title: Hashimoto's thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter.
abstract: BACKGROUND
  Hashimoto's thyroiditis (HT) is a common disease, and is the most prevalent cause of hypothyroidism. Symptoms and diseases associated with HT are considered to be caused by hypothyroidism. We hypothesized that higher antithyroperoxidase (anti-TPO) antibody levels would be associated with an increased symptom load and a decreased quality of life in a female euthyroid patient collective.
  
  
  METHODS
  In a prospective cohort study 426 consecutive euthyroid female patients undergoing thyroid surgery for benign thyroid disease were included. Main outcome measures were preoperative anti-TPO levels, a symptom questionnaire and the SF-36 questionnaire, and lymphocytic infiltration of the thyroid tissue as evaluated by histology.
  
  
  RESULTS
  Histology revealed HT in 28/426 (6.6%) subjects. To maximize the sum of the predictive values, a cut-off point for anti-TPO of 121.0 IU/mL was calculated (sensitivity 93.3% [95% confidence interval: 77.9%-99.0%]; specificity 94.7% [95% confidence interval: 92.0%-96.7%]) to predict the presence of histological signs of HT. The mean number of reported symptoms was significantly higher in patients with anti-TPO levels >121.0 IU/mL than in the other group (6.7 ± 2.5 vs. 4.1 ± 2.8; p < 0.001). There were no differences in preoperative thyroid-stimulating hormone levels (1.7 ± 1.3 vs. 1.5 ± 1.4 μU/mL, respectively; p = 0.155). Chronic fatigue, dry hair, chronic irritability, chronic nervousness, a history of breast cancer and early miscarriage, and lower quality-of-life levels were significantly associated with anti-TPO levels exceeding the cut-off point (p < 0.05).
  
  
  CONCLUSIONS
  Women with HT suffer from a high symptom load. Hypothyroidism is only a contributing factor to the development of associated conditions.
authors.affiliation: Department of Surgery, Kaiserin Elisabeth Spital, Vienna, Austria. johannes.ott@meduniwien.ac.at
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
authors.forename: Regina
authors.initials: R
authors.lastname: Promberger
authors.forename: Friedrich
authors.initials: F
authors.lastname: Kober
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Neuhold
authors.forename: Maria
authors.initials: M
authors.lastname: Tea
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Huber
authors.forename: Michael
authors.initials: M
authors.lastname: Hermann
mesh_terms: D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D001007:Anxiety / Q000209:etiology; D016022:Case-Control Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006042:Goiter / Q000601:surgery*; D050031:Hashimoto Disease / Q000150:complications*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007037:Hypothyroidism / Q000150:complications*; D007453:Iodide Peroxidase / Q000276:immunology*; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D013965:Thyroidectomy
chemical_list: D000888:Antibodies, Anti-Idiotypic; D007453:Iodide Peroxidase