Diagnosis and Treatment of Thyroid Disorders

Diagnosis and Treatment

There are many challenges to the diagnosis and treatment of thyroid disorders. In addition to the lack of patient information and support, the treatment for thyroid disorders seems to be still a work in progress, with conflicting evidence on the ‘right’ dose of thyroxin, the ‘right’ levels of TSH, which lab tests matter, the relationship between lab values and symptoms and different symptom scales.

There is a gap between health care provider knowledge about outcomes and patient expectations regarding outcomes. Few doctors know that thyroid disorders results in poorer quality of life for some patients and consequently few patients know this. This is partly due to the lack of research on patient quality of life up until recently.

Recent studies report lower quality of life or general health among people with thyroid conditions compared to the normal population. ^{[2, 3, 4, 6, 7]} This is true for patients with normal TSH levels. ^[2,]

There are conflicting studies on whether clinical symptoms and/or quality of life are related to TSH levels and/or T4 levels.^{[1, 2, 3, 4]} In the study by Watt in 2006, there were no difference in 25-50 mcg changes in dosage of T4 in any dimension of quality of life or self-reported health status even though TSH levels dropped or increased as a result of change in dosage. TSH levels were all within the range of .07-3.17. The mean dose of T4 was 103 for the low dose group, 127 for the mid range group and 157 for the high dose group. The study period was 8 weeks for each dosage. The study did not test the effect of changes on TSH levels outside of the normal range. What this study suggests that 'tweaking' the dose of T4 to levels within the normal range will have no impact on patient well being.

Another study showed no difference in self-reported health between patients with subclinical hypothyroidism treated with thyroxin vs. placebo except the group treated with T4 found their clothes were looser and subjects with TSH above the normal range were less likely to report being tired. ^[8]

REFERENCES

1. Walsh, J. P., Ward, L. C., Burke, V., Bhagat, C. I., et al. (2006) Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being, or quality of life: results of a double-blind, randomized clinical trial. J Clin Endocrinol Metab. 91(7): p. 2624-2630 http://jcem.endojournals.org/cgi/content/full/91/7/2624

2. Saravanan, P., Chau, W. F., Roberts, N., Vedhara, K., et al. (2002) Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf). 57(5): p. 577-585 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12390330

3. Wekking, E. M., Appelhof, B. C., Fliers, E., Schene, A. H., et al. (2005) Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. European journal of endocrinology / European Federation of Endocrine Societies. 153(6): p. 747-753 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16322379

4. Abraham-Nordling, M., Torring, O., Hamberger, B., Lundell, G., et al. (2005) Graves' disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid. 15(11): p. 1279-1286 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16356093

5. Watt, Torquil, Groenvold, Mogens, Rasmussen, Ase Krogh, Bonnema, Steen Joop, et al. (2006) Quality of life in patients with benign thyroid disorders. A review. European journal of endocrinology / European Federation of Endocrine Societies. 154(4): p. 501-510 http://www.eje-online.org/cgi/content/abstract/154/4/501

6. Abraham-Nordling, M., Wallin, G., Lundell, G., Torring, O. (2007) Thyroid hormone state and quality of life at long-term follow-up after randomized treatment of Graves' disease. European journal of endocrinology / European Federation of Endocrine Societies. 156(2): p. 173-179 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17287406

7. Elberling, T. V., Rasmussen, A. K., Feldt-Rasmussen, U., Hording, M., et al. (2004) Impaired health-related quality of life in Graves' disease. A prospective study. European journal of endocrinology / European Federation of Endocrine Societies. 151(5): p. 549-555

8. Jorde, R., Waterloo, K., Storhaug, H., Nyrnes, A., et al. (2006) Neuropsychological function and symptoms in subjects with subclinical hypothyroidism and the effect of thyroxine treatment. J Clin Endocrinol Metab. 91(1): p. 145-153 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16263815

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