| Abstract | Poremećaji štitne žlijezde značajno utječu na kvalitetu života bolesnika (QoL) zbog niza simptoma koji uključuju sve organske sustave. Najpouzdaniji test za otkrivanje hipotireoze je koncentracija tireotropnog hormona (TSH) u serumu. Povišena vrijednost TSH upućuje na hipotireozu, a potom se određuje koncentracija ukupnog tiroksina (T4) ili slobodnog tiroksina (Ft4).
S obzirom na sve navedene simptome koje oboljeli mogu imati te činjenicu da se radi o neizlječivoj kroničnoj bolesti, jasno je kako hipotireoza može značajno utjecati na kvalitetu života oboljelih. Budući da se bolesti štitnjače ne smatraju životno ugrožavajućima te se za oboljele očekuje podjednaka duljina života kao i kod opće populacije, upravo se procjena kvalitete života osoba s hipotireozom smatra klinički značajnom za procjenu zdravstvenog statusa.
Primarni cilj ovog istraživanja bio je ispitati kvalitetu života osoba koje boluju od hipotireoze, a na terapiji su levotiroksinom. Sekundarni cilj bio je ispitati adherenciju ispitanika koji uzimaju levotiroksin te utvrditi utječe li adherencija na simptome hipotireoze, a time i na kvalitetu života ispitanih. U istraživanje je bilo uključeno 50 pacijenata u dobi starijoj od 18 godina s dijagnozom hipotireoze, koji su primali stabilnu dozu levotiroksina. Pacijenti su prikupljeni unutar Zdravstvene ustanove Ljekarna Šibenik u razdoblju od siječnja do svibnja 2023. godine metodom namjenskog uzorkovanja (engl. purposive sampling).
Za potrebe istraživanja korišteni su upitnici “Procjena kvalitete života u ovisnosti o štitnoj žlijezdi” (engl.Thyroid depend quality of life questionnaire-ThyDQoL) i “Ocjena simptoma štitne žlijezde” (engl. Thyroid symptom rating questionnaire-ThySRQ). Za svakog ispitanika procijenjena je i adherencija pomoću skale Morisky (engl. Morisky Medication Adherence Scale-MMAS-8).
Analizom dobivenih rezultata utvrđena je statistički značajna razlika u kvaliteti života između pacijenata koji redovito uzimaju lijekove i onih koji ne uzimaju čime smo potvrdili istraživačku hipotezu prema kojoj pacijenti koji ne uzimaju redovito levotiroksin imaju lošiju kvalitetu života (hi-kvadrat test; p=0,017). Nadalje, ispitanici s različitim TSH vrijednostima unutar referentnog raspona (0,4-5,2mU/L) nisu pokazali statistički značajne razlike u intenzitetu simptoma umora, ali srednja vrijednost u kategoriji ispitanika s TSH nižim od 0,4 pokazala je najveću prisutnost simptoma umora (Kruskal-Wallis test; p>0,630). Analizom utjecaja vrijednosti TSH na simptom dobivanja na težini nije utvrđena statistički značajna razlika, što znači da ispitanici na terapiji levotiroksinom ne dobivaju na težini ukoliko imaju vrijednost TSH veću od 4 mU/L (Mann Whitney test; p=0,447). Nadalje, ispitanici s različitim vrijednostima TSH unutar referentnog intervala nisu pokazali značajne razlike u intenzitetu simptoma sniženog raspoloženja ili depresije, ali srednja vrijednost u kategoriji ispitanika s TSH nižim od 0,4 pokazala je najveću prisutnost simptoma sniženog raspoloženja ili depresije (Kruskal-Wallis test; p=0,201). Također, nije utvrđena statistički značajna razlika u ukupnoj kvaliteti života između ispitanika s različitim vrijednostima TSH, unutar referentnog intervala (hi-kvadrat test; p=0,235).
Iz navedenog jasno je kako je potreban individualan pristup liječenju hipotireoze koji uključuje dob pacijenta, komorbiditete kao i jačinu simptoma koje pacijent osjeća. Vrijednost TSH nije apsolutni pokazatelj dobre kontrole bolesti. Ipak, s obzirom na činjenicu da je većina provedenih studija koja je uključila veći broj ispitanika potvrdila puno bolju kvalitetu života kod pacijenata koji se nalaze unutar intervala 0,4-4mU/L, a na terapiji su levotiroksinom, trebalo bi težiti ka tom rasponu. |
| Abstract (english) | Thyroid disorders greatly affect the patient's quality of life (QoL) due to a series of symptoms that involve all organ systems. The most reliable test for detecting hypothyroidism is the concentration of TSH in the serum. An elevated TSH value indicates hypothyroidism, and then the concentration of total thyroxine (T4) or free thyroxine (Ft4) is determined.
Considering all the symptoms that the sufferers may have and the fact that it is an incurable chronic disease, it is clear that hypothyroidism can significantly affect the quality of life of the sufferers. Since thyroid diseases are not considered life-threatening, and patients are expected to have the same life expectancy as the general population, it is precisely the assessment of the quality of life of people with hypothyroidism that is considered clinically significant for assessing health status.
The primary aim of this research was to examine the quality of life of people who suffer from hypothyroidism and are on levothyroxine therapy depending on the TSH value. The secondary aim was to examine the quality of life of people who suffer from hypothyroidism and are on levothyroxine therapy in relation to adherence to therapy. 50 patients aged 18 to 65 with a diagnosis of hypothyroidism, who received a stable dose of levothyroxine, were included in the study. The patients were collected within the Health Institution Ljekarna Šibenik. We conducted the research using questionnaires. The first questionnaire is entitled "Assessment of the quality of life in dependence on the thyroid gland" (Thyroid depend quality of life questionnaire-ThyDQoL). The second questionnaire is called "Thyroid symptom rating questionnaire" (ThySRQ). For each subject, we also assessed medication adherence using the Morisky Medication Adherence Scale-MMAS-8.
The analysis of the obtained results revealed a statistically significant difference in the quality of life between patients who regularly take medication and those who do not, which confirmed the research hypothesis according to which patients who do not regularly take levothyroxine have a worse quality of life, which was confirmed by the chi-square test (p=0.017 ). Furthermore, subjects with different TSH values within the reference interval (0.4-5.2mU/L) did not show statistically significant differences in the intensity of fatigue symptoms, but the mean value in the category of subjects with TSH lower than 0.4 shows the highest presence of fatigue symptoms, which was confirmed by the Kruskal-Wallis test (p>0.630).
The analysis of the influence of TSH on the symptom of weight gain did not reveal a statistically significant difference, which means that subjects on levothyroxine therapy do not gain weight if they have a TSH value higher than 4 mU/L, which was confirmed by the Mann Whitney test (p=0.447). Furthermore, subjects with different TSH values within the reference interval did not show significant differences in the intensity of symptoms of low mood or depression, but the mean value in the category of subjects with TSH lower than 0.4 shows the highest presence of symptoms of low mood or depression, which was confirmed by the Kruskal-Wallis test (p=0.201). Also, there was no statistically significant difference in the overall quality of life between subjects with different TSH values, within the reference interval, which was confirmed by the chi-square test (p=0.235).
From the above, it is clear that an individual approach to the treatment of hypothyroidism is needed, which includes the patient's age, comorbidities, as well as the severity of the symptoms the patient feels. The TSH value is not an absolute indicator of good disease control. However, considering that the majority of the aforementioned studies, with a larger number of subjects, confirmed a much better quality of life in patients who are within the interval of 0.4-4mU/L, and are on levothyroxine therapy, we should aim for that range. |
