High frequency of mental fatigue after treatment of graves

Cathrin Andersson; Karin Tammelin; Agneta Lindo; Mats Holmberg; Nystrom Helena Filipsson

doi:10.1530/endoabs.101.PS1-08-03

PS1-08-03

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Endocrine Abstracts (2024) 101 PS1-08-03 | DOI: 10.1530/endoabs.101.PS1-08-03

ETA2024 Poster Presentations Hyperthyroidism (9 abstracts)

High frequency of mental fatigue after treatment of graves’ hyperthyroidism but low rate of sick-leave – report from a longitudinal cohort in sweden

Cathrin Andersson ¹ , Karin Tammelin ² , Agneta Lindo ³ , Mats Holmberg ⁴ & Helena Filipsson Nyström ⁵

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¹Praktikertjänst, Wallenberg’s Centre of Molecular and Translational Medicine, Region Västra Götaland, Sweden, Department of General Medicin, Region Västra Götaland, Ytterby, Sweden; ²Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden, Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden, Gothenburg, Sweden; ³Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden, Department of Endocrinology, Sahlgrenska University Hospital Gothenburg, Gothenburg, Sweden; ⁴Anova, Karolinska University Hospital, Stockholm, Sweden, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Anova, Karolinska University Hospital, Stockholm, Sweden; ⁵Department of Endocrinology, Inst of Medicine, Sahlgrenska Academ, University of Gothenburg, Göteborg, Sweden

Objective: Mental fatigue (MF) is part of the concept of mental illness but is poorly established. Pathological MF occurs in many diseases and greatly reduces both quality of life (QoL) and work capacity. In Graves’ disease (GD) that often affects women of working age, about 40% of patients show MF after the acute symptoms have been treated. MF can occur alone, but also in combination with depression or anxiety and women are more than twice as likely as men to be on long-term sick leave with a mental health diagnosis. In MF, life adjustments are needed, but the effect of MF on sick leave and work function in GD is poorly studied. In Sweden, sick-leave is reimbursed from the authority Swedish Social Insurance Agency.

Methods: In a cohort of GD patients (n = 127) from the CogThy and ImmunoGraves (IG) studies, patients were evaluated at diagnosis in hyperthyroidism and after 15 months of treatment for sick-leave, MF using the MF scale (MFS), anxiety, depression and clinical activity score (CAS).

Results: At debut 41.1% were on sick leave but 74.8% had MFS >10 indicating MF. Of those that were initially on sick leave 92% had MF. At 15 months (n = 105) 40.0% had MF but only 3.9% were on sick leave. All these patients had MF at the start of treatment. CAS did not differ between MF and non-MF groups at any occasion. The CogThy included premenopausla women with high FT4 (FT4<50 pmol/l) but the frequency of persistent MF did not differ from the IG study, which included men and women aged 18-65 with overt GD, 39.6% vs 49.4%, respectively.

Conclusion: MF was frequent at follow-up, as we have reported before. Despite its strong correlation to work ability most patients actually worked. Internationally reports on GD patients report a significant number of patients are long-term disabled and many change work. Our result may indicate problems for our patients to have MF approved by the Swedish Social Insurance Agency, as also witnessed by some patients, as MF is not an established complication to MF yet. MF in GD patients needs to visualised and our findings needs further evaluation.