Endocrine Abstracts

Background: A significant percentage of patients with adequately replaced primary hypothyroidism (PH) continue to be symptomatic. Some of these persisting symptoms maybe attributed to non-restoration of neurocognitive functions and psychological well-being.

Objectives: To estimate the prevalence of persisting hypothyroid symptoms in patients with PH on biochemically adequate replacement therapy. To correlate persistent symptoms with thyroid hormone levels, psychological distress scores and anti-thyroid peroxidase (TPO) antibody levels.

Methodology: Consequent adult patients (18–60 years), with PH, on replacement therapy and having achieved biochemical euthyroidism were enrolled in the study after informed consent. They were assessed for ongoing symptoms of hypothyroidism and psychological distress using three validated questionnaires i.e. Thyroid Symptom Questionnaire (TQ18), General Health Questionnaire (GHQ) and Hospital Anxiety and Depression (HAD) inventory. Serum was sampled on the same day for Free T4, Free T3, thyroid-stimulating hormone (TSH) assessments and for anti-TPO antibody titers.

Results: One hundred and seventeen patients (F: 102, M: 15, mean age 41years) diagnosed with PH were recruited. TQ18 scores revealed that 32 (27.3%) patients continued to be symptomatic despite biochemical euthyroidism. FT3, FT4 and TSH levels failed to reveal any significant correlation (P-0.18, P-0.96, P-0.54 respectively) with TQ18 scores whereas TPO antibodies titres were significantly correlated with TQ18 scores (P-0.008). HAD scores suggested that 27 (23%) patients had anxiety and 32 (27.3%) patients were depressed. Anti-TPO antibody titers and FT4 values had significant correlation with anxiety (P-0.008 & P-0.01) while depression was correlated only with elevated antibody titres only (P-0.02).

Conclusions: One in four patients with adequately replaced PH continue to be symptomatic. Symptom scores were significantly correlated with higher thyroid antibody titres but not with thyroid hormone levels. Psychological distress scores were correlated with lower FT4 levels and with higher antibody titres.