The Impact of Subclinical Hypothyroidism on the Quality of Life During Pregnancy: Mapping 5-Level Version of EQ-5D and ThyPRO-39

• Published in: Value in health Vol. 26; no. 7; pp. 1085 - 1097
• Main Authors: Tuzil, Jan, Pilnackova, Barbora Filkova, Watt, Torquil, Jiskra, Jan, Koudelkova, Marcela, Novotna, Eva, Tuzilova, Klara, Dolezal, Tomas, Bartakova, Jana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2023
• Subjects: EQ-5D; hypothyroidism; pregnancy; quality of life; ThyPRO-39; EQ-5D; quality of life; hypothyroidism; pregnancy; ThyPRO-39
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2023.02.015

To describe how subclinical hypothyroidism (SubHypo) influences the quality of life (QoL) during pregnancy. In primary data collection (NCT04167423), thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibodies, generic quality of life (QoL; 5-level version of EQ-5D [EQ-5D-5L]), and disease-specific QoL (ThyPRO-39) were measured among pregnant women. SubHypo during each trimester was defined according to the 2014 European Thyroid Association guidelines (TSH > 2.5, 3.0, and 3.5 IU/L, respectively; with normal FT4). Path analysis described relationships and tested mediation. Linear ordinary least squares, beta, tobit, and two-part regressions were used to map ThyPRO-39 and EQ-5D-5L. Alternative SubHypo definition was tested in sensitivity analysis. A total of 253 women at 14 sites (31 ± 5 years old, 15 ± 6 weeks pregnant) completed the questionnaires. Sixty-one (26%) had SubHypo and differed from 174 (74%) euthyroid women in smoking history (61% vs 41%), primiparity (62% vs 43%) and TSH level (4.1 ± 1.4 vs 1.5 ± 0.7 mIU/L, P < .001). EQ-5D-5L utility in SubHypo (0.89 ± 0.12) was lower than that in euthyroid (0.92 ± 0.11; P = .028) even after adjustment (difference −0.04, P = .033), whereas ocular (P = .001, ThyPRO-39), cognitive symptoms (P = .043), anxiety (P < .0001), and the composite score were higher. The impact of SubHypo on utility was mediated by anxiety. Results were confirmed by sensitivity analysis. Final mapping equation (ordinary least squares) includes goiter symptoms, anxiety, upset stomach, composite score (ThyPRO-39), FT4 levels, and week of pregnancy (determination coefficient 0.36). This is the first QoL mapping of SubHypo during pregnancy and the first evidence that SubHypo is associated with a negative impact on QoL. The effect is mediated by anxiety. EQ-5D-5L utilities can be generated based on ThyPRO-39 scores collected in pregnant euthyroid and patients with SubHypo. •Depending on diagnostic criteria, subclinical hypothyroidism affects between 1.5% and 43% of pregnancies. To date, none have assessed the quality of life in this health state, and specific symptoms are unknown.•Based on this primary data collection, we show that subclinical hypothyroidism is associated with ocular symptoms, cognitive symptoms, and increased anxiety (ThyPRO-39), resulting in decreased overall quality of life (5-level version of EQ-5D).•Specific symptoms of subclinical hypothyroidism can be considered in targeted screening during pregnancy. We tested several algorithms and chose the final one (linear least squares regression) to derive the mapping equation allowing to generate 5-level version of EQ-5D utilities based on ThyPRO-39 scores.