Most adults with hypothyroidism dissatisfied with treatment
A majority of adults with hypothyroidism responding to a survey said they were dissatisfied with treatment and reported having a low quality of life score, according to study data published in Clinical Endocrinology.
“The main findings of this survey were a high rate of dissatisfaction with treatment and care,” Anna L. Mitchell, MBBS (Hons), MRes, MRCP, PhD, department of endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals, NHS Foundation Trust, and colleagues wrote. “The form of thyroid hormone replacement taken did not correlate with treatment satisfaction. However, treatment with a combination of levothyroxine and liothyronine, and desiccated thyroid extract was associated with significantly better quality of life than levothyroxine or liothyronine monotherapies. However, when other factors were taken into account, using multivariate analysis, the form of thyroid hormone replacement taken failed to demonstrate any correlations between different treatments for hypothyroidism and either satisfaction or quality of life, while a variety of other parameters did.”
Researchers conducted an online survey for people with hypothyroidism in June 2019. Participants were invited to take the survey on the British Thyroid Foundation’s Facebook pages and website. The questionnaire included sections on demographics, hypothyroidism diagnosis and treatment, current satisfaction with treatment and care, experiences with levothyroxine therapy, information received about hypothyroidism, and self-reported quality of life at the time of the survey. Quality of life was rated on a scale of 0 to 100, with 0 being worst and 100 best.
Of the 969 respondents included in the analysis (mean age, 48.4 years; 97.6% women, 69.9% were treated with levothyroxine alone and 75.8% had their family physician manage their hypothyroidism. Only 14.5% said their primary care provider fully informed them about hypothyroidism, and 89.2% said they found other sources, such as the internet, media and patient organizations, more valuable.
Of the study cohort, 22.4% said they were satisfied with the treatment and care they received, and the mean quality of life score for all respondents was 48.3. Participants who were satisfied with their treatment had a higher quality of life score than those who were not satisfied (63.8 vs. 43.9; P < .001).
There was a difference in satisfaction with treatment depending on the form of thyroid hormone replacement. Those who had levothyroxine and liothyronine combination therapy reported the highest mean quality of life score (mean score, 55.5; 95% CI, 50.7-60.3), whereas those who received liothyronine monotherapy had the lowest quality of life (mean score, 45.7; 95% CI, 36.4-54.9). Those receiving combination therapy also had a higher mean quality of life score than those receiving levothyroxine monotherapy. After adjusting for additional clinical parameters, however, there was no significant correlation between thyroid hormone treatment and either satisfaction or quality of life score.
Older age, male sex, type of therapy, being cared for by a thyroid specialist, and feeling fully informed by the family physician about hypothyroidism were positively correlated with satisfaction with treatment. Some expectations at the time of diagnosis were negatively associated with satisfaction with treatment and care, including expectations for greater support from the family physician, levothyroxine resolving all symptoms, and referral to a specialist. Negative experiences with levothyroxine treatment also correlated negatively with satisfaction.
Male sex and longer duration of hypothyroidism were correlated positively with quality of life score. Older age, delay in diagnosis, need to source therapy without the family physician’s help, negative experiences with levothyroxine, expectations that levothyroxine would resolve all symptoms, and expectations of greater support from the family physician were negatively associated with quality of life.
“Managing patient expectations at the time of diagnosis of hypothyroidism, establishing a better rapport between the health care professional and the patient, maintaining a positive therapeutic relationship and providing good quality patient-centered information about hypothyroidism are tenable, nonpharmacologic and low-cost interventions that may improve treatment satisfaction and quality of life of patients with hypothyroidism,” the researchers wrote.