title: Quality-of-Life Impairments Persist Six Months After Treatment of Graves' Hyperthyroidism and Toxic Nodular Goiter: A Prospective Cohort Study.
abstract: The treatment of hyperthyroidism is aimed at improving health-related quality of life (HRQoL) and reducing morbidity and mortality. However, few studies have used validated questionnaires to assess HRQoL prospectively in such patients. The purpose of this study was to assess the impact of hyperthyroidism and its treatment on HRQoL using validated disease-specific and generic questionnaires.
  
  
  
  This prospective cohort study enrolled 88 patients with Graves' hyperthyroidism and 68 with toxic nodular goiter from endocrine outpatient clinics at two Danish university hospitals. The patients were treated with antithyroid drugs, radioactive iodine, or surgery. Disease-specific and generic HRQoL were assessed using the thyroid-related patient-reported outcome (ThyPRO) and the Medical Outcomes Study 36-item Short Form (SF-36), respectively, evaluated at baseline and six-month follow-up. The scores were compared with those from two general population samples who completed ThyPRO (n = 739) and SF-36 (n = 6638).
  
  
  
  Baseline scores for patients with Graves' hyperthyroidism and toxic nodular goiter were significantly worse than those for the general population scores on all comparable ThyPRO scales and all SF-36 scales and component summaries. ThyPRO scores improved significantly with treatment on all scales in Graves' hyperthyroidism and four scales in toxic nodular goiter, while SF-36 scores improved on five scales and both component summaries in Graves' hyperthyroidism and only one scale in toxic nodular goiter. In Graves' hyperthyroidism, large treatment effects were observed on three ThyPRO scales (Hyperthyroid Symptoms, Tiredness, Overall HRQoL) and moderate effects on three scales (Anxiety, Emotional Susceptibility, Impaired Daily Life), while moderate effects were seen in two ThyPRO scales in toxic nodular goiter (Anxiety, Overall HRQoL). However, significant disease-specific and generic HRQoL deficits persisted on multiple domains across both patient groups.
  
  
  
  Graves' hyperthyroidism and toxic nodular goiter cause severe disease-specific and generic HRQoL impairments, and HRQoL deficits persist in both patient groups six months after treatment. These data have the potential to improve communication between physicians and patients by offering realistic estimates of expected HRQoL impairments and treatment effects. Future studies should identify risk factors for persistent HRQoL deficits, compare HRQoL effects of the various therapies, and thereby aid in determining the optimal treatment strategies.
authors.affiliation: 1 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark .
authors.forename: Per
authors.initials: P
authors.lastname: Cramon
authors.affiliation: 2 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark .
authors.forename: Kristian Hillert
authors.initials: KH
authors.lastname: Winther
authors.affiliation: 1 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark .
authors.forename: Torquil
authors.initials: T
authors.lastname: Watt
authors.affiliation: 2 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark .
authors.forename: Steen Joop
authors.initials: SJ
authors.lastname: Bonnema
authors.affiliation: 3 Department of Public Health, University of Copenhagen , Copenhagen, Denmark .|4 QualityMetric, Patient Insights, Optum, Lincoln, Rhode Island.
authors.forename: Jakob Bue
authors.initials: JB
authors.lastname: Bjorner
authors.affiliation: 5 National Institute of Public Health, University of Southern Denmark , Copenhagen, Denmark .
authors.forename: Ola
authors.initials: O
authors.lastname: Ekholm
authors.affiliation: 3 Department of Public Health, University of Copenhagen , Copenhagen, Denmark .|6 Department of Palliative Medicine, Bispebjerg University Hospital , Copenhagen, Denmark .
authors.forename: Mogens
authors.initials: M
authors.lastname: Groenvold
authors.affiliation: 2 Department of Endocrinology and Metabolism, Odense University Hospital , Odense, Denmark .
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hegedüs
authors.affiliation: 1 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark .
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.affiliation: 1 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark .
authors.forename: Åse Krogh
authors.initials: ÅK
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006044:Goiter, Nodular / Q000188:drug therapy* / Q000523:psychology; D006111:Graves Disease / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents