Endocrine Abstracts

Background and aims

It has been reported that some patients with hypothyroidism treated with levothyroxine continue to experience persistent symptoms despite normal serum TSH. Thus, the aim was to study of causes of hypothyroidism symptoms in euthyroid patients.

Materials and methods

From 01.10.2020 to 26.12.2020 there was survey using THESIS questionnaire: Treatment of Hypothyroidism in Europe by Specialists: International Survey (Russian version). 210 members of Belarusian Public Medical Association ’Endocrinology and Metabolism’ received the mailing with questionnaire and agreed to participate. 146 endocrinologists with the medical practice for more than 5 years, the hypothyroidism working experience were included in the study.

Results

Persistent hypothyroidism symptoms despite normal serum TSH and levothyroxine treatment has been reported by 88.4% (129 persons) respondents. 52.1% (76 persons) respondents notice the symptoms in less than 5% of patients, and 32.9% (48 respondents) in 6–10% patients. Possible clinical conditions for thyroid hormone treatment in euthyroid subjects were admitted: unexplained fatigue – 7.5% (11 responses), obesity resistant to life-style interventions – 7.5% (11 responses), as a complementary treatment in severe hypercholesterolemia – 8.2% (12 responses), depression resistant to anti-depressant medications – 8.2% (12 responses), female infertility with high level of thyroid antibodies – 34.2% (50 responses), simple goiter growing over time – 24.7% (36 responses), treatment is never indicated for euthyroid patients – 57.5% (84 responses). Doctors who did not prescribe levothyroxine for normal TSH were comparable in gender (8 (5.5%) men vs 76 (52.0%) women, χ²= 0.00001, p=0.975), age (under 40 years 23.3% (34) vs over 40 years 34.3% (50), χ²= 0.046, P = 0.829) and medical experience (< 10 years in medical practice – 16.4% (24) vs > 10 years – 41.1% (60), χ²= 1.090, p=0.296). Using score range of likely causes from 1 (most likely) to 8 (least likely) explanations for persistent symptoms in patients with normal TSH were identified: psychosocial factors – 2 (1–4) score, comorbidities 2 (1–4) score, chronic fatigue syndrome – 2 (1–4) score, the burden of chronic disease– 2 (1–4) score. The least likely explanations were inability of levothyroxine to restore normal physiology – 8 (7–8) score and the burden of having to take medication – 8 (6–8) score. As neutral factors were assessed patient unrealistic expectations (4 (2–6) score) and presence of underlying inflammation due to autoimmunity (6 (4–8) score).

Conclusions

Despite the appointment of levothyroxine, symptoms of hypothyroidism in such patients are noted by 88.4% of endocrinologists, that is probably due to psychosocial factors, comorbidities, chronic fatigue syndrome and the burden of chronic disease.