Hypothyroidism is a chronic disease resulting in a multiplicity of symptoms that can affect the physical and mental quality of life of patients. The aim of the present study was to assess the quality of life in these patients and to identify the factors associated with its deterioration. This is a cross-sectional study carried out in 2019-2020 at the Endocrinology Department at Chu Hassan II in Fez in Morocco. The assessment of the quality of life was based on the SF12 score, which allows to calculate two scores: mental and physical. Multiple linear regressions were used to determine factors associated with quality of life by adjusting for confounding factors. A total of 80 hypothyroid patients were included in the study, 80% were female. The mean age of the patients was 50.53 ± 13.16 years. The mean physical score was 41.20 ± 10.23 and the mean mental score was 42.65 ± 10.79. The alteration of physical and mental score was associated with the presence of symptoms of hypothyroidism and comorbidities. Quality of life was not associated either with the socio-demographic profile of the patients or with thyroid function (TSH values). Our study showed that the quality of life of the hypothyroid patients was negatively affected by having symptoms and comorbidities. It is therefore imperative to integrate the assessment of quality of life into the management strategy for this pathology.
Hypothyroidism is defined as “failure of the thyroid gland to produce sufficient thyroid hormone to meet the metabolic demands of the body’’ [
The World Health Organization (WHO) defined QOL as “An individual’s perception of their position in the life in the context of the culture in which they live and in relation to their goals, expectations, standards and concerns” [
Thyroid hormone receptors regulate the physiology of many organs. As a result, hypothyroidism can lead to a myriad of clinical symptoms. Mood and emotional disturbances such as depressive syndrome and anxiety are common in patients with hypothyroidism. A meta-analysis reported that the risk of depression is nearly 2.5 times higher in adults with hypothyroidism, compared to their euthyroid counterparts [
Other somatic symptoms that lead to significant reductions in physical health such as; physical and intellectual fatigue, hypothermia, cramps and muscle pain, are commonly reported by many patients with hypothyroidism [
In addition, the depilation, hair and eyebrow loss, dry skin and brittle nails are a source of discomfort and cosmetic problems especially in women, which can also affect the quality of life.
Finally, women who have hypothyroidism may present menstrual irregularities and infertility. Infertility is a stressful condition that influences all aspects of affected couple’s life and has a considerable impact on the quality of life: Impaired mental, physical, social and personal aspects along with waste of time and money, marital disruption and divorce [
The evaluation of the quality of life is important in hypothyroidism; it is one of the elements that allow to judge the effectiveness and the quality of the patient’s care. However, there are no data regarding the quality of life in Moroccan patients with hypothyroidism, hence the interest of the present study. The aim is to assess the quality of life of hypothyroid patients and identify the factors associated with its deterioration.
A cross-sectional study was conducted at Hassan II University-Hospital of Fes over a period of 12 months, from the November 2019 to November 2020 were included adult’s patients with a confirmed diagnosis of hypothyroidism. We excluded patients with impairment from auditory, mental and cognitive related medical conditions and pregnant woman.
Data collection was carried out using an anonymous face to face questionnaire comprising:
The socio-demographic variables: age, gender, marital status, education level, employment status, residence and monthly income.
Clinical variables: medical and surgical history, characteristics of hypothyroidism: duration of disease, type, symptoms, treatment and thyroid stimulating hormone level (TSH).
For assessment of quality of life, a shortened form of SF36 questionnaire (SF 12) in its translated and validated Moroccan version [
For each participant, we calculated two summary scores of the SF-12 physical and mental health using the weighted means of the eight domains. Frequencies were used for qualitative variables. Means and standard deviations (mean ± SD), were used for quantitative variables. Student’s test and ANOVA, were used to test associations between scores of quality of life and qualitative variables. For associations between scores of QOL and age, duration of hypothyroidism, and TSH levels, Pearson correlation, was used. Multivariate analysis by multiple linear regressions was used to identify factors associated with the quality of life scores, adjusting for confounding factors. Factors having a p-value ≤ 0.2 in bivariate analysis were included in the model. In all the analyses, the level of significance was kept at <0.05. Statistical analyses were performed by using R software.
Ethical approval was obtained from the ethics committees of Hassan II University Hospital, Fez-Morocco. All participants were informed of the conditions related to the study and gave their informed consent.
In total, 80 subjects were included in the study. The average age of the study participants was 50.53 ± 13.16 years, 80% were females, 62.5% were married, more than half (56.3%) were illiterate, 87.5% were unemployed or retired, 66.3% hailed from urban area and 78.8% have a monthly income under 2000DH (
The majority of participants were diagnosed with hypothyroidism post thyroidectomy (87.8%). The mean duration of hypothyroidism diagnosis was 7.5 ± 6.2 years, while the mean TSH us measurement was 5.5 ± 9.9 mIU/L. regarding symptoms of hypothyroidism, 55.0% had more than 3 symptoms. Fatigue was the main symptom presented in our patients, it was present in 73.8% of patients followed by cramps and swarming (61.3%) and memory and concentration problems (43.8%). Depressive disorders were present in 37.5% of subjects. 51.5% of patients had comorbidity. Almost all of patients (96.3%) were on levothyroxine therapy and 3.8% were on surveillance. Clinical characteristics of participants are summarized in
The mean of physical score (PCS) was 41.20 ± 10.23. The domains most affected in terms of physical quality of life were role physical (37.36 ± 9.95) and general health (37.59 ± 10.81).
The score of Quality of life is described in
In bivariate analysis, there was a statistically significant relationship between physical score, and fatigue, depressive disorders, memory and concentration problems and comorbidities (p < 0.05). After consideration of confounding factors, variables reminding associated with PCS in multivariate regression analyses were: fatigue (ß = −5.35, 95%CI (−10.03, −0.68)), comorbidities (ß = −5.68, 95%CI (−9.77, −1.59)) and depressive disorders (ß = −6.68, 95%CI (−10.98, −2.40)). There was no statistically association between socio demographic, socio economic data, thyroid function and physical quality of life.
The mean of mental score (MCS) was 42.65 ± 10.79. The mental quality of life was more impaired in the domains of emotional role (37.76 ± 10.14) and mental health 40.15 ± 11.18.
| Socio-demographic variables | N (%) |
|---|---|
| Gender Male Female | 8 (10.0) 72 (90.0) |
| Age (Mean ± SD) | 50.53 ± 13.16 |
| Residence Rural Urban | 27 (33.8) 53 (66.3) |
| Profession Unemployed or retired Employed | 70 (87.5) 10 (12.5) |
| Education level Illiterate Primary Secondary or superior | 45 (56.3) 16 (20.0) 19 (23.8) |
| Marital status Single Married Divorced or widow | 13 (16.3) 50 (62.5) 17 (21.3) |
| Monthly income (Moroccan dirham) ≤2000 >2000 | 63 (78.8) 17 (21.2) |
| Clinical Variables | |
| Duration of disease (mean ± SD) | 7.54 ± 6.27 |
| Comorbidity No Yes | 39 (48.8) 41 (51.3) |
| Symptoms of hypothyroidism | |
| weight gain | 27 (33.8) |
| Concentration and memory problems | 35 (43.8) |
| Fatigue | 59 (73.8) |
| Feeling cold | 23 (28.8) |
| constipation | 30 (37.5) |
| Cramps/swarming | 49 (61.3) |
| Cardiovascular | 6 (7.5) |
| Menstrual irregularities/infertility | 10 (12.5) |
| Depressive symptoms | 30 (37.5) |
| Number of symptoms ≤3 >3 | 36 (45.0) 44 (55.0) |
| Etiology Post thyroidectomy Autoimmune/other | 63 (78.8) 17 (21.3) |
| Levothyroxine No Yes | 3 (3.8) 77 (96.3) |
| TSH us level (mean ± SD) (mIU/L) | 5.5 ± 9.9 |
SD: standard deviation. TSH: thyroid stimulating hormone.
| Domains of score SF12 | Mean ± SD |
|---|---|
| Physical function | 42.61 ± 9.41 |
| Role physical | 37.36 ± 9.95 |
| Body pain | 41.64 ± 15.79 |
| General health | 37.59 ± 10.81 |
| Social function | 45.46 ± 11.98 |
| vitality | 48.75 ± 11.04 |
| Role emotional | 37.76 ± 10.14 |
| Mental health | 40.15 ± 11.18 |
| Physical score PCS | 41.20 ± 10.23 |
| Mental score MCS | 42.65 ± 10.79 |
SD: standard deviation.
| Variables | Mean ± SD | p-value | Adjusted ß (95%CI) |
|---|---|---|---|
| Fatigue | 0.007 | ||
| Yes | 39.39 ± 10.38 | −5.35 (−10.03, −0.68) | |
| No | 46.29 ± 8.01 | reference | |
| Concentration and memory problems | 0.009 | ||
| Yes | 37.87 ± 11.42 | - | |
| No | 43.79 ± 8.47 | - | |
| Cardiovascular problems | 0.09 | ||
| Yes | 34.52 ± 14.95 | - | |
| No | 41.74 ± 9.69 | - | |
| Weight gain | 0.19 | ||
| Yes | 39.12 ± 12.21 | - | |
| No | 42.26 ± 9.00 | - | |
| Depressive symptoms | 0.003 | ||
| Yes | 36.96 ± 11.09 | −6.68 (−10.98, −2.40) | |
| No | 43.75 ± 8.85 | reference | |
| Number of symptoms | 0.19 | ||
| ≤3 | 42.87 ± 7.99 | - | |
| >3 | 39.84 ± 11.67 | - | |
| Comorbidities | 0.025 | ||
| Yes | 38.72 ± 10.72 | −5.68 (−9.77, −1.59) | |
| No | 43.81 ± 9.10 | reference | |
| TSH levels (mIU/L) | −0.05* | 0.68 | - |
*Correlation coefficient. SD: standard deviation. TSH: thyroid stimulating hormone. CI: confidence interval.
The alteration of mental score was associated with presence of fatigue (p = 0.033), constipation (p = 0.033) and depression (p < 0.0001). The mental QOL was not associated with the thyroid function (TSH) and with socio demographic and socio economic data.
Our study, the first in our knowledge, aimed to explore the quality of life of hypothyroidism patients in Morocco. Our data showed that patients with hypothyroidism experienced mental and physical QOL reductions. The findings of the present study agree with previous reports [
The QOL of Moroccan patients with hypothyroidism was affected by their thyroid symptoms. Ngiap Chuan Tan et al. [
Similar to the previously reported results [
Our data showed that QOL in patients with hypothyroidism was not affected
| Variables | Mean ± SD | p-value |
|---|---|---|
| Number of symptoms | 0.067 | |
| ≤3 | 45.09 ± 11.43 | |
| >3 | 40.66 ± 9.93 | |
| Fatigue | 0.033 | |
| Yes | 41,12 ± 11.18 | |
| No | 46.96 ± 8.42 | |
| Cramps and swarming | 0.14 | |
| Yes | 41.24 ± 10.29 | |
| No | 44.88 ± 11.35 | |
| Constipation | 0.033 | |
| Yes | 39.34 ± 10.47 | |
| No | 44.64 ± 10.59 | |
| Depressive symptoms Yes No | 34.56 ± 8.44 47.51 ± 9.02 | <0.0001 |
| Comorbidities | 0.12 | |
| Yes | 44.45 ± 11.15 | |
| No | 40.77 ± 10.20 | |
| TSH levels (mIU/L) | 0.19* | 0.11 |
*Correlation coefficient, SD: standard deviation, TSH: thyroid stimulating hormone.
by TSH levels. The results are compatible with the findings from other studies [
Socio demographic and economic, aspects may affect QOL. In our study, although, different variables were assessed, such as educational level, employment status, marital status, and monthly income, we found no relation with QOL in hypothyroid patients. This results are in line with others studies [
This study is first of its kind that had reported the quality of life in hypothyroidism patients in Morocco. Our subjects were heterogeneous in terms of clinical and socio demographic characteristics. However, our study presents a limitation, which is the small sample size. Due to the context of the COVID 19 pandemic, recruitment of more patients was difficult.
In conclusion, our study showed that the mental and physical quality of life of the hypothyroid patients was altered. This alteration is primarily associated with the presence of symptoms (fatigue, memory and concentration problems, constipation, and depressive disorders) and the presence of comorbidities.
In this instance, its improvement should be the target of clinicians who are monitoring patients.
Researchers should pay closer attention to QOL studies in these patients for more improvements in this field.
It is also necessary to introduce the aspect of QOL in the teaching of this pathology for medical students.
The authors declare that they have no competing interest.
Benmaamar, S., Lazar, N., El Harch, I., Diagne, B.J., Chakri, I., Omari, M., Maiouak, M., Qarmiche, N., Otmani, N., Salhi, H., Berraho, M., El Fakir, S., El Ouahabi, H. and Tachfouti, N. (2023) Quality of Life among Patients with Hypothyroidism in a Morocco: A Cross-Sectional Study. Open Access Library Journal, 10: e10065. https://doi.org/10.4236/oalib.1110065