Jesper Karmisholt1,2, Stig Andersen3,2. 1. Department of Medical Endocrinology, Aalborg University Hospital, Aalborg, Denmark. 2. Clinical Institute, Aalborg University, Aalborg, Denmark. 3. Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark.
Abstract
Guidelines suggest that subclinical hypothyroid (SCH) patients with thyrotropin (TSH) between 4 and 10 mU/L and symptoms associated with hypothyroidism should receive L-T4 substitution treatment, be evaluated, and continue treatment if symptoms subside. The latter requires detecting a true change in symptoms, which can be calculated from within-person variation in symptom evaluation tools. This led us to assess within-person variation in hypothyroid symptoms, in mood-related symptoms, and quality of life in patients with untreated SCH in order to support the recommended evaluations. METHOD: The within-person coefficient of variation (CV) was estimated from 13 consecutive monthly evaluations in 15 patients with initial TSH between 5 and 12 mU/L and no trend in TSH. RESULTS: The within-person CV was rather large for the Hospital Anxiety and Depression Scale (HADS) and Zulewski hypothyroid score at 41.6 and 60.9%, respectively. For quality of life the within-person CV was lower at 8.0% for the physical component summary and 8.7% for the mental component summary from the SF-36 questionnaire. The difference required between two measurements to detect a true change was 97% for mood-related symptoms (HADS) and 140% for hypothyroid symptoms. For quality of life (SF-36) the required difference was 20%. CONCLUSION: Score differences of almost 100% and higher were required to support a true change in mood (HADS) and hypothyroid symptom scores in untreated SCH patients. For quality of life a true change was detected at a 20% difference in SF-36 scores. The hypothyroid score and HADS questionnaire do not seem useful for the evaluation of individuals.
Guidelines suggest that subclinical hypothyroid (SCH) patients with thyrotropin (TSH) between 4 and 10 mU/L and symptoms associated with hypothyroidism should receive L-T4 substitution treatment, be evaluated, and continue treatment if symptoms subside. The latter requires detecting a true change in symptoms, which can be calculated from within-person variation in symptom evaluation tools. This led us to assess within-person variation in hypothyroid symptoms, in mood-related symptoms, and quality of life in patients with untreated SCH in order to support the recommended evaluations. METHOD: The within-person coefficient of variation (CV) was estimated from 13 consecutive monthly evaluations in 15 patients with initial TSH between 5 and 12 mU/L and no trend in TSH. RESULTS: The within-person CV was rather large for the Hospital Anxiety and Depression Scale (HADS) and Zulewski hypothyroid score at 41.6 and 60.9%, respectively. For quality of life the within-person CV was lower at 8.0% for the physical component summary and 8.7% for the mental component summary from the SF-36 questionnaire. The difference required between two measurements to detect a true change was 97% for mood-related symptoms (HADS) and 140% for hypothyroid symptoms. For quality of life (SF-36) the required difference was 20%. CONCLUSION: Score differences of almost 100% and higher were required to support a true change in mood (HADS) and hypothyroid symptom scores in untreated SCH patients. For quality of life a true change was detected at a 20% difference in SF-36 scores. The hypothyroid score and HADS questionnaire do not seem useful for the evaluation of individuals.
Authors: Joseph G Hollowell; Norman W Staehling; W Dana Flanders; W Harry Hannon; Elaine W Gunter; Carole A Spencer; Lewis E Braverman Journal: J Clin Endocrinol Metab Date: 2002-02 Impact factor: 5.958
Authors: Lily L Somwaru; Alice M Arnold; Neha Joshi; Linda P Fried; Anne R Cappola Journal: J Clin Endocrinol Metab Date: 2009-01-06 Impact factor: 5.958