Quality of Life in patients with Overt Hypothyroidism. A systematic review

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-termly treated hypothyroidism. Systematic review and meta-analysis. 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. 797 articles were screened for title-abstract,52 were assessed by full-text evaluation. 17 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. Fourteen studies included patients with HT, three evaluated QoL in CH. Mental and physical well-being was impaired in ten studies, social role impairments were detected in seven studies. Study design was to some degree flawed in thirteen studies, potentially hampering conclusions. The most frequent methodological issues were incomparable groups or lack of information on potential confounders like BMI or comorbidity. However, when focusing on the methodologically most robust studies, conclusions remained and were supported by meta-analyses. 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.