Quality of life in refractory Graves’ hyperthyroidism: a cross-sectional study comparing long-term ATDs therapy versus L-T4 replacement after iodine-131

Objective Evaluate and compare the patient-reported quality of life (QoL) outcomes in Graves’ disease patients on long-term antithyroid drugs (ATDs) therapy and levothyroxine (L-T4) replacement after iodine-131, and explore factors influencing QoL. Methods This single-center cross-sectional observational study included refractory Graves’ hyperthyroidism patients who were followed in outpatient between January 2015 and July 2024. Patients were divided into two groups based on their current treatment: the ATDs group and the L-T4 group. We collected demographic and clinical characteristics and assessed cross-sectionally QoL using the thyroid-related patient-reported outcome-39 questionnaire (ThyPRO-39). We compared QoL scores between the two groups and examined factors associated with QoL using regression analyses. Results A total of 499 patients were enrolled, of whom 300 completed the ThyPRO-39 (response rate 60.1%; 172 in the ATDs group and 128 in the L-T4 group). Compared with the ATDs group, patients in the L-T4 group had significantly higher scores across several subscales, including hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, anxiety, emotional susceptibility, social life, daily life, appearance, overall QoL, and the composite scale (all P < 0.05), indicating lower QoL. In the multiple linear regression analysis, female was positively correlated with the scores of hypothyroidism symptoms, tiredness and depressivity (all P < 0.05). Male was negatively correlated with the score of the composite scale, while L-T4 group was positively correlated with the score of the composite scale (all P < 0.05). Conclusion In patients with refractory Graves’ hyperthyroidism, female patients and those undergoing long-term L-T4 replacement therapy after iodine-131 treatment were associated with lower QoL.