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Ismailov Saidganihodja Ibragimovich, MD, PhD, professor, director of Republican Specialized Scientific and Practical Medical Center of Endocrinology, Uzbekistan Abdurazakova Dilbar Sodikovna, Assistant of the Department of Hospital Therapy and endocrinology of Andijan State Medical Institute, Uzbekistan E- mail dilbar.abdurazakova@mail.ru
The quality of life of women with subclinical hypothyroidism, depending on the level of thyroid stimulating hormone
Abstract: 81 women of 20 up to 57 years were included in the investigation. We have observed the fall of physical and psychic components of life quality in women with SH living in Andijan region by the questionnaire SF-36, it was highly expressed in patients with 10,0 mU/l level of TSH. The evaluation of the readings of women's QL enables to evaluate the clinical picture of the disease objectively at the beginning and the dynamic study of the readings of QL will give the opportunity to determine the effectiveness of the therapy in the future.
Keywords: subclinical hypothyroidism, Thyroid Stimulating Hormone, quality of life.
The destruction of the function of thyroid glands relates to highly spread endocrine diseases in Uzbekistan. The spread and the structure of the disease of thyroid glands depends on the sex, age, ethnic and geographic factors, and mainly iodine supply of the organism [11].
Subclinical hypothyroidism (SH) — is a rather spread disease of thyroid glands that are accompanied with the increase of the level of Thyroid Stimulating Hormone (TSH) when the normal level is free T4 [5]. In most cases SH is often met among women [3; 8].
According to the data of different researchers the spread of SH among the population ranges in a wide diapason: 4-10% in the population and 7-26% among grown-ups [4; 7; 9].
A cross-section, multi centre, epidemiological research was
carried out in 8 big cities of India with the aim of studying the
spread of SH among grown-up population, Unnikrishnan A. et al, 2013 [15]. The spread of SH (the normal level of which is fT4 and TSH>5.50 ^IU/ml) is 8,02% in India (95% Index of Correctness (IC) 7,29-8,74). In women (8,73%) SH occurred more often than in men (7,17%, p = 0,0358).The highest point of frequency of SH (8,93%) was met in the group of over 55 years and the lowest point of the age group was met in the age group of 18-35 years (6,91%).The increased level of antibodies of thyroid peroxidase (anti-TPO)was determined in 21,85% (95% IC 20,74-22,95) cases. High readings of anti-TPO are often marked in women (26,04%), than in men (16,81%, p<0,05).
The spread of thyroid pathology among women of 18 up to 65 ofAndijan region of the Republic of Uzbekistan composes 69,8%, subclinical hypothyroidism composes 12,4%. When the level ofup-per limit of TSH norms (>2,5 mME/1) falls, the frequency of SH really increases up to 28,3%, and this state is kept not depending on the age of the investigated women [10].
The destruction of the function of thyroid glands leads to the fall of the quality of life of patients (QL). «Quality of Life» is determined as integral characteristics of physical, psychological, emotional and social functioning of patients, and is based on his subjective understanding [6].
Aim ofthe research: to evaluate the life quality ofwomen with subclinical hypothyroidism depending on the level of TSH.
Patients and methods.
81 women of 20 up to 57 years were included in the investigation. The average age composed 40,4±10,1 years. The basic group was composed of 60 women with subclinical hypothyroidism, the average age composed 42,0±10,4 years. Depending on the level of
TSH, the patients are divided into 2 groups: the 1st group consisted of 39 women with TSH level was determined for the first time and the normal level was free T4, a second research of both data was made after 2-3 months, and also the degree of anti corpuscles of thyroid peroxidase was determined (anti-TPO).
The level of TSH, freeT4, anti-TPO in the plasma of the blood were determined by radio immune method with using commercial complex of the firm "Immunotech" (the Chezck Republic) on the base of RCSPMCE the Ministry of Health Care of the RU.
For the evaluation of lives of patients a short version of the questionnaire of health (MOS 36-Item Short-Form Health Survey — MOS SF-36) was used [17]. 36 parts were grouped in 8 scales: physical functioning (PF), role functioning (RF), body ache (B), general condition of health (GH), life activity (LA), social functioning (SF), role emotional functioning (REF) and psychic health (PH). The data ofeach scale varybetween 0 and 100, where 100 presents full health. All the scales form 2 readings: physical (PCH) and psychological component of health (PCH). The readings of each sub scale were counted by using a special key, defended by an International author's right [16].The results are presented as the ball marks of 8 scales. They are composed in such a way that a higher mark points to a higher level of quality of life (QL).
The received data were worked out with the help of computer program STATISTICA 6 and Biostat. Quantity readings were presented in the form of M±SD. The difference between the groups were considered as statistically valuable when P is <0,05.
Results
Auto immune thyroids, associated with thyroid peroxidase carrying anti corpuscles is one of the frequent causes of SH development. SH usually comes without symptoms, but some patients can complain to unspecific complaints of malaise, exhausting, gaining weight, occlusions in intestines, that are characterized to hypothyroidism [1; 2].
Analysis ofpatients' complaints of the 1st and 2nd groups didn't reveal considerable differences (Picture1). However the women with the level >10,0 mU/l TSH complained of increased exhausting more often (76,9% and 81,0% in accordance with the 1st and 2nd groups), malaise (56,4% and 76,2%), heartbeat (51,3% and 66,7%), the sense of sadness and alarm (53,8% and 71,4%), headache (48,7% and 61,9%), dryness of the skin (46,2% and 57,1%), worsening of the memory and attention (61,5% and 61,9%), the feeling of numbness (35,9% and 61,9%) bad tolerance to cold (41,0% and 47,6%) and destruction of Menstrual Cycle (43,6% and 57,1%).
Section 7. Medical science
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Picture 1. The frequency of the symptoms of hypothyroidism in the examined patients 1. - Increased exhausting; 2. - malaise; 3. - Heartbeat; 4. - the sense of sadness and alarm; 5. - headache; 6. - dryness of the skin; 7. - worsening of the memory and attention; 8. - the feeling of numbness; 9. - bad tolerance to cold; 10. - destruction of Menstrual Cycle.
The presence of subclinical hypothyroidism resulted in the worsening of the life quality. Especially, the analysis of physical components of health showed, that SH influenced on the ability of accomplishment of different physical exertion (the decrease of PF compared to the readings of control group of the 1st and 2nd groups
and 21,2% and 24,8% in accordance), daily role activity (RA — 31,7% and 36,3% in accordance), the ability of doing daily chores -B 32,3% and 36,4% in accordance), that reflected the decrease of subjective self evaluation of the patients' health (PCH — 30,1% and 35,2% in accordance) (Рicture 2).
F Control
r2ndgmu|h inctduetoIheoanTndl ■ * fill ind due to Ite l*t group
Picture 2. Readings of physical component of heath quality of women's lives with SH
So, half of the patients with SH (51,3% and 52,4% in accordance with the 1st and 2nd groups) pointed out that they are not able to do all the household affairs with the connection of their bad physical condition (tidying the room, ability to go to a grocery, walking down the stairs, transferring heavy things).comparative analysis ofQuality ofLife (QL) ofwomen in the 1st and 2nd groups had statistically important differences by parameters of general health ^=0,01) and PCH ^=0,001).
When analyzing the psychological components of health we have observed low quality of life (falling to 15% in the 1st group and 17.9% in the 2nd group) ^ictu^), it shows the limit of social contacts, decrease of the level of dealing with others with the connection of worsening of emotional and physical state, limit in daily household chores, causative worsening of emotional state.
ph pch
■ Control »lit group 13% fall lit due the corwoi
aindgjoup ■ ^ i*112nd due to Ihe contnol 9 fait ¡net due iu Hie 1 sr group
Picture 3.Readings of psychological components of health of women's life quality with SH
The readings of the scale (19,8% and 23,1% in accordance with the 1st and 2nd groups) initially was lower than the average norm in the control, it means the decrease of life activity of the patients, i. e. women do not think themselves strong and fully energetic. Low balls by the component of SF (14,3% and 16,7% in accordance) means considerable limit in social contacts, decrease of the level of dealing due to the worsening of the emotional and physical state. Average readings of REF (12,2% and 14,9% in accordance) were also lower comparing to clinic control and speaks about the presence of women's problems (worry about their health, bad mood). They result in considerably negative influence on their social activity and daily role activity. The reading of PH (13,8% and 16,9% in accordance) was initially low comparing to the control, it means about the lability of the mood and presence of alarm-depressive state of the examined women. Comparative analysis of the readings of the 1st and 2nd groups didn't reveal any differences.
Discussion
The problem of life quality of patients is studied in most works and multicentre investigations all over the world. The level of QL leads to position by the quantity and questionnaires. It enables widening the abilities of doctors in order to evaluate the state of patients much clearer [14]. A. V. Podzolkov and V. V. Fadeev (2010) decided to try evaluating the QL of the patients with high normal (2,0-4,0mU/l) and low normal (0,4-2,0 mU/L) of TSH. It was showed that average readings oflife quality of the examined women are in the middle and high levels. However there is a considerable difference of readings of QL between the women from the group with high and low normal intervals of TSH. Inspite of the fact that
summary levels of QL between 2 groups were close enough, it was determined that the patients from the group with high normal TSH had the worst readings. While investigating a statistically important difference between some parameters such as life activity, physical functioning, general condition of health and others were revealed.
According to the data of Madiyarova M.Sh. and others [12], differences, practically by none of the investigated parameters, including readings of QL, level of alarm and depression, cognitive functions, symptoms of hypothyroidism, lipid specter, between the patients with different level of TSH inside of any group was revealed. Only the level of TSH (p< 0,05) was differentiated.
We all know that both manifesting and subclinical development of hypothyroidism is accompanied with the fall of the QL of patients. Morgunova T. B. and others [13] determined that the readings of QL (except general health and role emotional functioning) in patients with hypothyroidism were statistically considerably lower than the group with healthy people. It is supposed that one of the causes is higher rate of depressing disturbances in patients with hypothyroidism comparing to general population.
Conclusion
1. We have observed the fall of physical and psychic components of life quality in women with SH living in Andijan region by the questionnaire SF-36, it was highly expressed in patients with 10,0 mU/l level of TSH.
2. The evaluation of the readings of women's QL enables to evaluate the clinical picture of the disease objectively at the beginning and the dynamic study of the readings of QL will give the opportunity to determine the effectiveness of the therapy in the future.
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