CoChat
Sign Up
Cited by 27Psychosomatic Disorders and Their TreatmentsThyroid Disorders and TreatmentsFibromyalgia and Chronic Fatigue Syndrome Research

Hypothyroidism and somatization: results from E-Mode patient self-assessment of thyroid therapy, a cross-sectional, International Online Patient Survey

Open access
Perros, Petros, Nagy, Endre Vezekenyi, Papini, Enrico, Van Der Feltz-Cornelis, Christina Maria, Weetman, Anthony Peter, Hay, Harriet Alexandra, Abad-Madroñero, Juan, Tallett, Amy Johanna +4 more·2023·Thyroid
DOI 10.1089/thy.2022.0641
Open this paper in CoChat — free account

Abstract

Background: Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained persistent symptoms can be a sign of somatization. This is associated with distress and high health care resource use and can be classified as somatic symptom disorder (SSD). Prevalence rates for SSD differ depending on classification criteria and how they are ascertained, varying between 4% and 25%. As this has not been studied in hypothyroid patients before, the aim of this study was to document somatization in people with hypothyroidism and to explore associations with other patient characteristics and outcomes. Methods: Online, multinational cross-sectional survey of individuals with self-reported, treated hypothyroidism, which included the validated Patient Health Questionnaire-15 (PHQ-15) for assessment of somatization. Chi-squared tests with the Bonferroni correction were used to explore outcomes for respondents with a PHQ-15 score ≥10 (probable somatic symptom disorder [pSSD]) versus a PHQ-15 score <10 (absence of SSD). Results: A total of 3915 responses were received, 3512 of which contained the valid PHQ-15 data (89.7%). The median score was 11.0 (range 0–30 [confidence interval 10.9–11.3]). The prevalence of pSSD was 58.6%. Associations were found between pSSD and young age ( p < 0.001), women ( p < 0.001), not working ( p < 0.001), having below average household income ( p < 0.001), being treated with levothyroxine (LT4) (rather than combination of LT4 and L-triiodothyronine [LT3], LT3 alone, or desiccated thyroid extract) ( p < 0.001), expression of the view that the thyroid medication taken did not control the symptoms of hypothyroidism well ( p < 0.001), and with number of comorbidities ( p < 0.001). pSSD was associated with respondent attribution of most PHQ-15 symptoms to the hypothyroidism or its treatment ( p < 0.001), dissatisfaction with care and treatment of hypothyroidism ( p < 0.001), a negative impact of hypothyroidism on daily living ( p < 0.001), and with anxiety and low mood/depression ( p < 0.001). Conclusions: This study demonstrates a high prevalence of pSSD among people with hypothyroidism and associations between pSSD and negative patient outcomes, including a tendency to attribute persistent symptoms to hypothyroidism or its treatment. SSD may be an important determinant of dissatisfaction with treatment and care among some hypothyroid patients.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1089/thy.2022.0641

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Complaints of persistent symptoms in patients with normal TSH may be due to concomitant comorbidities, psychosocial factors, and/or unrealistic expectations toward LT4 treatment.

    “These complaints may be due to concomitant comorbidities, psychosocial factors and/or unrealistic expectations toward LT4 treatment (8).”

    From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [8]

    The Introduction (page unavailable) lists comorbidities and factors related to symptom perception as possible contributors to persistent symptoms, while noting that direct evidence is unavailable. The Discussion (page unavailable) suggests some patients may mistakenly believe thyroid medication should control all their symptoms, but it does not establish unrealistic expectations of LT4 as a cause. The survey also lacked thyroid biochemical data, so its findings cannot be confined to patients with normal TSH. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 86 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Perros, 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., Poots, A. J., & Hegedüs, L.
Affiliations
  • Royal Victoria Infirmary (GB)
  • University of Debrecen (HU)
  • Ospedale Regina Apostolorum (IT)
  • Department of Health Sciences, HYMS, University of York, York, United Kingdom.
  • University of Sheffield (GB)
  • Picker Institute Europe (GB)
  • Thyroid Federation International, Transpolispark, Hoofddorp, The Netherlands.
  • Department of Endocrinology, Odense University Hospital, Odense, Denmark.
Corresponding author
Perros, Petros
ORCID
Venue
Thyroid
Publisher
SAGE Publications
Published
2023-08
Volume
33
Issue
8
Pages
927-939
ISSN
  • 1050-7256 (ISSN-L)
  • 1557-9077
DOI
10.1089/thy.2022.0641
OpenAlex
W4367840789
Cited by
27
References
86
Citations by year
2026: 1 · 2025: 11 · 2024: 9 · 2023: 6
FWCI
5.50
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Thyroid (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords
hypothyroidism, somatization, somatic symptom disorder, levothyroxine, thyroid hormone replacement, patient satisfaction, treatment dissatisfaction, comorbidities, socioeconomic factors, PHQ-15, prevalence, symptom attribution, quality of life, health care utilization, patient self-assessment, online surveys
MeSH terms
Medically Unexplained Symptoms, Cross-Sectional Studies, Female, Humans, Hypothyroidism, Self-Assessment, Thyroxine, Triiodothyronine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review