Adults with benign thyroid disease are more likely to report impaired sexual quality of life vs. those without thyroid disease, especially women with autoimmune versions of thyroid diseases, according to study findings reported in Thyroid.
“While much is known about the effects of treatment of benign thyroid diseases on biochemical changes, mortality and morbidity, data on the impact of chronic, benign thyroid diseases on the quality of sex life are scant,” Nadia Sawicka-Gutaj, MD, PhD, of the department of endocrinology, metabolism and internal disease at Poznan University of Medical Sciences, Poland, and colleagues wrote in the study background. “Sexual dysfunction in patients with thyroid diseases might result from hormonal changes, thyroid autoantibodies, psychological imbalance and somatic symptoms in the genital organs, as well as from psychiatric and somatic morbidity. These complex alterations are often associated with infertility.”
Sawicka-Gutaj and colleagues analyzed data from a cross-sectional sample of 759 women and 118 men with thyroid diseases followed at or referred to two Copenhagen University Hospital Rigshospitalet and Odense University Hospital in Denmark in 2007-2008, as well as a longitudinal sample of 358 women and 74 men undergoing treatment for thyroid diseases at the same institutions between 2008 and 2012, evaluated at baseline and 6 months after treatment. Researchers stratified patients by five diagnostic groups: nontoxic goiter, toxic nodular goiter, Graves’ hyperthyroidism, Graves’ orbitopathy and autoimmune hypothyroidism. Patients completed the ThyPRO questionnaire, designed to evaluate the influence of thyroid disease on physical, mental and social symptoms, functioning and well-being, including sexual quality of life (scores range from 0-100, with higher scores indicating more symptoms and impact on quality of life). Patients also completed the thyroid-independent measure of the SF-36 health survey to assess mental and physical health status (higher scores indicate better status). Researchers also analyzed thyroid hormone levels and degree of thyroid dysfunction, comorbidities and thyroid autoantibody levels, and used multiple linear regression analysis to predict impaired sex life scores by clinical variable, adjusting for age and education level.
In the cross-sectional sample, 36% of women and 31% of men reported experiencing an impaired sex life. In women, those with nontoxic and toxic nodular goiter reported less sexual impairment vs. women with autoimmune thyroid disease (among men, diagnostic groups were too small for analysis).
In the longitudinal sample, 42% of women and 33% of men reported an impaired sex life at baseline; however, among women, the number fell to 34% after 6 months of treatment, and no change was observed in men. Additionally, in the longitudinal group, more women with Graves’ hyperthyroidism reported an impaired sex life vs. women with nontoxic goiter; however, at 6 months, there were no-between group differences among women in different diagnostic groups, according to researchers.
In the longitudinal sample, total triiodothyronine was positively associated with impaired sex life scores in patients with Graves’ disease at baseline. For each nanomole per liter increment in total T3 (reference interval, 1.4-2.8 nmol/L), researchers observed a 6-point worsening of the impaired sex life score (P = .0007).
Researchers noted that impaired sex life scores at 6 months’ follow-up were associated with baseline variables in patients with toxic and nodular goiter who were either students or had long education (at least 5 years). In patients with Graves’ disease, plasma T3 was positively associated with impaired sex life scores, with a 4-point worsening per 1 nmol/L increment in plasma T3 (P = .0032), according to researchers.
Among patients with autoimmune hypothyroidism, age was negatively associated with impaired sex life scores.
Researchers did not observe a relationship between variables and change in impaired sex life scores between baseline and 6 months.
Researchers also observed that patients across diagnostic groups in the cross-sectional sample who reported an impaired sex life scored worse on both measured domains of the SF-36 and on the ThyPRO. In the longitudinal sample, similar findings were observed only in patients with nontoxic or nodular goiter.
“Self-perceived impaired sex life persisted in treated women with Graves’ disease, suggesting that the normalization of thyroid function is not sufficient to abolish sexual dysfunction,” the researchers wrote. “These observations support a multidisciplinary approach to thyroid patients to facilitate communication and improve the quality of their sex life.” – by Regina Schaffer
Disclosure: One of the authors reports being an employee of Optum, which distributes the SF-36 questionnaire.