Advertisement

Endocrine

, Volume 63, Issue 1, pp 87–93 | Cite as

The relationship between quality of life, cognition, and thyroid status in Graves’ disease

  • Cínthia Minatel RiguettoEmail author
  • Arnaldo Moura Neto
  • Marcos Antônio Tambascia
  • Denise Engelbrecht Zantut-Wittmann
Original Article
  • 109 Downloads

Summary

Purpose

To assess quality of life (QoL) and cognitive function among Graves’ disease (GD) patients with different thyroid status, with and without ophthalmopathy.

Methods

This is a cross-sectional clinic-based study involving 154 patients with GD (81.27% were female, mean age 45.6 ± SD 11.2 years) and 54 (35.06%) had ophthalmopathy. Data were collected after an informed consent from all patients was obtained. All patients completed the 36-Item Short Form Health Survey and Mini-Mental State Examination. Patients with ophthalmopathy also completed the Graves’ Orbitopathy Quality of Life Questionnaire.

Results

Patients with hyperthyroidism presented a greater impairment in QoL when compared to euthyroidism group. A lower score in physical role functioning was found in both subgroups with active disease (hyperthyroidism and euthyroidism using thionamides). A lower score was also seen in visual function, only in patients with hyperthyroidism, without difference in appearance. No difference was found in cognition between patients. Younger ages at diagnosis, male sex, euthyroidism and absence of ophthalmopathy were factors associated with better QoL, as well as a shorter disease duration was associated with better recall, attention and calculation.

Conclusions

An impairment in QoL among patients with active GD was evidenced, even in those receiving thionamides and in euthyroidism. Ophthalmopathy was a factor associated with a poor QoL and no clear evidence of cognitive impairment was demonstrated.

Keywords

Graves’ disease Graves’ ophthalmopathy Quality of life Cognitive function Hyperthyroidism 

Notes

Acknowledgements

We acknowledge all the patients who voluntarily participated in our study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    T.J. Smith, L. Hegedus, Graves’ disease. N. Engl. J. Med. 375(16), 1552–1565 (2016).  https://doi.org/10.1056/NEJMra1510030 CrossRefGoogle Scholar
  2. 2.
    H.B. Burch, D.S. Cooper, Management of Graves disease: a review. JAMA 314(23), 2544–2554 (2015).  https://doi.org/10.1001/jama.2015.16535 CrossRefGoogle Scholar
  3. 3.
    M. Bauer, T. Goetz, T. Glenn, P.C. Whybrow, The thyroid-brain interaction in thyroid disorders and mood disorders. J. Neuroendocrinol. 20(10), 1101–1114 (2008).  https://doi.org/10.1111/j.1365-2826.2008.01774.x CrossRefGoogle Scholar
  4. 4.
    M. Ritchie, B.B. Yeap, Thyroid hormone: Influences on mood and cognition in adults. Maturitas 81(2), 266–275 (2015).  https://doi.org/10.1016/j.maturitas.2015.03.016. CrossRefGoogle Scholar
  5. 5.
    A. Vogel, T.V. Elberling, M. Hording, J. Dock, A.K. Rasmussen, U. Feldt-Rasmussen et al. Affective symptoms and cognitive functions in the acute phase of Graves’ thyrotoxicosis. Psychoneuroendocrinology 32(1), 36–43 (2007).  https://doi.org/10.1016/j.psyneuen.2006.09.012 CrossRefGoogle Scholar
  6. 6.
    M. Abraham-Nordling, O. Torring, B. Hamberger, G. Lundell, L. Tallstedt, J. Calissendorff et al. Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid 15(11), 1279–1286 (2005).  https://doi.org/10.1089/thy.2005.15.1279 CrossRefGoogle Scholar
  7. 7.
    P. Cramon, K.H. Winther, T. Watt, S.J. Bonnema, J.B. Bjorner, O. Ekholm et al. Quality-of-life impairments persist 6 months after treatment of Graves’ hyperthyroidism and toxic nodular goiter: a prospective cohort study. Thyroid 26(8), 1010–1018 (2016).  https://doi.org/10.1089/thy.2016.0044 CrossRefGoogle Scholar
  8. 8.
    C. Terwee, I. Wakelkamp, S. Tan, F. Dekker, M.F. Prummel, W. Wiersinga, Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur. J. Endocrinol. 146(6), 751–757 (2002)CrossRefGoogle Scholar
  9. 9.
    M.N. Gerding, C.B. Terwee, F.W. Dekker, L. Koornneef, M.F. Prummel, W.M. Wiersinga, Quality of life in patients with Graves’ ophthalmopathy is markedly decreased: measurement by the medical outcomes study instrument. Thyroid 7(6), 885–889 (1997).  https://doi.org/10.1089/thy.1997.7.885 CrossRefGoogle Scholar
  10. 10.
    G.J. Kahaly, F. Petrak, J. Hardt, S. Pitz, U.T. Egle, Psychosocial morbidity of Graves’ orbitopathy. Clin. Endocrinol. 63(4), 395–402 (2005).  https://doi.org/10.1111/j.1365-2265.2005.02352.x CrossRefGoogle Scholar
  11. 11.
    T.V. Elberling, A.K. Rasmussen, U. Feldt-Rasmussen, M. Hording, H. Perrild, G. Waldemar, Impaired health-related quality of life in Graves’ disease. A prospective study. Eur. J. Endocrinol. 151(5), 549–555 (2004).  https://doi.org/10.1530/eje.0.1510549 CrossRefGoogle Scholar
  12. 12.
    H.M. Conaglen, J.A.U. Tamatea, J.V. Conaglen, M.S. Elston, Treatment choice, satisfaction and quality of life in patients with Graves’ disease. Clin. Endocrinol. (2018).  https://doi.org/10.1111/cen.13611
  13. 13.
    J.G. Ljunggren, O. Torring, G. Wallin, A. Taube, L. Tallstedt, B. Hamberger et al.Quality of life aspects and costs in treatment of Graves’ hyperthyroidism with antithyroid drugs, surgery, or radioiodine: results from a prospective, randomized study. Thyroid 8(8), 653–659 (1998).  https://doi.org/10.1089/thy.1998.8.653 CrossRefGoogle Scholar
  14. 14.
    C. Chattopadhyay, N. Chakrabarti, S. Ghosh, An assessment of psychiatric disturbances in Graves' disease in a medical college in eastern India. Niger. J. Clin. Pract. 15(3), 276–279 (2012).  https://doi.org/10.4103/1119-3077.100620 CrossRefGoogle Scholar
  15. 15.
    M.F. Schreckenberger, U.T. Egle, S. Drecker, H.G. Buchholz, M.M. Weber, P. Bartenstein et al. Positron emission tomography reveals correlations between brain metabolism and mood changes in hyperthyroidism. J. Clin. Endocrinol. Metab. 91(12), 4786–4791 (2006).  https://doi.org/10.1210/jc.2006-0573 CrossRefGoogle Scholar
  16. 16.
    W. Zhang, X. Liu, Y. Zhang, L. Song, J. Hou, B. Chen et al.Disrupted functional connectivity of the hippocampus in patients with hyperthyroidism: evidence from resting-state fMRI. Eur. J. Radiol. 83(10), 1907–1913 (2014).  https://doi.org/10.1016/j.ejrad.2014.07.003 CrossRefGoogle Scholar
  17. 17.
    L.C. Delfino, A. Zunino, V. Sapia, M. Croome, V. Ilera, A.T. Gauna, Related quality of life questionnaire specific to dysthyroid ophthalmopathy evaluated in a population of patients with Graves’ disease. Arch. Endocrinol. Metab. 61(4), 374–381 (2017).  https://doi.org/10.1590/2359-3997000000252 CrossRefGoogle Scholar
  18. 18.
    K.A. Ponto, S. Merkesdal, G. Hommel, S. Pitz, N. Pfeiffer, G.J. Kahaly, Public health relevance of Graves’ orbitopathy. J. Clin. Endocrinol. Metab. 98(1), 145–152 (2013).  https://doi.org/10.1210/jc.2012-3119 CrossRefGoogle Scholar
  19. 19.
    C. Ferlov-Schwensen, T.H. Brix, L. Hegedus, Death by suicide in Graves’ disease and Graves’ orbitopathy: A Nationwide Danish Register Study. Thyroid 27(12), 1475–1480 (2017).  https://doi.org/10.1089/thy.2017.0365 CrossRefGoogle Scholar
  20. 20.
    E.H. Gan, S.H.S. Pearce, The thyroid in mind: cognitive function and low thyrotropin in older people. J. Clin. Endocrinol. Metab. 97(10), 3438–3449 (2012).  https://doi.org/10.1210/jc.2012-2284 CrossRefGoogle Scholar
  21. 21.
    M.H. Samuels, I. Kolobova, A. Smeraglio, D. Peters, J.S. Janowsky, K.G. Schuff, The effects of levothyroxine replacement or suppressive therapy on health status, mood, and cognition. J. Clin. Endocrinol. Metab. 99(3), 843–851 (2014).  https://doi.org/10.1210/jc.2013-3686 CrossRefGoogle Scholar
  22. 22.
    M.H. Samuels, R. Kaimal, A. Waring, H.A. Fink, K. Yaffe, A.R. Hoffman et al.Thyroid function variations within the reference range do not affect quality of life, mood, or cognitive function in community-dwelling older men. Thyroid 26(9), 1185–1194 (2016).  https://doi.org/10.1089/thy.2016.0104 CrossRefGoogle Scholar
  23. 23.
    J.H. Moon, S. Ahn, J. Seo et al. The effect of long-term thyroid-stimulating hormone suppressive therapy on the cognitive function of elderly patients with differentiated thyroid carcinoma. J. Clin. Endocrinol. Metab. 99(10), 3782–3789 (2014).  https://doi.org/10.1210/jc.2013-4454 CrossRefGoogle Scholar
  24. 24.
    I.M. Benseñor, P.A. Lotufo, P.R. Menezes, M. Scazufca, Subclinical hyperthyroidism and dementia: the Sao Paulo Ageing & Health Study (SPAH). BMC. Public. Health 10, 298–298 (2010). doi.org/10.1186/1471-2458-10-298CrossRefGoogle Scholar
  25. 25.
    G. Ceresini, F. Lauretani, M. Maggio, et al. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in older Italians and is associated with cognitive impairment. J Am Geriatr Soc (2018).  https://doi.org/10.1111/j.1532-5415.2008.02080.
  26. 26.
    J.H. Moon, Y.J. Park, T.H. Kim, J.W. Han, S.H. Choi, S. Lim, et al. Lower-but-normal serum TSH level is associated with the development or progression of cognitive impairment in elderly: Korean Longitudinal Study on Health and Aging (KLoSHA). J. Clin. Endocrinol. Metab. 99(2), 424–432 (2014).  https://doi.org/10.1210/jc.2013-3385 CrossRefGoogle Scholar
  27. 27.
    C.E. Aubert, D.C. Bauer, B.R. da Costa, M. Feller, C. Rieben, E.M. Simonsick et al. The association between subclinical thyroid dysfunction and dementia: the health, aging and body composition (Health ABC) study. Clin. Endocrinol. 87(5), 617–626 (2017).  https://doi.org/10.1111/cen.13458 CrossRefGoogle Scholar
  28. 28.
    B.B. Yeap, H. Alfonso, S.A. Chubb, G. Puri, G.J. Hankey, L. Flicker et al. Higher free thyroxine levels predict increased incidence of dementia in older men: the Health in Men Study. J. Clin. Endocrinol. Metab. 97(12), E2230–E2237 (2012).  https://doi.org/10.1210/jc.2012-2108 CrossRefGoogle Scholar
  29. 29.
    M. Lillevang-Johansen, I. Petersen, K. Christensen, L. Hegedus, T.H. Brix, Is previous hyperthyroidism associated with long-term cognitive dysfunction? A twin study. Clin. Endocrinol. 80(2), 290–295 (2014).  https://doi.org/10.1111/cen.12255 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Endocrinology Division, Faculty of Medical SciencesUniversity of CampinasCampinasBrazil

Personalised recommendations