A multicenter, prospective cohort of 450 patients receiving hemodialysis examined the association of thyroid status with health-related quality of life and depressive symptoms over a 2-year period. Thyroid status was defined by thyroid-stimulating hormone (TSH) testing. The health-related quality of life outcome was ascertained by the Short-Form 36 surveys (SF-36), and depression symptoms determined by the Beck Depression Inventory-II (BDI-II) questionnaires. The investigators then assessed the association of baseline and time-dependent TSH (measured in one central laboratory), with eight SF-36 domains (physical functioning, role limitations due to physical health, pain, general health, energy/fatigue, social functioning, role limitations due to emotional problems, and emotional wellbeing) and BDI-II scores.
The study discovered that patients with the highest baseline TSH were associated with a five-point lower Short-Form 36 domain score for energy/fatigue (P = .04). The highest time-dependent tertile was associated with a five-point lower physical function score (P = .03). Additionally, higher baseline serum TSH was associated with lower role limitations due to physical health (P = .04); energy/fatigue (P = .03); and pain scores (P = .002); equivalent to five-, three-, and five-point lower scores, respectively, for every 1-standard deviation higher TSH. Higher time-dependent TSH levels were associated with lower role limitations due to physical health scores (P = .03), equivalent to a three-point decline for every 1-standard deviation higher TSH. Baseline and time-dependent TSH were not associated with any changes in BDI-II scores.
Investigators concluded that CKD patients undergoing hemodialysis with higher TSH levels were independently associated with an impaired HRQOL, in particular scoring lower in the domains of physical health, energy/fatigue, and pain. Further studies, however, are needed to determine the underlying mechanisms by which thyroid functional disease impairs functional status and wellbeing.
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