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Cited by 81Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryPatient Satisfaction in Healthcare

Patient satisfaction and quality of life in hypothyroidism: An online survey by the british thyroid foundation

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Mitchell, Anna L., Hegedüs, Laszlo, Žarković, Miloš, Hickey, Janis L., Perros, Petros·2021·Clinical Endocrinology
DOI 10.1111/cen.14340
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Abstract

Objective: Dissatisfaction with treatment and impaired quality of life (QOL) are reported among people with treated hypothyroidism. We aimed to gain insight into this. Design and patients: We conducted an online survey of individuals with self‐reported hypothyroidism. Results: Nine hundred sixty‐nine responses were analysed. Dissatisfaction with treatment was common (77.6%), and overall QOL scores were low. Patient satisfaction did not correlate with type of thyroid hormone treatment, but treatment with combination levothyroxine (L‐T4) and liothyronine (L‐T3) or with desiccated thyroid extract (DTE) was associated with significantly better reported QOL than L‐T4 or L‐T3 monotherapies (P < .001); however, multivariate analysis inclusive of other clinical parameters failed to confirm an association between type of thyroid hormone treatment and QOL or satisfaction. Multivariate analysis showed positive correlations between satisfaction and age (P = .026), male gender (P = .011), being under the care of a thyroid specialist (P < .001), family doctor (GP) prescribing DTE or L‐T4 + L‐T3 or L‐T3 (P < .001) and being well informed about hypothyroidism (P < .001); negative correlations were observed between satisfaction and negative experiences with L‐T4 (P < .001) and expectations for more support from the GP (P < .001), for L‐T4 to resolve all symptoms (P = .004), and to be referred to a thyroid specialist (P < .001). For QOL, positive correlations were with male gender (P = .011) and duration of hypothyroidism (P = .002); negative correlations were with age (P = .027), visiting the GP more than 3 times before diagnosis (P < .001), sourcing DTE or L‐T3 independently (P = .014), negative experiences with L‐T4 (P = .013), having expectations for L‐T4 to resolve all symptoms (P < .001) and of more support from the GP (P = .006). Conclusions: Multiple parameters including prior healthcare experiences and expectations influence satisfaction with hypothyroidism treatment and QOL. Focusing on enhancing the patient experience and clarifying expectations at diagnosis may improve satisfaction and QOL.

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  • Online surveys show that most patients have persistent symptoms despite liothyronine/levothyroxine or DTE therapy.

    “Online surveys show that most patients have persistent symptoms despite liothyronine/levothyroxine or DTE therapy. 63,64”

    From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [64]

    The survey’s treatment-group results (Table 2, page unavailable) show that most respondents taking levothyroxine/liothyronine or DTE were dissatisfied with treatment. But dissatisfaction is not the same as persistent symptoms: the paper does not report that most patients on either therapy had persistent symptoms. Its Introduction describes persistent symptoms in a minority of patients taking levothyroxine alone. (LLM, conf=0.86)

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  • In the UK online survey, satisfaction and QoL were not substantially different between users of LT4, T4+T3, and DTE.

    “It is surprising to find that the level of satisfaction and QoL were not substantially different between users of LT4, T4+T3, and DTE, suggesting that other determinants than the thyroid hormone preparation must play a role.”

    From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [43]

    The Comparisons between treatment groups section reports no difference in treatment satisfaction by thyroid hormone preparation. It also reports significantly higher unadjusted QoL scores for T4+T3 and DTE users than for LT4 users, so the claim omits an important qualification. The paper's later multivariate analysis found no association between preparation and either satisfaction or QoL after accounting for other factors (Author Manuscript; page unavailable). (LLM, conf=0.88)

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  • Both the US and UK online surveys of hypothyroid patients were prone to bias.

    “It should be emphasized that this online survey among treated hypothyroid patients was based on responses from a self-selected sample, unlikely to represent the whole United States population of hypothyroid patients, and therefore liable to multiple biases [40].”

    From T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity (2021) · cites this paper as [43]

    The paper’s limitations discussion (Author Manuscript; page not provided) says its UK survey used self-selected participants and likely overrepresented dissatisfied patients. It mentions a US online survey but does not establish that the US sample was self-selected or subject to the same biases; the US-specific part of the citing sentence is therefore unsupported by this source. (LLM, conf=0.86)

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  • The cause of ongoing symptoms and impaired quality of life are complex-even prediagnostic factors, such as pretreatment expectations and the number of visits to their general practitioner before diagnosis of hypothyroidism, might influence patients' treatment satisfaction.

    “The cause of ongoing symptoms and impaired quality of life are complex-even prediagnostic factors, such as pretreatment expectations and the number of visits to their general practitioner before diagnosis of hypothyroidism, might influence patients' treatment satisfaction.163”

    From Hypothyroidism (2024) · cites this paper as [163]

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  • Online surveys both in the United Kingdom and the United States show that most patients have persistent symptoms despite liothyronine/levothyroxine combination or DTE therapy.

    “online surveys both in the United Kingdom and the United States show that most patients have persistent symptoms despite liothyronine/levothyroxine combination or DTE therapy. 63,64”

    From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [64]

    The UK survey’s Table 2 (Additional information; page not available) shows that most respondents taking DTE (82.9%) or levothyroxine/liothyronine (69.4%) were dissatisfied with treatment. It does not establish that most in either group had persistent symptoms; dissatisfaction and persistent symptoms are not the same measure. This paper does not report a US survey. (LLM, conf=0.88)

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Authors
Mitchell, A. L., Hegedüs, L., Žarković, M., Hickey, J. L., & Perros, P.
Affiliations
  • Royal Victoria Infirmary (GB)
  • Department of Endocrinology Odense University Hospital Odense Denmark
  • University of Belgrade (RS)
  • British Thyroid Foundation (GB)
Corresponding author
Mitchell, Anna L.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2020-12-17
Volume
94
Issue
3
Pages
513-520
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.14340
OpenAlex
W3089042156
Cited by
81
References
51
Citations by year
2025: 10 · 2024: 11 · 2023: 16 · 2022: 22 · 2021: 18 · 2020: 4
FWCI
11.31
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
Keywords
hypothyroidism, patient satisfaction, quality of life, thyroid hormone replacement, levothyroxine, liothyronine, desiccated thyroid extract, combination thyroid hormone therapy, patient expectations, patient experience
MeSH terms
Humans, Hypothyroidism, Male, Quality of Life, Thyrotropin, Thyroxine, Triiodothyronine, Patient Satisfaction

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