Objective: To explore the nature and extent of possible residual complaints among Dutch hypothyroid patients using thyroid replacement therapy, we initiated a comprehensive study measuring health-related quality of life (QoL), daily functioning, and hypothyroidism-associated symptoms in patients and control persons. Methods: An online survey measuring thyroid-specific QoL (ThyPRO), daily functioning, and hypothyroidismassociated symptoms (ThySHI) was distributed among treated hypothyroid patients and control individuals. The advertising text was formulated in an open-ended manner. Patients also provided their most recent thyroid blood values and their thyroid medication. Results: There was a large-sized impairment of QoL (Cohen’s d = 1.04, +93 % ThyPRO score) in hypothyroid patients on thyroid replacement therapy (n = 1195) as compared to controls (n = 236). Daily functioning was significantly reduced i.e., general health (-38 %), problems with vigorous- (+64 %) and moderate activities (+77 %). Almost 80 % of patients reported having complaints despite thyroid medication and in-range thyroid blood values, with 75 % expressing a desire for improved treatment options for hypothyroidism (total n = 1194). Hypothyroid patients experienced 2.8 times more intense hypothyroidism-associated symptoms than controls (n = 865, n = 203 resp). Patients’ median reported serum concentrations were: TSH 0.90 mU/L, FT4 17.0 pmol/L, and FT3 2.67 pmol/L, with 52 % having low T3 levels (<3.1 pmol/L). The QoL was not found to be related to age, sex, BMI, menopausal status, stress, serum thyroid parameters, the origin and duration of hypothyroidism, the type of thyroid medication, or the LT4 dose used. Conclusions: Our study revealed major reductions in quality of life and daily functioning, and nearly three times more intense hypothyroidism-associated symptoms in treated hypothyroid patients as compared to controls, despite treatment and largely in-range serum TSH/FT4 concentrations. The QoL was not associated with serum thyroid parameters. We recommend future research into the origin of persisting complaints and the development of improved treatment modalities for hypothyroidism.
Background: Hypothyroidism is a common endocrine disorder and the standard treatment is replacement therapy with levothyroxine (LT4). Although many hypothyroid patients improve upon treatment with LT4, a proportion seems to experience residual hypothyroid complaints despite treatment, even when plasma TSH and FT4 are within reference ranges. Methods: Using an on-line survey we investigated 1. the health-related quality of life (QoL) (ThyPRO), 2. the activities of daily living (SF-36), 3. hypothyroid-related symptoms (ThySHI) in diagnosed, treated hypothyroid patients (>18 years, treated >6 months) and control persons (without thyroid disease, >18 years). In patients, the time course of symptoms from diagnosis until 3 years was asked (retrospectively, ThySHI). Patients and control persons were recruited by e-mails from patient organizations, posters in pharmacies and health centers and Twitter/Facebook. For data analysis (ThyPRO, 0-100 scale, t-test; daily functioning, 1-5 scale and ThySHI 0-3 scale, Mann-Whitney; time course symptoms, Friedmann-Dunnett; confounding factors, ANCOVA) IBM SPSS 24 was used. Results: In this cohort consisted of 1667 patients (mean duration of illness 12.2 ± SD 9.9 years) and 275 controls. Treated hypothyroid patients had 1. a significant decrease in health-related QoL and all domains (fatigue, vitality, cognition, anxiety, depressivity, emotional susceptibility, social life, daily life), as compared to controls (mean total QoL 39.9 vs 19.1 resp. and all domains p<0.001), 2. Significantly more impairment with activities of daily living (p<0.001), and 3. significantly higher scores for symptoms related to hypothyroidism, as compared to control persons (all p<0.01). Symptoms generally decreased after 3 years of treatment, with fatigue, reduce daily functioning, coldness, muscle pain/cramps and being overweight as the most intense residual complaints. Many patients (78.5%) reported having complaints despite taking thyroid medication and reported not feeling well (77.8%) while their blood values were within range. TSH level, age, gender and duration of illness did not significantly affect total QoL, whereas the M3 comorbidity index did. Desiccated thyroid hormone users (9.4%) had a significantly better mean total QoL than LT4 users (90.5%) (36,0 vs 40.6, p=0.003). Conclusions: Persistent complaints, such as reduced health-related quality of life, reduced daily functioning, and residual hypothyroid related symptoms, are common in this group of hypothyroid patients despite replacement therapy. Caregivers should be aware that persistent complaints can be present in treated hypothyroid patients, despite following current guidelines, and that these remaining symptoms may affect their quality of life and daily functioning.
Background: Osteoarthritis (OA) is the most common rheumatic disease of the musculoskeletal system, with the knee as the most affected joint. The number of people with OA of the knee is likely to increase due to the ageing society and the obesity epidemic. The predominant clinical symptom of knee OA is pain, which is described as worsening by activity and relieving by rest. Knee instability has been recognized as an important clinical feature in persons with knee OA. Pain and knee instability are associated with limitations in performing daily activities. Non-pharmacological options in the management of knee OA consist of education, weight loss, exercise, braces and physical therapy. Knee bracing has been recommended by the Osteoarthritis Research Society International (OARSI). Valgus knee braces designed to decrease loads on the medial compartment of the knee for patients with varus alignment are the most common. It has been shown however, that valgus bracing may have little or no effect on pain and physical functioning, and adherence to this treatment in patients with knee OA is low.Because of ease of use and access, lack of complications and low cost, soft knee braces are commonly used in persons with knee OA. However, the evidence for efficacy of soft knee bracing on pain and activity limitations in knee OA is limited. Therefore, it is important to strengthen the evidence of using a soft brace to reduce pain and activity limitations as well as to evaluate the efficacy of soft knee bracing on knee instability in persons with knee OA. There is also debate about the effectiveness of soft braces in other affected joints of the lower extremity and in conditions other than OA such as rheumatoid arthritis.Objectives: The aim of the study will be to evaluate the effect of wearing a soft brace on dynamic knee instability in patients with OA of the knee.Methods: Persons with knee OA and self-reported knee instability from the Amsterdam Osteoarthritis cohort participated in a single-session lab-experimental study. A within-subject design was used, comparing no brace versus brace, and comparing a non-tight versus a tight brace (standard fit). The primary outcome measure was dynamic knee instability, expressed by the Perturbation Response (PR), i.e., a biomechanics based measure reflecting deviation in the mean knee varus-valgus angle after a controlled mechanical perturbation, standardized to the mean (SD) varus-valgus angle during level walking. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.Results: The wearing of a soft brace reduced the knee instability significantly during perturbed walking. Results will also be presented from the literature search and from the lab-experimental study.Conclusion: Wearing a soft brace reduces dynamic knee instability in patients with knee OA. However, longitudinal studies are needed to evaluate the clinical implications of wearing a soft brace.
