Residual Symptoms and Quality of Life in Female Patients with Hypothyroidism and Cardiovascular Disease

Background Current clinical management of patients with hypothyroidism emphasizes thyroid hormone replacement at doses that normalize serum thyroid-stimulating hormone (TSH) levels. However, biochemical correction does not always translate into symptom resolution or restored health-related quality of life (QoL). We evaluated whether higher TSH levels within the reference range would be associated with worse Thyroid-Related Patient-Reported Outcome (ThyPRO)-39 scores, reflecting greater symptom burden. Objective The objective of this study was to assess residual symptoms and health-related quality of life in women with normal TSH levels in patients with cardiovascular disease being treated for hypothyroidism. Materials and methods We prescreened 96 participants who completed study assessments. Following the TSH obtained at the study visit, 14 participants were excluded due to TSH values falling outside the predefined euthyroid range (0.35-4.94 ?IU/mL), resulting in a final cohort of 82 women. We also investigated whether comorbidities contributed to symptom burden. Results Although mean composite scores were numerically higher in the upper TSH quartiles, neither multivariable regression nor ordered trend testing demonstrated a significant association between increasing TSH and overall symptom burden (Jonckheere-Terpstra p = .333). Notably, major depressive disorder (MDD) (?=16.93, 95% CI 8.22?25.65; p<.001) and hypertension (HTN) (?=12.45, 95% CI 2.24?22.66; p=.018) were independently associated with greater Thy-PRO-39 scores. Conclusions MDD and HTN were independently associated with higher Thy-PRO-39 scores, suggesting that comorbidities may be more strongly related to persistent symptoms than modest variation in TSH within the euthyroid range. Our results suggest that in patients with hypothyroidism and cardiovascular disease, comorbidities may be particularly important when interpreting residual symptoms in biochemically euthyroid patients.