Clinical and Social Concerns in Treated Patients with Primary Hypothyroidism in Basrah: A Cross Sectional Study
American Journal of Internal Medicine
Volume 3, Issue 6, November 2015, Pages: 256-263
Received: Oct. 21, 2015; Accepted: Nov. 2, 2015; Published: Dec. 30, 2015
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Haider Ayad Alidrisi, Al-Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah College of Medicine, Basrah, Iraq
Alaa Khattar Musa, Department of Medicine, Basrah College of Medicine, Basrah, Iraq
Abbas Ali Mansour, Al-Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC), Basrah College of Medicine, Basrah, Iraq
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Background: Despite available treatment for hypothyroidism, L-thyroxine replacement therapy in a biochemically appropriate dose does not necessarily relieve patients' symptoms and complaints. The aim of the study was to evaluate the concerns of patients treated with hypothyroidism and to correlate these concerns with different patient characteristics and thyroid biochemical control. Subjects and Methods: one hundred eighteen treated primary hypothyroid patients attending Al-Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Al-Basrah were entering a questionnaire designed to capture personal, anthropometric, biochemical and clinical data. Twenty-four concerns were questioned to the patients who score these concerns on a 4 point Likert scale. Results: The most scored patients' concerns were fatigue, neuropathic pain, lack of weight loss, cold intolerance, breathing problems, and swallowing problems. No statistically significant relations were existed between these concerns and thyroid stimulating hormone (TSH) control, except for a high TSH group which were highly likely to have concerns of feeling sick (OR: 0.27, 95%CI 0.54 to 2.0, p=0.001), neuropathic pain (OR: 0.4, 95%CI 0.17 to 1.6, p=0. 01), cold intolerance (OR: 0.35, 95%CI 0. 0.3 to 1.7, p=0.005), and hair problems (OR: 0.26, 95%CI 0.6 to 2.1, P<0.0001). A significant correlation existed between duration of the hypothyroidism and patients' concerns of swelling of the hands and feet (R=0.7 P<0.0001), memory problems (R=0.4 P<0.0001), hearing disturbance (R=0. 38 P<0.0001), and hair problems (R=0. 3 P=0.001). Age significantly affects patients' concerns of memory problems (R=0. 6 P<0.0001), swelling of the hands and feet (R=0.4 P<0.0001), and hearing disturbance (R=0.37 P<0.0001). Positive correlation was present between low density lipoprotein cholesterol level and patients' concerns of cold intolerance (R=0.3 P=0.001), hair problems (R=0. 28 P=0.003), feeling sick (R=0. 2 P=0. 02), and neuropathic pain (R=0.18 P=0.04). The total cholesterol level also showed a positive correlation with patients' concerns of cold intolerance (R=0.3 P=0.001), hair problems (R=0. 25 P=0.01), neuropathic pain (R=0. 22 P=0. 01), and fatigue (R=0. 2 P=0.04). Conclusion: We cannot rely on the TSH level alone as a marker of optimal treatment outcome in patients with primary hypothyroidism because it does not reflect the concern status of the patients.
Hypothyroidism, Patients' Concerns, Thyroid Stimulating Hormone
To cite this article
Haider Ayad Alidrisi, Alaa Khattar Musa, Abbas Ali Mansour, Clinical and Social Concerns in Treated Patients with Primary Hypothyroidism in Basrah: A Cross Sectional Study, American Journal of Internal Medicine. Vol. 3, No. 6, 2015, pp. 256-263. doi: 10.11648/j.ajim.20150306.17
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Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000 Feb 28; 160(4): 526-34.
Wilson GR, Curry RW Jr. Subclinical thyroid disease. Am Fam Physician. 2005 Oct 15; 72(8): 1517-24.
Meier C, Staub JJ, Roth CB, Guglielmetti M, Kunz M, Miserez AR, Drewe J, Huber P, Herzog R, Müller B.TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab. 2001 Oct; 86(10): 4860-6.
Robert ND. Psychological problems in thyroid disease. Br Thyroid Found Newsl 1996; 18: 3.
Dale J, Daykin J, Holder R, Sheppard MC, Franklyn JA. Weight gain following treatment of hyperthyroidism. Clin Endocrinol (Oxf). 2001 Aug; 55(2): 233-9.
Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM. Clin Endocrinol (Oxf). Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled community-based questionnaire study. 2002 Nov; 57(5): 577-85.
Kalra S, Kalra B, Khandelwal SK. Vitamin D status in well controlled hypothyroid patients in Haryana, India. Thyroid Res Pract 2011; 8: 12-6.
Collins D, Wilcox R, Nathan M, Zubarik R. Celiac disease and hypothyroidism. Am J Med. 2012 Mar; 125(3): 278-82. doi: 10.1016/j.amjmed. 2011. 09. 003.
Erdogan M, Kösenli A, Ganidagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012; 59(3): 213-20.
Hernández Valencia M1, Córdova Pérez N, Zárate A, Basurto L, Manuel Apolinar L, Ruiz M, Vargas C, Vargas A. Hypothyroidism associated to menopause symptoms worsening change with thyroid substitution therapy. Ginecol Obstet Mex. 2008 Oct; 76(10): 571-5.
Bahammam SA, Sharif MM, Jammah AA, Bahammam AS. Prevalence of thyroid disease in patients with obstructive sleep apnea. Respir Med. 2011 Nov; 105(11): 1755-60. doi: 10.1016/j.rmed. 2011.07.007.
Watt T, Hegedüs L, Rasmussen AK, Groenvold M, Bonnema SJ, Bjorner JB, Feldt-Rasmussen U. Which domains of thyroid-related quality of life are most relevant? Patients and clinicians provide complementary perspectives. Thyroid. 2007 Jul; 17(7): 647-54.
Bhutani S, Bhutani J, Balhara YP, Kalra S. Patient concerns in treated hypothyroidism: A cross-sectional evaluation. Thyroid Res Pract 2013; 10: 72-7.
Watt T, Groenvold M, Rasmussen AK, Bonnema SJ, Hegedüs L, Bjorner JB, Feldt-Rasmussen U. Quality of life in patients with benign thyroid disorders. A review. Eur J Endocrinol. 2006 Apr; 154(4): 501-10.
Duyff RF, Van den Bosch J, Laman DM, van Loon BJ, Linssen WH. Neuromuscular findings in thyroid dysfunction: a prospective clinical and electrodiagnostic study. J Neurol Neurosurg Psychiatry. 2000 Jun; 68(6): 750-5.
Kececi H, Degirmenci Y. Hormone replacement therapy in hypothyroidism and nerve conduction study. Neurophysiol Clin. 2006 Mar-Apr; 36(2): 79-83.
Beghi E, Delodovici ML, Bogliun G, Crespi V, Paleari F, Gamba P, Capra M, Zarrelli M. Hypothyroidism and polyneuropathy. J Neurol Neurosurg Psychiatry. 1989 Dec; 52(12): 1420-3.
Zulewski H, Müller B, Exer P, Miserez AR, Staub JJ. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997 Mar; 82(3): 771-6.
Misiolek M, Marek B, Namyslowski G, Scierski W, Zwirska-Korczala K, Kazmierczak-Zagorska Z, Kajdaniuk D, Misiolek H. Sleep apnea syndrome and snoring in patients with hypothyroidism with relation to overweight. J Physiol Pharmacol. 2007 Mar; 58 Suppl 1: 77-85.
Joshi JV, Bhandarkar SD, Chadha M, Balaiah D, Shah R. Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre. J Postgrad Med. 1993 Jul-Sep; 39(3): 137-41.
Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC. Incidence of early loss of pregnancy. N Engl J Med. 1988 Jul 28; 319(4): 189-94.
Staub JJ, Althaus BU, Engler H, Ryff AS, Trabucco P, Marquardt K, Burckhardt D, Girard J, Weintraub BD. Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med. 1992 Jun; 92(6): 631-42.
Larsen PR, Silva JE, Kaplan MM. Relationships between circulating and intracellular thyroid hormones: physiological and clinical implications. Endocr Rev. 1981 Winter; 2(1): 87-102.
Sturgess I, Thomas SH, Pennell DJ, Mitchell D, Croft DN.Diurnal variation in TSH and free thyroid hormones in patients on thyroxine replacement. Acta Endocrinol (Copenh). 1989 Nov; 121(5): 674-6.
Carr D, McLeod DT, Parry G, Thornes HM. Fine adjustment of thyroxine replacement dosage: comparison of the thyrotrophin releasing hormone test using a sensitive thyrotrophin assay with measurement of free thyroid hormones and clinical assessment. Clin Endocrinol (Oxf). 1988 Mar; 28(3): 325-33.
Todd CH.Management of thyroid disorders in primary care: challenges and controversies. Postgrad Med J. 2009 Dec; 85(1010): 655-9. doi: 10.1136/pgmj. 2008.077701.
Kaplan MM, Sarne DH, Schneider AB. In search of the impossible dream? Thyroid hormone replacement therapy that treats all symptoms in all hypothyroid patients. J Clin Endocrinol Metab. 2003 Oct; 88(10): 4540-2.
Erdogan M, Kösenli A, Ganidagli S, Kulaksizoglu M. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012; 59(3): 213-20.
Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Evans JG, Young E, Bird T, Smith PA. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf). 1977 Dec; 7(6): 481-93.
Shafer RB, Prentiss RA, Bond JH. Gastrointestinal transit in thyroid disease. Gastroenterology. 1984 May; 86(5 Pt1): 852-5.
Kahraman H, Kaya N, Demirçali A, Bernay I, Tanyeri F.Gastric emptying time in patients with primary hypothyroidism. Eur J Gastroenterol Hepatol. 1997 Sep; 9(9): 901-4.
Safer JD. Thyroid hormone action on skin. Dermatoendocrinol. 2011 Jul; 3(3): 211-5. doi: 10.4161/derm. 3. 3. 17027.
Malik V, Shukla GK, Bhatia N. Hearing profile in hypothyroidism. Indian J Otolaryngol Head Neck Surg. 2002 Oct; 54(4): 285-90. doi: 10.1007/BF02993744.
Smith TJ, Bahn RS, Gorman CA. Connective tissue, glycosaminoglycans, and diseases of the thyroid. Endocr Rev. 1989 Aug; 10(3): 366-91.
Goto S, Billmire DF, Grosfeld JL. Hypothyroidism impairs colonic motility and function. An experimental study in the rat. Eur J Pediatr Surg. 1992 Feb; 2(1): 16-21.
Smith TJ, Murata Y, Horwitz AL, Philipson L, Refetoff S. Regulation of glycosaminoglycan synthesis by thyroid hormone in vitro. J Clin Invest. 1982 Nov; 70(5): 1066-73.
Mennemeier M, Garner RD, Heilman KM. Memory, mood and measurement in hypothyroidism. J Clin Exp Neuropsychol. 1993 Sep; 15(5): 822-31.
Hedden T, Gabrieli JD. Insights into the ageing mind: a view from cognitive neuroscience. Nat Rev Neurosci. 2004 Feb; 5(2): 87-96.
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