Comparative Effectiveness of Replacement Therapy with L-thyroxine in Women with Postoperative and Autoimmune Hypothyroidism

Objective. To compare the lipid profile, psychoemotional features, cognitive function, quality of life in women receiving adequate replacement therapy with levothyroxine for postoperative hypothyroidism and autoimmune (Hashimoto's) hypothyroidism.Methods. 121 women (18-45 y.o.) with primary hypothyroidism receiving levothyroxine for more than one year participated in the study. 66 women with autoimmune hypothyroidism, 55 - with hypothyroidism after subtotal thyroidectomy for Graves' disease. The scores for the Short-Form 36, Hospital Anxiety and Depression Scale, symptoms of hypothyroidism, Inventory of memory and attention, TSH, free T3, free T4 and lipid profiles were analyzed. Results. There were no significant differences between groups in the age, BMI, TSH, fT3, fT4 levels. The total cholesterol was higher in patients with postoperative hypothyroidism in comparison to autoimmune hypothyroidism ( р = 0,041). The levels of social functioning and mental health that reflect mental component of health were lower in patients with autoimmune hypothyroidism than with postoperative hypothyroidism ( p = 0,038, p = 0,019, respectively). The anxiety was higher in the same group ( p = 0,004). There was no difference in memory and attention levels. The anxiety level was higher in autoimmune hypothyroidism and “low-normal” TSH (0,4 - 2 µU/L) than in postoperative hypothyroidism and the same TSH ( p = 0,016). Also in the group with postoperative hypothyroidism and “low-normal” TSH the cholesterol and prevalence of hypercholesterolemia were higher than in autoimmune hypothyroidism ( p = 0,017; р = 0,013). Conclusion. In young women with compensated autoimmune hypothyroidism the mental component of health is lower and the anxiety - higher than in postoperative hypothyroidism. Even in stable compensation of postoperative hypothyroidism the cholesterol level is higher comparing to the patients with autoimmune thyroiditis. And even in “low-normal” TSH level in this group the prevalence of hypercholesterolemia is 47%.

primary hypothyroidism, replacement therapy, autoimmune thyroiditis, Graves’ disease

1. Карелин А. Большая энциклопедия психологических тестов. М.: Эксмо, 2007.

2. Bianchi P, Zaccheroni V, Solaroli E et al. Health-related quality of life in patients with thyroid disorders. Quality of Life Research. 2004;13(1):45-54.

3. Ladenson P. Psychological wellbeing in patients. Clin Endocrinol. 2002;57:575-576.

4. Saravanan P, Chau WF, Roberts N et al. Psychological well-being in patients on ‘adequate’ doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf). 2002;57:577-585.

5. Walsh J, Ward L, Burke V et al. Small changes in thyroxine dosage do not produce measurable changes in hypothyroid symptoms, well-being or quality of life: results of a double blind, randomized clinical trial. J Clin Endocrinol Metab. 2006;91:2624-2630.

6. Wekking E, Appelhof B, Fliers E et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol. 2005;153(6): 747-753.