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Psychological well‐being in patients on ‘adequate’ doses of l‐thyroxine: results of a large, controlled community‐based questionnaire study
Abstract
Summary: objective Over 1% of the UK population is receiving thyroid hormone replacement with l‐thyroxine (T4). However, many patients complain of persistent lethargy and related symptoms on T4 even with normal TSH levels. To date there has been no large study to determine whether this is related to thyroxine replacement or coincidental psychological morbidity. We have therefore attempted to address this issue using a large, community‐based study. design and patients Computerized prescribing records of five general practices were used to identify 961 patients who had been on thyroxine for a minimum of 4 months from a population of 63 000 (1·5%), along with age‐ and sex‐matched controls. All 1922 individuals were sent a two‐page questionnaire, made up of the short form of the General Health Questionnaire (GHQ‐12), designed to detect minor psychiatric disorders in the community, and a 12‐question ‘thyroid symptom questionnaire’ (TSQ) in the same format. A covering letter explained that we were interested in ‘how patients felt on medication’ and made no direct reference to thyroxine. measurements Scores from the GHQ and TSQ were marked for each individual using the GHQ and Likert scoring methods. Patients’ latest TSH measurements were obtained from laboratory records. Comparisons were then made on scores for the total GHQ‐12, TSQ and individual questions between patients (P) and control (C) groups. Separate analyses were made comparing the patients with a normal TSH (nP) and the control group. results Five hundred and ninety‐seven (62%) of the patients (P) and 551 (57%) of the controls (C) responded and fully completed at least one of the two questionnaire. Three hundred and ninety‐seven responding patients (nP) had a TSH estimation performed in the previous 12 months with the last result being in the local laboratory normal range for TSH (0·1–5·5 or 0·2–6·0 mU/l, according to the assay method used). The responding P, nP and C populations were well matched for age (59·96, 59·73, 59·35 years) and sex (85%, 83%, 87% female). The number of individuals scoring 3 or more on the GHQ‐12 (indicating ‘caseness’) was 21% higher in P than C [185/572 (32·3%) vs. 137/535 (25·6%), P = 0·014] and 26% higher in nP than C [131/381 (34·4%) vs. 137/535 (25·6%), P < 0·005]. Stronger differences were seen with the TSQ scores [C = 187/535 (35·0%), P = 273/583 (46·8%), P < 0·001, P vs. C; and nP = 189/381 (48·6%), P < 0·001, nP vs. C]. Differences existed in chronic drug use and chronic disease prevalence between the control and patient groups, but the differences in GHQ and TSQ scores between the groups remained significant even after correction for these factors as well as age and sex in multiple regression analysis. conclusions This community‐based study is the first evidence to indicate that patients on thyroxine replacement even with a normal TSH display significant impairment in psychological well‐being compared to controls of similar age and sex. In view of the large numbers of people on thyroxine replacement, we believe that these differences, although not large, could contribute to significant psychological morbidity in a substantial number of individuals.
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In the citing paper
“Patients on levothyroxine display ongoing substantial impairment of psychological wellbeing compared with controls of similar age and sex.165”
From Hypothyroidism (2024) · cites this paper as [165]
In the citing paper
“Persistent symptoms in patients treated for hypothyroidism are common.”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [4]
In the citing paper
“a proportion of individuals have significant dissatisfaction with it, including ongoing significant impairment in psychological well -being compared to controls of similar age and sex. 4 -8”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [4]
In the citing paper
“There is now a consensus that a fraction of the LT4-treated hypothyroid patients with normal serum TSH levels remains symptomatic ( 6 , 7 , 23 , 24 ).”
From Comparative Effectiveness of Levothyroxine, Desiccated Thyroid Extract, and Levothyroxine+Liothyronine in Hypothyroidism (2021) · cites this paper as [6]
In the citing paper
“For some patients, however, the success story was limited by the persistence of residual cognitive symptoms and decrements in the quality of life (5–7).”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [5]
In the citing paper
“However, a minority of the patients remain symptomatic despite the normalization of serum thyrotropin levels.”
From Emerging Therapies in Hypothyroidism (2024) · cites this paper as [5]
In the citing paper
“Limiting the analysis to patients with serum TSH in a narrow normal range (0.4-4.0 mU/l) gave similar outcomes: caseness was 35.1% in GHQ-12 and 48.5% in TSQ.”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [11]
In the citing paper
“After correction for age, sex, chronic diseases and chronic medication, the proportion of caseness was higher in patients than in controls, both in the GHQ-12 (34.4 vs. 25.6%,p = 0.012, odds ratio (OR) 1.48 [1.09-2.00])and in the TSQ (48.6 vs. 35.0%,p ! 0.001, OR 1.71 [1.29-2.25]).”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [11]
In the citing paper
“After correction for age, sex, chronic diseases and chronic medication, the proportion of caseness was higher in patients than in controls, both in the GHQ-12 (34.4 vs. 25.6%,p = 0.012, odds ratio (OR) 1.48 [1.09-2.00])and in the TSQ (48.6 vs. 35.0%,p ! 0.001, OR 1.71 [1.29-2.25]).”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [11]
In the citing paper
“The study provided evidence that patients on L-T4 replacement even with a normal serum TSH display significant impairment of psychological well-being compared to controls of similar age and sex.”
From 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism (2012) · cites this paper as [11]
In the citing paper
“However, a proportion of individuals continue to suffer with symptoms despite achieving adequate biochemical correction.”
From Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee (2016) · cites this paper as [22]
In the citing paper
“Approximately 10%–15% of subjects with hypothyroidism on L-thyroxine (LT4) alone have persistent symptoms affecting their quality of life (QoL).”
In the citing paper
“Hypothyroid subjects on long-term LT4 alone have (a) a 15% excess of psychological caseness (5)”
In the citing paper
“We observed that in individuals on LT4 alone (n = 573), homozygosity for the Thr92Ala polymorphism was associated with reduced QoL (5).”
Citations
Cites
The Validity of Two Versions of the GHQ in the WHO Study of Mental Illness in General Health Care
GOLDBERG, D. P., GATER, R., SARTORIUS, N., USTUN, T. B., PICCINELLI, M., GUREJE, O., & RUTTER, C. (1997) · Psychological Medicine · doi:10.1017/s0033291796004242 · Cited by 3,657
The detection of psychiatric illness by questionnaire
Levy, R. (1973) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(73)90039-1 · Cited by 2,707
THE SPECTRUM OF THYROID DISEASE IN A COMMUNITY: THE WHICKHAM SURVEY
Tunbridge, W. M. G., Evered, D. C., Hall, R., Appleton, D. R., BREWIS, M., CLARK, F., Evans, J. G., Young, E. T., Bird, T., & Smith, P. (1977) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1977.tb01340.x · Cited by 2,665
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.7.979 · Cited by 1,485
The use of the General Health Questionnaire as an indicator of mental health in occupational studies
Banks, M. H., Clegg, C., Jackson, P. R., Kemp, N. J., Stafford, E. M., & Wall, T. D. (1980) · Journal of Occupational Psychology · doi:10.1111/j.2044-8325.1980.tb00024.x · Cited by 690
Andersen, S., Pedersen, K. M., Bruun, N. H., & Laurberg, P. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8165 · Cited by 686
Larsen, P. R., Silva, J. E., & Kaplan, M. M. (1981) · Endocrine Reviews · doi:10.1210/edrv-2-1-87 · Cited by 546
Identification of a tHyroid Hormone Receptor That Is Pituitary-Specific
Hodin, R. A., Lazar, M. A., Wintman, B. I., Darling, D. S., Koenig, R. J., Larsen, P. R., Moore, D. D., & Chin, W. W. (1989) · Science · doi:10.1126/science.2539642 · Cited by 486
Bunevičius, R., Kažanavičius, G., Žalinkevičius, R., & Prange, A. J. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902113400603 · Cited by 482 · cited 3×
“Relative hypothyroidism on T4 therapy titrated to a normal TSH would also be consistent with the observation that additional T4 (Carr et al., 1988) or partial T3 supplementation (Bunevicius et al., 1999) results in increases in well-being.”
BackgroundMari, J. D. J., & Williams, P. R. (1985) · Psychological Medicine · doi:10.1017/s0033291700031500 · Cited by 469
Research works printed but not linked: 2
- Roberts N.D., 1996, Psychological problems in thyroid disease, British Thyroid Foundation Newsletter, 18, 3
- 10.1210/jc.82.3.771 · DOI
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Sorted by citations
Items 101–200 of 513
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Samuels, M. H. (2014) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2014.02.006 · Cited by 67
Dayan, C., & Panicker, V. (2018) · Thyroid Research · doi:10.1186/s13044-018-0045-x · Cited by 62
“However, even with these guidelines studies have shown that a high percentage of patients on T4 have serum TSH above the reference range, even those on for many years [2, 3, 47, 48].”
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Romitti, M., Tourneur, A., de Faria da Fonseca, B., Doumont, G., Gillotay, P., Liao, X.-H., Eski, S. E., Van Simaeys, G., Chomette, L., Lasolle, H., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-34776-7 · Cited by 64
McMillan, C., Bradley, C., Razvi, S., & Weaver, J. U. (2007) · Value in Health · doi:10.1111/j.1524-4733.2007.00232.x · Cited by 65
“professionals. Other symptom measures exist [ 9-14 ], usually designed specifically for a clinical trial”
BackgroundPerros, P., Van Der Feltz‐Cornelis, C., Papini, E., Nagy, E. V., Weetman, A. P., & Hegedüs, L. (2023) · Clinical Endocrinology · doi:10.1111/cen.14473 · Cited by 65
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Dayan, C. M., Saravanan, P., & Bayly, G. (2002) · The Lancet · doi:10.1016/s0140-6736(02)09602-2 · Cited by 61
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“Still, a significant number of patients complain of hypothyroidism-related symptoms and/or have persistent dissatisfaction with treatment (6,7).”
Pathophysiological relevance of deiodinase polymorphism
Bianco, A. C., & Kim, B. S. (2018) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/med.0000000000000428 · Cited by 59
Yalçın, M. M., Altınova, A. E., Cavnar, B., Bolayır, B., Aktürk, M., Arslan, E., Özkan, Ç., Çakır, N., & Törüner, F. B. (2017) · Endocrine Journal · doi:10.1507/endocrj.ej16-0418 · Cited by 60
Gender differences in symptoms of hypothyroidism: a population‐based DanThyr study
Carlé, A., Bülow Pedersen, I., Knudsen, N., Perrild, H., Ovesen, L., & Laurberg, P. (2015) · Clinical Endocrinology · doi:10.1111/cen.12787 · Cited by 59
Gning, I., Trask, P. C., Mendoza, T. R., Harle, M. T., Gutierrez, K. A., Kitaka, S. A., Sherman, S. I., & Cleeland, C. S. (2008) · Oncology · doi:10.1159/000178809 · Cited by 59
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Guglielmi, R., Grimaldi, F., Negro, R., Frasoldati, A., Misischi, I., Graziano, F., Cipri, C., Guastamacchia, E., Triggiani, V., & Papini, E. (2018) · Endocrine, Metabolic & Immune Disorders - Drug Targets · doi:10.2174/1871530318666180125155348 · Cited by 57
Lang, X., Hou, X., Shangguan, F., & Zhang, X. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.004 · Cited by 55
Joffe, R. T., Brimacombe, M., Levitt, A. J., & Stagnaro-Green, A. (2007) · Psychosomatics · doi:10.1176/appi.psy.48.5.379 · Cited by 57
Yaniv, D., Vainer, I., Amir, I., Robenshtok, E., Hirsch, D., Watt, T., Hilly, O., Shkedy, Y., Shpitzer, T., Bachar, G., et al. (2022) · Journal of Surgical Oncology · doi:10.1002/jso.26983 · Cited by 55
“The association between thyroid hormone deficiency, anxiety, and depression has been reported extensively.13 However, it was Saraven et al.14 in a community‐based study, who showed for the first time that patients on LT4 therapy and TSH levels within normal range have impaired psychological well‐being compared to a ma…”
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Banarjee, S. (2020) · Aggression and Violent Behavior · doi:10.1016/j.avb.2020.101384 · Cited by 54
Ward, L. S. (2010) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302010000500002 · Cited by 53
“However, nearly 10% of the patients are not satisfied and another important part of our patients is not well controlled and needs unusually high doses of thyroid hormone replacement (1).”
BackgroundTHERAPY OF ENDOCRINE DISEASE: T4 + T3 combination therapy: is there a true effect?
Wiersinga, W. M. (2017) · European Journal of Endocrinology · doi:10.1530/eje-17-0645 · Cited by 52
Leow, M. K.-S., & Goede, S. L. (2014) · Theoretical Biology and Medical Modelling · doi:10.1186/1742-4682-11-35 · Cited by 51
“However, this well established strategy has only recently been subject to scrutiny and critique due to many thyroid patients who persistently complained of residual symptoms despite being rendered ‘euthyroid’ according to the above criteria [4-8], an enigma that challenges the existing notion of what exactly is euthyr…”
BackgroundMethodInfluentialGroenewegen, K. L., Mooij, C. F., & van Trotsenburg, A. S. P. (2021) · Journal of Translational Autoimmunity · doi:10.1016/j.jtauto.2021.100101 · Cited by 49
Fatigue and fatigue-related symptoms in patients treated for different causes of hypothyroidism
Louwerens, M., Appelhof, B. C., Verloop, H., Medici, M., Peeters, R. P., Visser, T. J., Boelen, A., Fliers, E., Smit, J. W. A., & Dekkers, O. M. (2012) · European Journal of Endocrinology · doi:10.1530/eje-12-0501 · Cited by 50
Valdés, S., Maldonado‐Araque, C., Lago‐Sampedro, A., Lillo‐Muñoz, J. A., Garcia‐Fuentes, E., Perez‐Valero, V., Gutiérrez‐Repiso, C., Garcia‐Escobar, E., Goday, A., Urrutia, I., et al. (2017) · Obesity · doi:10.1002/oby.21796 · Cited by 50
“Furthermore, treating individuals with levothyroxine substantially reduces their T3:T4 ratio (40), and the consequences of these changes in the metabolism of individuals with obesity are currently unclear.”
BackgroundGraves’ disease: moving forwards
Lane, L. C., Wood, C. L., & Cheetham, T. D. (2022) · Archives of Disease in Childhood · doi:10.1136/archdischild-2022-323905 · Cited by 57
Kaplan, M. M., Sarne, D. H., & Schneider, A. B. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031436 · Cited by 50
“A survey conducted in Bristol, United Kingdom, attempted to determine the degree of dissatisfaction with T4 therapy (1).”
BackgroundHennessey, J. V., & Espaillat, R. (2018) · International Journal of Clinical Practice · doi:10.1111/ijcp.13062 · Cited by 49
Brain Fog in Hypothyroidism: What Is It, How Is It Measured, and What Can Be Done About It
Samuels, M. H., & Bernstein, L. J. (2022) · Thyroid · doi:10.1089/thy.2022.0139 · Cited by 58
Samuels, M. H., Kolobova, I., Smeraglio, A., Peters, D., Janowsky, J. S., & Schuff, K. G. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3686 · Cited by 48
Massolt, E. T., van der Windt, M., Korevaar, T. I. M., Kam, B. L. R., Burger, J. W., Franssen, G. J. H., Lehmphul, I., Köhrle, J., Visser, W. E., & Peeters, R. P. (2016) · Clinical Endocrinology · doi:10.1111/cen.13101 · Cited by 47
Psychological wellbeing in patients
Ladenson, P. W. (2002) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2002.01682.x · Cited by 46
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Wiersinga, W. M. (2009) · European Journal of Endocrinology · doi:10.1530/eje-09-0879 · Cited by 43
Health status in patients with sub-clinical hypothyroidism
Razvi, S., Ingoe, L. E., McMillan, C., & Weaver, J. U. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01907 · Cited by 45
Tariq, A., Wert, Y., Cheriyath, P., & Joshi, R. (2018) · Southern Medical Journal · doi:10.14423/smj.0000000000000823 · Cited by 43
Biondi, B., Bartalena, L., Chiovato, L., Lenzi, A., Mariotti, S., Pacini, F., Pontecorvi, A., Vitti, P., & Trimarchi, F. (2016) · Journal of Endocrinological Investigation · doi:10.1007/s40618-016-0511-z · Cited by 44
An, J. H., Kim, Y. J., Kim, K. J., Kim, S. H., Kim, N. H., Kim, H. Y., Kim, N. H., Choi, K. M., Baik, S. H., Choi, D. S., et al. (2016) · Endocrine Journal · doi:10.1507/endocrj.ej16-0109 · Cited by 44
Tan, B., Yuan, W., Li, J., Yang, P., Ge, Z., Liu, J., Qiu, C., Zhu, X., Qiu, C., Lai, D., et al. (2018) · Cytotherapy · doi:10.1016/j.jcyt.2018.04.001 · Cited by 37
Razvi, S., McMillan, C., & Weaver, J. U. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02381.x · Cited by 46
Combination L-T3 and L-T4 therapy for hypothyroidism
Wartofsky, L. (2013) · Current Opinion in Endocrinology, Diabetes & Obesity · doi:10.1097/01.med.0000432611.03732.49 · Cited by 42
“[9], who reported impaired psychological well-being in T4-treated hypothyroid patients with normal TSH levels.”
BackgroundPerceived Health Status of Women with Overt and Subclinical Hypothyroidism
Vigário, P. D. S., Teixeira, P. D. F. D. S., Reuters, V. S., Almeida, C., Maia, M., Silva, M., & Vaisman, M. (2009) · Medical Principles and Practice · doi:10.1159/000215731 · Cited by 43
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Salvatore, D., Porcelli, T., Ettleson, M. D., & Bianco, A. C. (2022) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(22)00004-3 · Cited by 44
Salazar, P. L., Cisternas, P., Codocedo, J. F., & Inestrosa, N. C. (2017) · Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease · doi:10.1016/j.bbadis.2017.01.002 · Cited by 44
Taylor, P. N., Panicker, V., Sayers, A., Shields, B., Iqbal, A., Bremner, A. P., Beilby, J. P., Leedman, P. J., Hattersley, A. T., Vaidya, B., et al. (2011) · European Journal of Endocrinology · doi:10.1530/eje-10-0938 · Cited by 41
Self-citationRoss, D. S. (2022) · Journal of Internal Medicine · doi:10.1111/joim.13410 · Cited by 42
Adjuvant rituximab—exploratory trial in young people with Graves disease
Cheetham, T. D., Cole, M. F., Abinun, M., Allahabadia, A., Barratt, T., Davies, J. H., Dimitri, P., Drake, A. J., Mohamed, Z., Murray, R. D., et al. (2022) · White Rose Research Online (University of Leeds, The University of Sheffield, University of York) · Cited by 42
Jonklaas, J., & Burman, K. D. (2016) · Thyroid® · doi:10.1089/thy.2015.0629 · Cited by 41
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Najafi, L., Malek, M., Hadian, A., Ebrahim Valojerdi, A., Khamseh, M. E., & Aghili, R. (2015) · Endocrine Research · doi:10.3109/07435800.2014.896924 · Cited by 41
Thyroid disease‐specific quality of life questionnaires ‐ A systematic review
Uslar, V., Becker, C., Weyhe, D., & Tabriz, N. (2022) · Endocrinology Diabetes & Metabolism · doi:10.1002/edm2.357 · Cited by 46
Brain Fog in Hypothyroidism: Understanding the Patient’s Perspective
Ettleson, M. D., Raine, A., Batistuzzo, A., Batista, S. P., McAninch, E., Teixeira, M. C. T. V., Jonklaas, J., Laiteerapong, N., Ribeiro, M. O., & Bianco, A. C. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2021.12.003 · Cited by 42
Hypothyroidism After a Cancer Diagnosis: Etiology, Diagnosis, Complications, and Management
Carter, Y. M., Sippel, R. S., & Chen, H. (2013) · The Oncologist · doi:10.1634/theoncologist.2013-0237 · Cited by 43
Persistent hypothyroid symptoms in a patient with a normal thyroid stimulating hormone level
Jonklaas, J. (2017) · Current Opinion in Endocrinology Diabetes and Obesity · doi:10.1097/med.0000000000000355 · Cited by 39
“9% of a control population using a Thyroid Symptom Questionnaire score of greater than 4 as a measure of dissatisfaction with therapy [7].”
Quinque, E. M., Karger, S., Arélin, K., Schroeter, M. L., Kratzsch, J., & Villringer, A. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2014.01.015 · Cited by 37
“It thus remains unclear where reported residual complaints result from (Saravanan et al., 2002; Wekking et al., 2005).”
BackgroundResultEmerging Therapies in Hypothyroidism
Bianco, A. C. (2024) · Annual Review of Medicine · doi:10.1146/annurev-med-060622-101007 · Cited by 36
Quinque, E. M., Villringer, A., Kratzsch, J., & Karger, S. (2013) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-11-68 · Cited by 36
Schoormans, D., Wijnberg, L., Haak, H. R., Husson, O., & Mols, F. (2020) · Head & Neck · doi:10.1002/hed.26290 · Cited by 36
Treatment of adult Graves’ disease
Corvilain, B., Hamy, A., Brunaud, L., Borson‐Chazot, F., Orgiazzi, J., Hachmi, L. B. S., Semrouni, M., Rodien, P., & Lussey‐Lepoutre, C. (2018) · Annales d Endocrinologie · doi:10.1016/j.ando.2018.08.003 · Cited by 36
“[115] Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Dayan CM.”
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Physical fatigability and muscle pain in patients with Hashimoto thyroiditis
Jordan, B., Uer, O., Buchholz, T., Spens, A., & Zierz, S. (2021) · Journal of Neurology · doi:10.1007/s00415-020-10394-5 · Cited by 35
“However, these symptoms sometimes consistently persist despite a euthyroid status while receiving hormone substitution [6, 12, 14, 19, 27].”
BackgroundAiraksinen, J., Komulainen, K., Velázquez, R. G., Määttänen, I., Gluschkoff, K., Savelieva, K., & Jokela, M. M. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152253 · Cited by 33
Combined T4 and T3 Therapy—Back to the Drawing Board
Cooper, D. S. (2003) · JAMA · doi:10.1001/jama.290.22.3002 · Cited by 35
Ahluwalia, R., Baldeweg, S. E., Boelaert, K., Chatterjee, K., Dayan, C., Okosieme, O., Priestley, J., Taylor, P., Vaidya, B., Zammitt, N., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14935 · Cited by 34
Self-citationTSH may not be a good marker for adequate thyroid hormone replacement therapy
Alevizaki, M., Mantzou, E., Cimponeriu, A. T., Alevizaki, C. C., & Koutras, D. A. (2005) · Wiener klinische Wochenschrift · doi:10.1007/s00508-005-0421-0 · Cited by 34
“the local conversion of T4. The amount of T3 provided in this way is believed to be adequate for full replacement treatment; however, there is much discussion of whether the current guidelines lead to satisfactory clinical results [ 2 , 3]. It is not known whether peripheral production of T3 from T4 can fully substitu…”
BackgroundTaylor, P. N., Sayers, A., Okosieme, O., Das, G., Draman, M. S., Tabasum, A., Abusahmin, H., Rahman, M., Stevenson, K., Groom, A., et al. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2016-3605 · Cited by 34
“Individuals on levothyroxine have a higher FT 4 and a lower FT 3 than euthyroid individuals despite having similar TSH levels (26 – 28).”
BackgroundSelf-citationThyroid hormone replacement: current status and challenges
Okosieme, O. E. (2011) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2011.600307 · Cited by 33
Molecular markers in the diagnosis of thyroid nodules
Ward, L. S., & Kloos, R. T. (2013) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302013000200001 · Cited by 34
Pharmacokinetics of L-Triiodothyronine in Patients Undergoing Thyroid Hormone Therapy Withdrawal
Van Tassell, B., Wohlford, G. F., Linderman, J. D., Smith, S., Yavuz, S., Pucino, F., & Celi, F. S. (2019) · Thyroid® · doi:10.1089/thy.2019.0101 · Cited by 31
Azizi, F. (2020) · Thyroid · doi:10.1089/thy.2019.0814 · Cited by 33
“Patients on levothyroxine (LT4) replacement may exhibit significant impairment in psychological well-being (18) and lower resting energy expenditure, compared with normal controls (19,20).”
Sustained release T3 therapy: animal models and translational applications
Idrees, T., Price, J. D., Piccariello, T., & Bianco, A. C. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00544 · Cited by 30
“In fact, these findings go along with the observation that non-objective symptoms of hypothyroidism remain in about 15–20% of the LT4-treated hypothyroid patients (difficulty with weight management, low energy, depressed mood, and memory impairment) despite achieving normal TSH and free T4 levels (26, 27).”
BackgroundThyroid Hormone Replacement Therapy: Three ‘Simple’ Questions, Complex Answers
Bianco, A. C., & Casula, S. (2012) · European Thyroid Journal · doi:10.1159/000339447 · Cited by 32
Regalbuto, C., Maiorana, R., Alagona, C., Paola, R. D., Cianci, M., Alagona, G., Sapienza, S., Squatrito, S., & PEZZINO, V. (2007) · Thyroid · doi:10.1089/thy.2006.0084 · Cited by 32
“In these patients psychological well-being often occurs at LT4 doses higher than required to normalize serum TSH levels (42,43), a situation that may result in adverse effects such as bone demineralization and atrial fibrillation.”
Rajput, R., & Pathak, V. (2017) · European Thyroid Journal · doi:10.1159/000477348 · Cited by 31
Morón-Díaz, M., Saavedra, P., Alberiche-Ruano, M. P., Rodríguez-Pérez, C. A., López-Plasencia, Y., Marrero, D., González-Lleó, A. M., & Boronat, M. (2020) · Endocrine · doi:10.1007/s12020-020-02449-4 · Cited by 31
The management and metabolic characterization: hyperthyroidism and hypothyroidism
Wang, Y., Sun, Y., Yang, B., Wang, Q., & Kuang, H. (2022) · Neuropeptides · doi:10.1016/j.npep.2022.102308 · Cited by 34
Medici, M., Visser, T. J., & Peeters, R. P. (2017) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2017.04.002 · Cited by 32
Genetic variation in thyroid hormone transporters
van der Deure, W. M., Peeters, R. P., & Visser, T. J. (2007) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2007.03.006 · Cited by 31
Exploring the Experiences of People With Hypo- and Hyperthyroidism
Nexø, M. A., Watt, T., Cleal, B. R., Hegedűs, L. D., Bonnema, S. J., Rasmussen, Å. K., Feldt‐Rasmussen, U., & Bjørner, J. B. (2014) · Qualitative Health Research · doi:10.1177/1049732314554093 · Cited by 32
“In addition, several studies have identified daily role limitations (Fahrenfort, Wilterdink, & van der Veen, 2000; Kahaly, Hardt, Petrak, & Egle, 2002; Saravanan et al., 2002) and difficulty maintaining employment (Nexø et al., 2014; Thvilum, Brandt, Brix, & Hegedus, 2014).”
BackgroundLong-Term Continuous Methimazole or Radioiodine Treatment for Hyperthyroidism
Azizi, F., Yousefi, V., Bahrainian, A., Sheikholeslam, F., Tohidi, M., & Mehrabi, Y. (2011) · The Endocrine Society eBooks · doi:10.1210/endo-meetings.2011.part2.p17.p1-682 · Cited by 30
Kraut, E., & Farahani, P. (2015) · Clinical and investigative medicine · doi:10.25011/cim.v38i6.26194 · Cited by 30
Identifying a Small Molecule Blocking Antigen Presentation in Autoimmune Thyroiditis
Li, C. W., Menconi, F., Osman, R., Mezei, M., Jacobson, E. M., Concepcion, E., David, C. S., Kastrinsky, D. B., Ohlmeyer, M. H. J., & Tomer, Y. (2015) · Journal of Biological Chemistry · doi:10.1074/jbc.m115.694687 · Cited by 32
Investigation of thyroid dysfunction is more likely in patients with high psychological morbidity
Bould, H., Panicker, V., Kessler, D., Durant, C., Lewis, G., Dayan, C., & Evans, J. (2012) · Family Practice · doi:10.1093/fampra/cmr059 · Cited by 29
Self-citationEscobar-Morreale, H. F., Botella-Carretero, J. I., & Morreale de Escobar, G. (2015) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2014.10.004 · Cited by 30
Risks and safety of combination therapy for hypothyroidism
Jonklaas, J. (2016) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2016.1182019 · Cited by 27
Thyroid–Brain Interactions in Neuropsychiatric Disorders
Bunevičius, R., & Prange, A. J. (2010) · Springer eBooks · doi:10.1007/978-4-431-53871-4_2 · Cited by 28
Wang, F., ZENG, X., Zhu, Y., NING, D., LIU, J., LIU, C., Jia, X., & Zhu, D. (2014) · Molecular Medicine Reports · doi:10.3892/mmr.2014.2825 · Cited by 28
“Clinical observations have suggested that neurocognitive functioning as well as psychological well-being may not be completely resolved in patients with hypothyroidism, despite T4 treatment (14-16).”
BackgroundInsulin Plant (Costus pictus) extract restores thyroid hormone levels in experimental hypothyroidism
Bobby, Z., Ashwini, S., Sridhar, M. G., & Cherupanakkal, C. (2017) · Pharmacognosy Research · doi:10.4103/0974-8490.199766 · Cited by 29
“Recent studies have reported that a significant number of hypothyroid patients on levothyroxine replacement therapy experience decreased neurocognitive function and lead poorer quality of life despite being biochemically euthyroid.[2,3] Clinically, it has been observed that since levothyroxine replacement therapy requ…”
BackgroundFatigue and quality of life among thyroid cancer survivors without persistent or recurrent disease
Maki, Y., Horiuchi, K., & Okamoto, T. (2022) · Endocrine Connections · doi:10.1530/ec-21-0506 · Cited by 31
“Some hypothyroid patients on levothyroxine monotherapy have a low serum fT3 level, and those with a normal serum TSH level were not necessarily euthyroid in terms of energy expenditure, lipid metabolism, dissatisfaction, or quality of life, including fatigue (38-40).”
BackgroundBagattini, B., Cosmo, C. D., Montanelli, L., Piaggi, P., Ciampi, M., Agretti, P., Marco, G. D., Vitti, P., & Tonacchera, M. (2014) · European Journal of Endocrinology · doi:10.1530/eje-14-0621 · Cited by 28
McMillan, C., Bradley, C., Razvi, S., & Weaver, J. U. (2006) · Value in Health · doi:10.1111/j.1524-4733.2006.00091.x · Cited by 28
“For example one study found that the number of individuals with significant impairment in psychological well-being was 21% higher in thyroxine-treated patients than euthyroid controls of similar age and sex, even though patients’ TSH levels were within the normal laboratory reference range [6].”
BackgroundPerros, P., Nagy, E. V., Papini, E., Van Der Feltz-Cornelis, C. M., Weetman, A. P., Hay, H. A., Abad-Madroñero, J., Tallett, A. J., Bilas, M., Lakwijk, P., et al. (2023) · Thyroid · doi:10.1089/thy.2022.0641 · Cited by 27
Roerink, S. H. P. P., Wagenmakers, M. A. E. M., Wessels, J. F., Sterenborg, R. B. T. M., Smit, J. W. A., Hermus, A. R. M. M., & Netea-Maier, R. T. (2014) · Pituitary · doi:10.1007/s11102-014-0583-8 · Cited by 27
“depressive symptoms [31].”
Forini, F., Nicolini, G., Pitto, L., & Iervasi, G. (2019) · Frontiers in Endocrinology · doi:10.3389/fendo.2019.00601 · Cited by 26
Samuels, M. H., Kolobova, I., Smeraglio, A., Niederhausen, M., Janowsky, J. S., & Schuff, K. G. (2016) · Thyroid® · doi:10.1089/thy.2016.0141 · Cited by 26
Weight Gain After Thyroidectomy: A Systematic Review and Meta-Analysis
Huynh, C., Pearce, J., Kang, L., & Celi, F. S. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa754 · Cited by 28
Lan, H., Wen, J., Mao, Y., Huang, H., Chen, G., & Lin, W. (2022) · Clinical Endocrinology · doi:10.1111/cen.14742 · Cited by 26
Taïeb, D., Bournaud, C., Eberlé, M., Catargi, B., Schvartz, C., Cavarec, M.-B., Faugeron, I., Toubert, M., Benisvy, D., Archange, C., et al. (2016) · European Journal of Endocrinology · doi:10.1530/eje-15-1099 · Cited by 25
Thyroid Hormone Replacement in Patients Following Thyroidectomy for Thyroid Cancer
Hannoush, Z. C., & Weiss, R. E. (2016) · Rambam Maimonides Medical Journal · doi:10.5041/rmmj.10229 · Cited by 30
Mood Disorders in Levothyroxine-Treated Hypothyroid Women
Romero-Gómez, B., Guerrero-Alonso, P., Carmona-Torres, J. M., Notario-Pacheco, B., & Cobo-Cuenca, A. I. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16234776 · Cited by 25
Treatment of congenital thyroid dysfunction: Achievements and challenges
Krude, H., Kühnen, P., & Biebermann, H. (2015) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2015.04.004 · Cited by 25
Parretti, H. M., Okosieme, O. E., & Vanderpump, M. P. J. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x687493 · Cited by 28
Long-term thionamide antithyroid treatment of Graves' disease
Azizi, F., Abdi, H., Amouzegar, A., & Moeini, A. S. H. (2022) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2022.101631 · Cited by 24
Metadata
- Authors
- Saravanan, P., Chau, W. ‐., Roberts, N., Vedhara, K., Greenwood, R., & Dayan, C. M.
- Affiliations
- Weston General Hospital (GB)
- Bristol Royal Infirmary (GB)
- University of Bristol (GB)
- Corresponding author
- Dayan, C. M.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2002-10-22
- Volume
- 57
- Issue
- 5
- Pages
- 577-585
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W1888479777
- Cited by
- 514
- References
- 33
- Citations by year
- 2026: 12 · 2025: 27 · 2024: 26 · 2023: 30 · 2022: 45 · 2021: 33 · 2020: 37 · 2019: 33 · 2018: 27 · 2017: 26 · 2016: 31 · 2015: 21 · 2014: 25 · 2013: 15 · 2012: 16
- FWCI
- 7.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- levothyroxine, thyroid hormone replacement, psychological well-being, thyroid symptoms, thyroid-stimulating hormone, psychiatric morbidity, lethargy, General Health Questionnaire, community-based study, adverse drug reactions, quality of life
- MeSH terms
- Adolescent, Adult, Aged, Drug Administration Schedule, Female, Humans, Hypothyroidism, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Thyrotropin, Thyroxine, Chi-Square Distribution, Case-Control Studies
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