Steentjes, E. (Ellen) (2016) ‘The relationship between serum thyrotropin and wellbeing in patients on levothyroxine therapy for hypothyroidism. thesis, Medicine.
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Abstract
Background: Many patients on levothyroxine (L-T4) therapy for hypothyroidism complain of an impaired wellbeing, even with levels of serum thyrotropin (TSH) within the reference range. However, the reference range of serum TSH is controversial. Its use as a therapeutic target might therefore be contributing to the impaired wellbeing in L-T4 therapy. Studies focusing on this subject by examining the relationship between serum TSH and wellbeing in patients on L-T4 therapy for hypothyroidism show conflicting results. This study therefore addresses this issue. Methods: In this cross-sectional study, wellbeing is assessed by means of the RAND 36-item Health Survey (RAND-36) and by questionnaires based on Zulewski’s clinical score and the Hyperthyroidism Symptoms Scale (HSS). The primary outcome, the relationship between these measures of wellbeing and serum TSH, is evaluated with multivariate regression analysis. In addition, the relationship between the measures of wellbeing and thyroxine (fT4) was evaluated as well. Important covariates included in the regression models were comorbidity and the number of prescribed medication. Results: No relationship is found between wellbeing and serum TSH or fT4. There are, however, significant associations between some of the covariates and wellbeing. For example, a significant association was found between the number of prescribed medication and Zulewski’s clinical score. This implicates that the impaired wellbeing in patients on L-T4 therapy can be explained by comorbidity or chronic use of medication. Conclusions: The use of the current reference range of serum TSH as a therapeutic endpoint is not contributing to the impaired wellbeing in patients on L-T4 therapy for hypothyroidism. Comorbidity and chronic use of medication may be important explanations for this problem.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Groeneveld, Dr. P.H.P. and Co-supervisor and Ockenburg, Dr. S.L. van and Institution Isala, Zwolle and Department Internal medicine |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1631 |
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