Hashimoto's thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter

Thyroid. 2011 Feb;21(2):161-7. doi: 10.1089/thy.2010.0191. Epub 2010 Dec 27.


Background: Hashimoto's thyroiditis (HT) is a common disease, and is the most prevalent cause of hypothyroidism. Symptoms and diseases associated with HT are considered to be caused by hypothyroidism. We hypothesized that higher antithyroperoxidase (anti-TPO) antibody levels would be associated with an increased symptom load and a decreased quality of life in a female euthyroid patient collective.

Methods: In a prospective cohort study 426 consecutive euthyroid female patients undergoing thyroid surgery for benign thyroid disease were included. Main outcome measures were preoperative anti-TPO levels, a symptom questionnaire and the SF-36 questionnaire, and lymphocytic infiltration of the thyroid tissue as evaluated by histology.

Results: Histology revealed HT in 28/426 (6.6%) subjects. To maximize the sum of the predictive values, a cut-off point for anti-TPO of 121.0 IU/mL was calculated (sensitivity 93.3% [95% confidence interval: 77.9%-99.0%]; specificity 94.7% [95% confidence interval: 92.0%-96.7%]) to predict the presence of histological signs of HT. The mean number of reported symptoms was significantly higher in patients with anti-TPO levels >121.0 IU/mL than in the other group (6.7 ± 2.5 vs. 4.1 ± 2.8; p < 0.001). There were no differences in preoperative thyroid-stimulating hormone levels (1.7 ± 1.3 vs. 1.5 ± 1.4 μU/mL, respectively; p = 0.155). Chronic fatigue, dry hair, chronic irritability, chronic nervousness, a history of breast cancer and early miscarriage, and lower quality-of-life levels were significantly associated with anti-TPO levels exceeding the cut-off point (p < 0.05).

Conclusions: Women with HT suffer from a high symptom load. Hypothyroidism is only a contributing factor to the development of associated conditions.

MeSH terms

  • Adult
  • Aged
  • Antibodies, Anti-Idiotypic / blood*
  • Anxiety / etiology
  • Case-Control Studies
  • Fatigue / etiology
  • Female
  • Goiter / surgery*
  • Hashimoto Disease / complications*
  • Health Status
  • Health Surveys
  • Humans
  • Hypothyroidism / complications*
  • Iodide Peroxidase / immunology*
  • Middle Aged
  • Mood Disorders / etiology
  • Outcome Assessment, Health Care
  • Prospective Studies
  • Quality of Life*
  • Thyroidectomy*


  • Antibodies, Anti-Idiotypic
  • Iodide Peroxidase