Disease-Specific as Well as Generic Quality of Life Is Widely Impacted in Autoimmune Hypothyroidism and Improves during the First Six Months of Levothyroxine Therapy

PLoS One. 2016 Jun 3;11(6):e0156925. doi: 10.1371/journal.pone.0156925. eCollection 2016.


Background: Hypothyroidism is often diagnosed, and subsequently treated, due to health-related quality of life (HRQL) issues. However, HRQL following treatment has never previously been assessed in longitudinal descriptive studies using validated instruments.

Objective: To investigate disease-specific (ThyPRO) and generic (SF-36) HRQL, following levothyroxine therapy in patients with hypothyroidism due to autoimmune thyroiditis.

Methods: This prospective cohort study was set at endocrine outpatient clinics at two Danish university hospitals. Seventy-eight consecutive patients were enrolled and completed HRQL questionnaires before, six weeks, and six months after initiation of levothyroxine therapy. Normative ThyPRO (n = 739) and SF-36 (n = 6,638) data were available for comparison and changes in HRQL following treatment were estimated and quantified.

Results: Prior to treatment, all ThyPRO scales were significantly impacted (p<0.0001), compared to the general population sample. The same was observed for seven of eight SF-36 scales, the exception being Bodily Pain. Tiredness (ThyPRO) and Vitality (SF-36) were the most markedly impacted scales. After six weeks of treatment, nine of thirteen ThyPRO scales had significantly improved. ThyPRO improvements were consistent at six months, where five of eight SF-36 scales had also significantly improved, but deficits persisted for a subset of both ThyPRO and SF-36 scales.

Conclusions: In this population of hypothyroid patients, HRQL was widely affected before treatment, with tiredness as the cardinal impairment according to both ThyPRO and SF-36. Many aspects of HRQL improved during the first six months of LT4 therapy, but full recovery was not obtained. Our results may help clinicians inform patients about expected clinical treatment effects.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hashimoto Disease / drug therapy*
  • Hashimoto Disease / physiopathology*
  • Hormones / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Psychometrics
  • Quality of Life
  • Surveys and Questionnaires
  • Thyroiditis, Autoimmune / drug therapy*
  • Thyroiditis, Autoimmune / physiopathology*
  • Thyroxine / therapeutic use*
  • Time Factors
  • Young Adult


  • Hormones
  • Thyroxine

Supplementary concepts

  • Hypothyroidism, Autoimmune

Grants and funding

This study was supported by research grants from the Danish Agency for Science, Technology and Innovation: Council for Strategic Research and Council for Independent Research (ID: 09-066886), and Agnes & Knut Mørks Foundation. KHW is supported by grants from the University of Southern Denmark and the Region of Southern Denmark; UFR and LH are supported by an unrestricted grant from the Novo Nordisk Foundation. SB is supported by grants from Odense University Hospital Research Council. JBB is an employee of Optum Patient Insights. The above funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of all authors are articulated in the ‘author contributions’ section.