Quality of life in patients with overt hypothyroidism: a systematic review

OBJECTIVE: Persistent symptoms and impaired quality of life (QoL) in hypothyroidism despite treatment with levothyroxine (LT4) receive increasing attention. We aimed at reviewing QoL in long-term treated hypothyroidism. DESIGN: This is a systematic review and meta-analysis. METHODS: The systematic literature search "hypothyroidism AND quality of life" was conducted in PubMed and Embase. We considered studies on QoL in adults with Hashimoto's thyroiditis (HT) or congenital hypothyroidism (CH), treated with levothyroxine for 6 months. Seven hundred and ninety-seven articles were screened for title-abstract, and 52 were assessed by full-text evaluation. Seventeen articles met eligibility criteria and were included. We summarize study finding within the domains mental well-being, physical well-being, and social role supported by meta-analyses. Studies were evaluated using Newcastle-Ottawa Scale. Two meta-analyses were performed using random effects model. RESULTS: Fourteen studies included patients with HT, and 3 evaluated QoL in CH. Mental and physical well-being was impaired in 10 studies, and social role impairments were detected in 7 studies. Study design was to some degree flawed in 13 studies, potentially hampering conclusions. The most frequent methodological issues were incomparable groups or lack of information on potential confounders like body mass index or comorbidity. However, when focusing on the methodologically most robust studies, conclusions remained and were supported by meta-analyses. CONCLUSION: Based on this systematic review and meta-analysis, despite methodological concerns in the available literature, QoL in patients with hypothyroidism is impaired. Future studies should address potential residual bias displayed and explore the impact of disease etiology, duration, and timing of diagnosis in relation to comorbidity, to reveal groups of patients susceptible to inadequate treatment response and guide our way to improve QoL in hypothyroidism.