Szakirodalom

Hypothyroidism is linked to depression and several metabolic alterations, including insulin resistance, dyslipidemia, and oxidative stress. This study investigates the impact of hormones, autoimmunity, metabolic, and antioxidant indicators on the severity of depression in patients with hypothyroidism.

This study aimed to assess the effectiveness of information-motivation-behavioral (IMB) skills model of hypothyroidism self-management integrated into prenatal care in pregnant women with newly diagnosed hypothyroidism. Participants were 119 women with newly diagnosed hypothyroidism during pregnancy, with 59 cases receiving prenatal care based on IMB skills model (IMB group) and 60 cases receiving prenatal usual care (PUC group). The IMB group had a higher proportion of high adherence than the PUC group (48 vs. 35, P = 0.022). The incidence rate of preterm birth was significantly different between the IMB group and the PUC group (0 vs. 5, P = 0.024). The IMB group had fewer proportions of pregnant women with maternal stress, anxiety and depression than the PUC group (P < 0.05). Increased GSES scores indicating better self-efficacy and high patient satisfaction to prenatal care were noted in the IMB group compared to the PUC group post intervention (P < 0.05). The study demonstrates IMB skills model of hypothyroidism self-management integrated into prenatal care is found to be effective in improving medication adherence, mental health and self-efficacy in pregnant women with newly diagnosed hypothyroidism.

To identify pre-treatment determinants of hypothyroidism and decision regret (DR) following radioiodine (RAI) therapy in Graves’ disease (GD), and to assess their longitudinal impact on health-related quality of life (QoL).

BACKGROUND AND OBJECTIVE: The relationship between quality of life (QoL) and thyroid stimulating hormone (TSH) levels in patients receiving levothyroxine (LT4) therapy is unclear. Our aim was to determine the efficacy of replacement therapy and the relationship between TSH concentration and QoL in patients diagnosed with primary hypothyroidism and receiving LT4 replacement therapy. METHODS: This is a national retrospective cross-sectional study. Demographic information, a questionnaire for diagnosis and management of thyroid diseases and Thyroid related Patient Reported Outcome (ThyPRO ) and EQ-5D questionnaires to assess quality of life were used to collect data. The study included retrospective 3 year follow up data. RESULTS: Our study included 1750 patients (90.3% female, 9.7% male) from 26 centers with a mean age of 47.8 ± 12.6 years (18–88) and a body mass index of 28.84 ± 5.89 kg/m2. Patients had been receiving levothyroxine replacement for 10.23 ± 7.03 (3–55) years. The mean number of visits during the three-year follow-up period was 6.34 ± 2.78 [1–22]. A total of 188 patients (10.7%) had never reached the specific TSH target. The target TSH value was reached < 3 times (n = 715; 40.8%), 3–5 times (n = 775; 44.2%), and ≥ 6 times (n = 260; 14.8%). According to the ThyPRO questionnaire, patients who achieved their treatment target fewer than 3 times had higher (worse thyroid related quality of life) scores in several domains, including goiter symptoms, hyper-/hypothyroid symptoms, fatigue, cognitive complaints, anxiety, depression, and impairments in social, sexual, and daily functioning. In contrast, these patients had lower EQ-5D scores, indicating poorer overall health-related quality of life. CONCLUSION: In hypothyroidism replacement therapy, it is crucial to establish an individualized TSH target, and the patient’s cognitive functions and quality of life are positively impacted by the attainment of euthyroidism.

Overweight/obesity and subclinical hypothyroidism (SCH) are common in major depressive disorder (MDD). This study investigates the prevalence of overweight/obesity and its clinical correlates in Chinese first-episode, drug-naïve (FEDN) MDD patients with comorbid SCH, stratified by sex.

This study aimed to investigate the prevalence of anxiety and depression symptoms and analyse the associated risk factors in postmenopausal women with type 2 diabetes mellitus (T2DM) and comorbid hypothyroidism.

This study examined the knowledge, attitudes and practices of pregnant women regarding hypothyroidism during pregnancy.

Subclinical hypothyroidism (SCH) is of particular importance due to its high prevalence and its association with cognitive deficits. Patients often express complaints of neuropsychological symptoms and cognitive impairments including lack of attention. Also, patients treated with levothyroxine (LT-4) often report persistent complaints related to mental slowing or lack of attention despite normal TSH levels. To investigate the effects of different ranges of TSH on sustained attention in SCH. Included in the study were 136 participants that were divided into four groups: Group 1, 35 healthy individuals; Group 2, 33 newly diagnosed patients with SCH; Group 3, 36 patients on LT-4 with uncontrolled or elevated TSH; Group 4, 32 euthyroid patients (ongoing LT-4). Laboratory measurements and clinical assessment were done. Rapid visual processing (RVP) task was performed on standardized battery (Cambridge Automated Neuropsychological Test Battery). There was significant impairment in sustained attention (=<0.05) in Group 2 patients who had neuropsychological symptoms and SCH diagnosed with a TSH range of ≥2.5mIU/L. Our findings encourage screening for sustained attention along with thyroid profile in those who report neuropsychological symptoms. TSH mean range of ≥2.5 mIU/L was established as a more reasonable threshold for evaluating sustained attention and initiating LT-4 in SCH.

Persistent symptoms and impaired quality of life (QoL) in hypothyroidism despite treatment with levothyroxine (LT4) receive increasing attention. We aimed at reviewing QoL in long-term treated hypothyroidism.

Physicians demonstrate differing attitudes about the management of hypothyroid patients on optimal replacement with thyroxine (T4) who have persisting symptoms. The use of liothyronine (T3) as combination therapy (T4+T3) has been promoted, and some patients demonstrate a compelling benefit. They can be identified by delayed relaxation of tendon reflexes, that is, a positive Woltman’s sign. This is specific for T3 responders. A generation of Endocrinologists has neglected this useful clinical sign. Patients with autoimmune symptoms and elevated anti-thyroid peroxidase (anti-TPO) antibodies show improvement after total thyroidectomy, but with the risk of significant postoperative complications. This discrete subgroup tends to be disregarded by authorities in the literature. There is a compelling need for further research on the nonsurgical treatment of this subgroup. Many dissatisfied patients have psychosomatic symptoms because of the burden of having a chronic disease, the need to take regular medication, and other psychosocial concerns. They have medically not yet explained symptoms (MNYES) and require support, counselling, and sometimes cognitive behaviour therapy. True thyroxine allergy and/or sensitivity does occur but is extremely rare. These four subgroups could be designated as – (1) T3-hypothyroidism; (2) Anti-TPO-toxic hypothyroidism; (3) Hypothyroidism-in-denial; and (4) Thyroxine- sensitivity. Recognition of these individual categories is necessary to achieve agreement among physicians and to promote further targeted research.