) total score increased from baseline by 5.8 (18.3) points. Baseline mean (SD) PHQ-9 score (in those ≥ 12 years old) was 5.3 (3.8) and was generally maintained through Week 52.

Conclusions

Patients with POMC or LEPR deficiency had impaired, and in some cases severely impaired, QOL before setmelanotide treatment. Setmelanotide improved QOL in patients as early as Week 5, with some patients no longer experiencing impaired QOL at Week 52. Improvements in QOL may be related to a reduction in hunger and body weight associated with setmelanotide. Because of the highly complex psychological consequences of rare genetic diseases of obesity, some patients may require a long period of treatment to improve QOL and benefit from interdisciplinary care.

Relatively Lower FT3 Levels Are Associated with Impaired Quality of Life in Levothyroxine-Treated Patients with Hashimoto Thyroiditis

OBJECTIVE

Patients with Hashimoto thyroiditis (HT) frequently have some complaints despite achieving euthyroidism after levothyroxine (LT4) treatment. This study aimed to investigate the relevant factors affecting the quality of life (QoL) in euthyroid HT patients after LT4 treatment.

METHODS

In this case-control study, 133 participants with HT were included. They were divided into two groups: 64 euthyroid HT subjects (control group) and 69 HT patients were rendered euthyroid by LT4 treatment (well-controlled group). QoL was measured with the Thyroid-Related Patient-Reported Outcome (ThyPRO-39) questionnaire.

RESULTS

Both study groups were well matched with respect to gender, age, BMI, euthyroidism, and thyroid antibodies (TPOAb and TGAb). Compared with the control group, the well-controlled group had lower FT3 (P < 0.01) levels. Of note, QoL was impaired on all scales in the well-controlled group. Moreover, ThyPRO-39 scores among the well-controlled group were significantly higher (worse) than the control group in all scales. Regarding the composite scale, its score was related to FT3 (r = -0.176, P=0.043) but not to FT4 and TSH levels. Further logistic regression analysis revealed FT3 was significantly associated with elevated composite QoL [0.128 (0.029-0.577), P < 0.01] after adjustment of potential confounders.

CONCLUSION

Relatively lower FT3 concentrations, even within the normal reference range, were related to impaired QoL in HT patients treated with LT4. This finding supports the great value of FT3 in clinical decision-making on dose adequacy.