Endocrine Abstracts

Objectives: Quality of life (QoL) is severely affected in Graves’ disease (GD) but long-term longitudinal assessment of QoL is lacking. Furthermore, whether QoL is comparable to controls after treatment of GD is unclear. For the first time, we present serial, longitudinal data on thyroid-related QoL during 24 months of follow-up in a cohort of newly diagnosed GD patients. In addition, we compare QoL in GD and controls.

Methods: All patients were treated with anti-thyroid medication according to standard care. QoL was assessed on eight occasions using the highly validated, disease-specific ThyPRO-39 questionnaire (score 0–100, higher worse). Patients were excluded from analysis in case of relapse. A matched euthyroid control group (n = 55) also completed ThyPRO-39. All patients were enrolled in the DAGMAR study (clinicaltrial.gov NCT02384668) a randomized double-blind trial on effects of vitamin D (70 mg/d) vs placebo on the clinical course of GD. Longitudinal data were analyzed in the entire cohort using linear mixed modeling with time, intervention group (vitamin D or placebo) and their interaction term. Changes in QoL-scores are reported as the main effect of time. A ‘large’ change has previously been defined as >16 points difference in score. The QoL scores of placebo treated GD and controls (one assessment) were compared using Wilcoxon ranksum test.

Results: Eighty-six hyperthyroid GD-patients (86% females, mean age 41 ± 14) were enrolled. Baseline QoL scores were 50 ± 19 and 47 ± 19 on the Hyperthyroid Symptoms and the Composite QoL Scales. Compared to baseline scores, ‘large’ improvements were observed at six weeks on Hyperthyroid Symptoms, Tiredness, Impaired Daily Life, Composite QoL and Emotional Susceptibility Scales, whereas Cognitive Complaints showed large improvement at six months. Significant improvements of QoL beyond six months were observed on the Hyperthyroid Symptoms, Tiredness, and Composite QoL Scales. Vitamin D supplementation did not improve QoL. Compared to the controls, the QoL scores among the GD patients remained significantly worse at every assessments for the Hyperthyroid Symptoms, Tiredness and Cognitive Complaints Scales. For the Impaired Daily Life and Emotional Susceptibility Scales, QoL scores remained worse until six months.

Conclusion: These novel data demonstrate that despite marked and early improvement of QoL with anti-thyroid treatment, QoL impairments in GD were prolonged, albeit improved beyond 6 months of treatment. Importantly, compared to controls GD patients have worse mental QoL for as long as 6 or even 24 months after diagnosis, despite being euthyroid and/or in remission.