Background: Subclinical hypothyroidism (SCH) is defined as high TSH and normal thyroxine. Data on the effects of early substitution by levothyroxine on psychophysical health in SCH are still not consistent enough to support its introduction.
Methods: Clinical parameters, biochemical data and quality of life (Short Form 36 questionnaire) were measured before the intervention and 3 months after the euthyroid state had been achieved in SCH patients.
Results: Significant reduction in body weight (p=0.030), systolic and diastolic blood pressure (p=0.024, p=0.019), homocysteine (p<0.001), leukocytes and neutrophils (p=0.011, p=0.001), INR (p=0.049), K levels (p=0.040, p=0.013), HbA1c (p=0.001), fasting insulin (p<0.001) and insulin resistance measured by HOMA index (p<0.001), lipid parameters (total cholesterol (p<0.001), LDL-cholesterol (p<0.001), triglycerides (p=0.007), apoB (p=0.022), Lp(a) (p<0.001), LDL/HDL (p=0.008), LAP (p=0.04) and apoB/apoA1 ratios (p<0.023)), TSH (p<0.001) and tAbs (p<0.001) was recorded. Frequency of fatty liver (20% to 2.9%, p=0.016), hyperlipidemia (85% to 65.7%, p=0.001) and metabolic syndrome (34.3% to 2.9%, p=0.070) significantly decreased. A statistically significant positive association was found between the average dose of levothyroxine and changes in physical functioning (r=0.391, p=0.020), vitality (r=0.393, p=0.020), mental health (r=0.374, p=0.027) and overall dimensions of mental health (r=0.376, p=0.026). With increasing doses of levothyroxine, the previously listed scores of SF 36 grew (r=0.296, p=0.084).
Conclusions: Early substitution of SCH improved the many clinical and biochemical parameters related to cardiovascular risk. Quality of life was also improved, and correlated only with thyroxine doses suggesting an indirect relationship between the degree of hypothyroidism and quality of life.
Uvod: Supklinička hipotireoza (SCH) definiše se kao povišen TSH uz normalne vrednosti tiroksina. Podaci o efektima rane supstitucije na psihofizički status individua sa SCH nisu dovoljno konzistentni da bi podržali njeno uvođenje.
Metode: Klinički i biohemijski parametri, kao i kvalitet života mereni su pre intervencije i 3 meseca nakon postiza nja eutiroidnog stanja.
Rezultati: Zabeležena je značajna redukcija telesne mase (p=0,030), sistolnog i dijastolnog krvnog pritiska (p=0,024, p=0,019), homocisteina (p<0,001), leukocita i neutrofila u krvi (p=0,011, p=0,001), INR-a (p=0,049), nivoa K (p=0,040, p=0,013), HbA1c (p=0,001), insulinemije bazno (p<0,001) i insulinske rezistencije merene HOMA indeksom (p<0,001), lipidnih parametara (ukupnog holesterola (p<0,001), LDL-holesterola (p<0,001), triglicerida (p=0,007), apoB (p=0,022), Lp(a) (p<0,001), LDL/HDL (p=0,008), LAP (p=0,04) i apoB/apoA1 (p<0.023)), TSH (p<0,001) i tAbs (p<0.001). Učestalost masne jetre (sa 20% na 2,9%, p=0,016), hiperlipidemije (sa 85% na 65,7%, p=0,001) i metaboličkog sindroma (sa 34,3% na 2,9%, p=0,070) značajno je snižena. Statistički značajna pozitivna povezanost nađena je između prosečne doze levotiroksina i promena u fizičkom funkcionisanju (r=0,391, p=0,020), vi - talnosti (r=0,393, p=0,020), mentalnom zdravlju (r=0,374, p=0,027) i ukupnoj dimenziji mentalnog zdravlja (r=0,376, p=0,026). Sa porastom doze levotiroksina, prethodno navedeni skorovi SF 36 su rasli (r=0,296, p=0,084).
Zaključak: Rana supstitucija supkliničke hipotireoze poboljšava brojne kliničke i biohemijske parametre, koji su u vezi sa kardiovaskularnim rizikom. Kvalitet života je takođe poboljšan i korelira jedino sa dozama levotiroksina, sugerišući indirektnu vezu između dubine hipotiroidnog stanja i kvaliteta života.
Keywords: biochemical parameters; early T4 substitution; quality of life; subclinical hypothyroidism.