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The relationship between quality of life, cognition, and thyroid status in Graves’ disease

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Summary

Purpose

To assess quality of life (QoL) and cognitive function among Graves’ disease (GD) patients with different thyroid status, with and without ophthalmopathy.

Methods

This is a cross-sectional clinic-based study involving 154 patients with GD (81.27% were female, mean age 45.6 ± SD 11.2 years) and 54 (35.06%) had ophthalmopathy. Data were collected after an informed consent from all patients was obtained. All patients completed the 36-Item Short Form Health Survey and Mini-Mental State Examination. Patients with ophthalmopathy also completed the Graves’ Orbitopathy Quality of Life Questionnaire.

Results

Patients with hyperthyroidism presented a greater impairment in QoL when compared to euthyroidism group. A lower score in physical role functioning was found in both subgroups with active disease (hyperthyroidism and euthyroidism using thionamides). A lower score was also seen in visual function, only in patients with hyperthyroidism, without difference in appearance. No difference was found in cognition between patients. Younger ages at diagnosis, male sex, euthyroidism and absence of ophthalmopathy were factors associated with better QoL, as well as a shorter disease duration was associated with better recall, attention and calculation.

Conclusions

An impairment in QoL among patients with active GD was evidenced, even in those receiving thionamides and in euthyroidism. Ophthalmopathy was a factor associated with a poor QoL and no clear evidence of cognitive impairment was demonstrated.

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References

  1. T.J. Smith, L. Hegedus, Graves’ disease. N. Engl. J. Med. 375(16), 1552–1565 (2016). https://doi.org/10.1056/NEJMra1510030

    Article  PubMed  Google Scholar 

  2. H.B. Burch, D.S. Cooper, Management of Graves disease: a review. JAMA 314(23), 2544–2554 (2015). https://doi.org/10.1001/jama.2015.16535

    Article  CAS  PubMed  Google Scholar 

  3. M. Bauer, T. Goetz, T. Glenn, P.C. Whybrow, The thyroid-brain interaction in thyroid disorders and mood disorders. J. Neuroendocrinol. 20(10), 1101–1114 (2008). https://doi.org/10.1111/j.1365-2826.2008.01774.x

    Article  CAS  PubMed  Google Scholar 

  4. M. Ritchie, B.B. Yeap, Thyroid hormone: Influences on mood and cognition in adults. Maturitas 81(2), 266–275 (2015). https://doi.org/10.1016/j.maturitas.2015.03.016.

    Article  CAS  PubMed  Google Scholar 

  5. A. Vogel, T.V. Elberling, M. Hording, J. Dock, A.K. Rasmussen, U. Feldt-Rasmussen et al. Affective symptoms and cognitive functions in the acute phase of Graves’ thyrotoxicosis. Psychoneuroendocrinology 32(1), 36–43 (2007). https://doi.org/10.1016/j.psyneuen.2006.09.012

    Article  PubMed  Google Scholar 

  6. M. Abraham-Nordling, O. Torring, B. Hamberger, G. Lundell, L. Tallstedt, J. Calissendorff et al. Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid 15(11), 1279–1286 (2005). https://doi.org/10.1089/thy.2005.15.1279

    Article  CAS  PubMed  Google Scholar 

  7. P. Cramon, K.H. Winther, T. Watt, S.J. Bonnema, J.B. Bjorner, O. Ekholm et al. Quality-of-life impairments persist 6 months after treatment of Graves’ hyperthyroidism and toxic nodular goiter: a prospective cohort study. Thyroid 26(8), 1010–1018 (2016). https://doi.org/10.1089/thy.2016.0044

    Article  CAS  PubMed  Google Scholar 

  8. C. Terwee, I. Wakelkamp, S. Tan, F. Dekker, M.F. Prummel, W. Wiersinga, Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur. J. Endocrinol. 146(6), 751–757 (2002)

    Article  CAS  Google Scholar 

  9. M.N. Gerding, C.B. Terwee, F.W. Dekker, L. Koornneef, M.F. Prummel, W.M. Wiersinga, Quality of life in patients with Graves’ ophthalmopathy is markedly decreased: measurement by the medical outcomes study instrument. Thyroid 7(6), 885–889 (1997). https://doi.org/10.1089/thy.1997.7.885

    Article  CAS  PubMed  Google Scholar 

  10. G.J. Kahaly, F. Petrak, J. Hardt, S. Pitz, U.T. Egle, Psychosocial morbidity of Graves’ orbitopathy. Clin. Endocrinol. 63(4), 395–402 (2005). https://doi.org/10.1111/j.1365-2265.2005.02352.x

    Article  CAS  Google Scholar 

  11. T.V. Elberling, A.K. Rasmussen, U. Feldt-Rasmussen, M. Hording, H. Perrild, G. Waldemar, Impaired health-related quality of life in Graves’ disease. A prospective study. Eur. J. Endocrinol. 151(5), 549–555 (2004). https://doi.org/10.1530/eje.0.1510549

    Article  CAS  PubMed  Google Scholar 

  12. H.M. Conaglen, J.A.U. Tamatea, J.V. Conaglen, M.S. Elston, Treatment choice, satisfaction and quality of life in patients with Graves’ disease. Clin. Endocrinol. (2018). https://doi.org/10.1111/cen.13611

  13. J.G. Ljunggren, O. Torring, G. Wallin, A. Taube, L. Tallstedt, B. Hamberger et al.Quality of life aspects and costs in treatment of Graves’ hyperthyroidism with antithyroid drugs, surgery, or radioiodine: results from a prospective, randomized study. Thyroid 8(8), 653–659 (1998). https://doi.org/10.1089/thy.1998.8.653

    Article  CAS  PubMed  Google Scholar 

  14. C. Chattopadhyay, N. Chakrabarti, S. Ghosh, An assessment of psychiatric disturbances in Graves' disease in a medical college in eastern India. Niger. J. Clin. Pract. 15(3), 276–279 (2012). https://doi.org/10.4103/1119-3077.100620

    Article  CAS  PubMed  Google Scholar 

  15. M.F. Schreckenberger, U.T. Egle, S. Drecker, H.G. Buchholz, M.M. Weber, P. Bartenstein et al. Positron emission tomography reveals correlations between brain metabolism and mood changes in hyperthyroidism. J. Clin. Endocrinol. Metab. 91(12), 4786–4791 (2006). https://doi.org/10.1210/jc.2006-0573

    Article  CAS  PubMed  Google Scholar 

  16. W. Zhang, X. Liu, Y. Zhang, L. Song, J. Hou, B. Chen et al.Disrupted functional connectivity of the hippocampus in patients with hyperthyroidism: evidence from resting-state fMRI. Eur. J. Radiol. 83(10), 1907–1913 (2014). https://doi.org/10.1016/j.ejrad.2014.07.003

    Article  PubMed  Google Scholar 

  17. L.C. Delfino, A. Zunino, V. Sapia, M. Croome, V. Ilera, A.T. Gauna, Related quality of life questionnaire specific to dysthyroid ophthalmopathy evaluated in a population of patients with Graves’ disease. Arch. Endocrinol. Metab. 61(4), 374–381 (2017). https://doi.org/10.1590/2359-3997000000252

    Article  PubMed  Google Scholar 

  18. K.A. Ponto, S. Merkesdal, G. Hommel, S. Pitz, N. Pfeiffer, G.J. Kahaly, Public health relevance of Graves’ orbitopathy. J. Clin. Endocrinol. Metab. 98(1), 145–152 (2013). https://doi.org/10.1210/jc.2012-3119

    Article  CAS  PubMed  Google Scholar 

  19. C. Ferlov-Schwensen, T.H. Brix, L. Hegedus, Death by suicide in Graves’ disease and Graves’ orbitopathy: A Nationwide Danish Register Study. Thyroid 27(12), 1475–1480 (2017). https://doi.org/10.1089/thy.2017.0365

    Article  PubMed  Google Scholar 

  20. E.H. Gan, S.H.S. Pearce, The thyroid in mind: cognitive function and low thyrotropin in older people. J. Clin. Endocrinol. Metab. 97(10), 3438–3449 (2012). https://doi.org/10.1210/jc.2012-2284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. M.H. Samuels, I. Kolobova, A. Smeraglio, D. Peters, J.S. Janowsky, K.G. Schuff, The effects of levothyroxine replacement or suppressive therapy on health status, mood, and cognition. J. Clin. Endocrinol. Metab. 99(3), 843–851 (2014). https://doi.org/10.1210/jc.2013-3686

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. M.H. Samuels, R. Kaimal, A. Waring, H.A. Fink, K. Yaffe, A.R. Hoffman et al.Thyroid function variations within the reference range do not affect quality of life, mood, or cognitive function in community-dwelling older men. Thyroid 26(9), 1185–1194 (2016). https://doi.org/10.1089/thy.2016.0104

    Article  PubMed  PubMed Central  Google Scholar 

  23. J.H. Moon, S. Ahn, J. Seo et al. The effect of long-term thyroid-stimulating hormone suppressive therapy on the cognitive function of elderly patients with differentiated thyroid carcinoma. J. Clin. Endocrinol. Metab. 99(10), 3782–3789 (2014). https://doi.org/10.1210/jc.2013-4454

    Article  CAS  PubMed  Google Scholar 

  24. I.M. Benseñor, P.A. Lotufo, P.R. Menezes, M. Scazufca, Subclinical hyperthyroidism and dementia: the Sao Paulo Ageing & Health Study (SPAH). BMC. Public. Health 10, 298–298 (2010). doi.org/10.1186/1471-2458-10-298

    Article  Google Scholar 

  25. G. Ceresini, F. Lauretani, M. Maggio, et al. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in older Italians and is associated with cognitive impairment. J Am Geriatr Soc (2018). https://doi.org/10.1111/j.1532-5415.2008.02080.

  26. J.H. Moon, Y.J. Park, T.H. Kim, J.W. Han, S.H. Choi, S. Lim, et al. Lower-but-normal serum TSH level is associated with the development or progression of cognitive impairment in elderly: Korean Longitudinal Study on Health and Aging (KLoSHA). J. Clin. Endocrinol. Metab. 99(2), 424–432 (2014). https://doi.org/10.1210/jc.2013-3385

    Article  CAS  PubMed  Google Scholar 

  27. C.E. Aubert, D.C. Bauer, B.R. da Costa, M. Feller, C. Rieben, E.M. Simonsick et al. The association between subclinical thyroid dysfunction and dementia: the health, aging and body composition (Health ABC) study. Clin. Endocrinol. 87(5), 617–626 (2017). https://doi.org/10.1111/cen.13458

    Article  CAS  Google Scholar 

  28. B.B. Yeap, H. Alfonso, S.A. Chubb, G. Puri, G.J. Hankey, L. Flicker et al. Higher free thyroxine levels predict increased incidence of dementia in older men: the Health in Men Study. J. Clin. Endocrinol. Metab. 97(12), E2230–E2237 (2012). https://doi.org/10.1210/jc.2012-2108

    Article  CAS  PubMed  Google Scholar 

  29. M. Lillevang-Johansen, I. Petersen, K. Christensen, L. Hegedus, T.H. Brix, Is previous hyperthyroidism associated with long-term cognitive dysfunction? A twin study. Clin. Endocrinol. 80(2), 290–295 (2014). https://doi.org/10.1111/cen.12255

    Article  Google Scholar 

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Acknowledgements

We acknowledge all the patients who voluntarily participated in our study.

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Authors and Affiliations

  1. Endocrinology Division, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil

    Cínthia Minatel Riguetto, Arnaldo Moura Neto, Marcos Antônio Tambascia & Denise Engelbrecht Zantut-Wittmann

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  1. Cínthia Minatel Riguetto
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  2. Arnaldo Moura Neto
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  3. Marcos Antônio Tambascia
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  4. Denise Engelbrecht Zantut-Wittmann
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Correspondence to Cínthia Minatel Riguetto.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Riguetto, C.M., Neto, A.M., Tambascia, M.A. et al. The relationship between quality of life, cognition, and thyroid status in Graves’ disease. Endocrine 63, 87–93 (2019). https://doi.org/10.1007/s12020-018-1733-y

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  • DOI: https://doi.org/10.1007/s12020-018-1733-y

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