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Medscape

Mental Health Drives Life Quality in Treated Hypothyroidism

In patients with primary hypothyroidism receiving a stable dose of levothyroxine, thyroid-dependent quality of life (QOL) was driven by psychological factors, including somatosensory amplification and depression, and body mass index (BMI), rather than by thyroid biomarkers. METHODOLOGY: Levothyroxine monotherapy to normalise serum thyrotropin (TSH) is the standard treatment for primary hypothyroidism and greatly improves symptoms and life expectancy, yet at least 10%-15% of patients still experience persistent symptoms and reduced QOL despite having normal TSH levels. Researchers conducted a cross-sectional study (August 2021 to 2022) to examine predictors of QOL in 157 adults (mean age, 49.5 years) with primary hypothyroidism for more than 2 years who were free of major comorbidities and had been on a stable dose of levothyroxine monotherapy and maintained a normal TSH level for more than 6 months; 70.7% of participants had autoimmune thyroiditis and 29.3% had iatrogenic hypothyroidism. Levels of various thyroid-specific biomarkers such as TSH, free tissue triiodothyronine, and free thyroxine were measured. Participants completed the Underactive Thyroid-Dependent Quality of Life Questionnaire and Underactive Thyroid Symptom Rating Questionnaire to assess thyroid-dependent QOL and the number of hypothyroidism symptoms; other validated questionnaires were used to measure depressive symptoms and somatosensory amplification. TAKEAWAY: The negative impact of hypothyroidism on QOL was most evident in women and participants with higher BMI, autoimmune thyroiditis, greater somatosensory amplification, more severe depression, and a higher count of hypothyroidism-related symptoms. None of the thyroid-specific biomarkers were associated with thyroid-dependent QOL. In the final model, significant predictors of thyroid-dependent QOL were somatosensory amplification ( P = .002), BMI ( P = .021), and depression ( P < .001). IN PRACTICE: "When considered collectively, our findings are consistent with the theory that once TSH is normalized, thyroid-dependent QoL is primarily influenced by unrecognized comorbidities such as obesity, somatic symptom disorder, and depression," the authors wrote. SOURCE: This study was led by Bence Bakos, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary. It was published online on May 26, 2025, in BMC Endocrine Disorders . LIMITATIONS: Researchers could not establish causality owing to the cross-sectional design of this study. DISCLOSURES: This study did not receive any specific grant from any funding agency. The authors declared having no conflicts of interest.