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Sofie Larsen Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen

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Lars Rejnmark Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

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Eva Ebbehøj Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen

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Åse Krogh Rasmussen Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen

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Jakob Bue Bjorner QualityMetric (an Optum Company), Lincoln, R.I., USA

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Torquil Watt Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet, Copenhagen

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Introduction and Purpose: Use of electronic questionnaires to collect health-related quality-of-life data has evolved as an alternative to paper questionnaires. For the electronic questionnaire to be used interchangeably with the validated paper questionnaire, measurement properties similar to the original must be demonstrated. The aim of the present study was to assess the equivalence between the paper version and the electronic version of the thyroid-related quality-of-life questionnaire ThyPRO. Methods: Patients with Graves' hyperthyroidism or autoimmune hypothyroidism in a clinically stable phase were included. The patients were recruited from two endocrine outpatient centers. All patients completed both versions in a randomized test-retest set-up. Scores were compared using intraclass correlation coefficients (ICCs), paired t tests and Bland-Altman plots. Limits of agreement were compared with data from a previous paper-paper test-retest study. Results: 104 patients were included. ICCs were generally high for the 13 scales, ranging from 0.76 to 0.95. There was a small but significant difference in the scale score between paper and electronic administration for the Cosmetic complaints scale, but no differences were found for any other scale. Bland-Altman plots showed similar limits of agreement compared to the earlier test-retest study of the paper version of ThyPRO. Conclusion: Based on our analyses using ICCs, paired t tests and Bland-Altman plots, we found adequate agreement between the paper and electronic questionnaires. The statistically significant difference in score found in the Cosmetic complaints scale is small and probably clinically insignificant.

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Torquil Watt Department of Endocrinology, Copenhagen University Hospital Rigshospitalet
Institute of Public Health, University of Copenhagen

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Jakob Bue Bjorner Institute of Public Health, University of Copenhagen
National Research Centre for the Working Environment, Copenhagen

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Mogens Groenvold Institute of Public Health, University of Copenhagen
Department of Palliative Medicine, Bispebjerg Hospital

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Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Åse Krogh Rasmussen Department of Endocrinology, Copenhagen University Hospital Rigshospitalet

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Ulla Feldt-Rasmussen Department of Endocrinology, Copenhagen University Hospital Rigshospitalet

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Purpose: To evaluate the relationship between thyroid variables and health-related quality of life (QoL) in patients with autoimmune hypothyroidism, using the thyroid-specific QoL questionnaire ThyPRO. Methods: In a cross-sectional study, responses to the ThyPRO from 199 outpatients with autoimmune hypothyroidism were analyzed in relation to thyroid volume, thyroid function and markers of thyroid autoimmunity. Based on a classical QoL framework, we hypothesized that physiological dysfunction caused specific physical and psychological symptoms, which affected functioning and well-being, and consequently participation in life and QoL. These hypotheses were tested through multiple regression and multivariate path analysis models. Results: None of the thyroid function tests were associated with QoL scores. However, in the pairwise regression, the thyroid peroxidase antibody (TPOAb) level was associated with several QoL outcomes: Goitre Symptoms (p = 0.024), Depressivity (p = 0.004), Anxiety (p = 0.004), Emotional Susceptibility (p = 0.005) and Impaired Social Life (p = 0.047). In the multivariate model, the TPOAb level was related to Goitre Symptoms (r = 0.17, p = 0.019), Depressivity (r = 0.24, p = 0.001), and Anxiety (r = 0.23, p = 0.002), but no longer to Emotional Susceptibility or Impaired Social Life, indicating that the effect on these were mediated through an effect on the symptom scales (i.e. Goitre Symptoms, Depressivity and Anxiety). Conclusion: Health-related QoL, evaluated with state-of-the-art QoL methodology, was related to TPOAb level but not to thyroid function. This raises the hypothesis that autoimmunity, independent of thyroid function, impacts on QoL in patients with autoimmune hypothyroidism, especially in terms of psychological symptoms. Longitudinal studies, in initially untreated patients, are needed to test this hypothesis.

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Signe Buhl Gram Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Jacob Høygaard Rasmussen Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Jens Bentzen Department of Oncology, Herlev Hospital, Copenhagen University, Copenhagen, Denmark

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Giedrius Lelkaitis Department of Pathology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Christian von Buchwald Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Christoffer Holst Hahn Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark

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Objectives: The aims of this study were to report the risk of thyroid malignancy in cases of either benign fine-needle aspiration (FNA) or without FNA performed, and to investigate possible predictive factors for thyroid malignancy in a population with recent moderately low iodine intake. Methods: All patients referred for thyroid surgery in a tertiary cancer centre between 2000 and 2016 were included (n = 3,703). After excluding cases indicating malignant histology, we included group 1: patients with benign FNA (n = 764), and group 2: patients without FNA (n = 740), leaving 1,504 eligible for further investigation. Information on age, gender, tracheal compression or dislocation, thyroid specimen weight, scintigraphy, ultrasound, medically treated thyrotoxicosis, serum stimulating thyroid hormone, indication for surgery, TNM classification, stage, and outcome were retrieved. Results: The malignancy risk was 7.6% (58/764) in group 1 and 6.8% (50/740) in group 2. Patients with T2–4 tumours constituted 2.2% (33/1,504). In the combined groups, ultrasound verified that solitary solid tumour was predictive for malignancy (p = 0.01 by χ<sup>2</sup>, and OR = 1.69, p = 0.02 in multiple logistic regression). For group 1 patients, thyrotoxicosis (which in this case was medically treated) was a significant predictive factor for malignancy (p = 0.04). Conclusions: The risk of malignancy of 7.6% and 6.8% was high, considering that patients with malignant FNA, suspicious FNA, or clinical findings indicating malignancy were excluded, and 2.2% of these malignancies were stages T2–4. In cases with solitary solid tumour on ultrasound, the risk of malignancy should not be ignored, even with benign FNA.

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Rodrigo Moreno-Reyes R Moreno-Reyes, Department of Nuclear Medicine, Université Libre de Bruxelles, Bruxelles, 1050, Belgium

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Ulla Feldt-Rasmussen U Feldt-Rasmussen, Department of Endocrinology and Metabolism, University of Copenhagen, Kobenhavn, 1165, Denmark

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Agnieszka Piekiełko-Witkowska A Piekiełko-Witkowska, Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Warsaw, 01-813, Poland

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Adriana Gaspar da Rocha A Gaspar da Rocha, Public Health Unit, University of Porto Institute of Molecular Pathology and Immunology, Porto, 4200-465, Portugal

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Corin Badiu C Badiu, National Institute of Endocrinology "C Davila" University of Medicine and Pharmacy, Bucharest, Romania

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Josef Koehrle J Koehrle, Institut für Experimentelle Endokrinologie, Berlin, Germany

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Leonidas Duntas L Duntas, Metabolism and Diabetes National Kapodistrian University of Athens, Athens, Greece

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Abstract

In 2022, the European Chemicals Agency (ECHA) made a statement concluding that iodine is an endocrine disruptor (ED). "We stress the fact that the ECHA opinion ECHA/BPC/357/2022 is based on their misguidedly zooming in on exclusively the biocidal products (e.g., hand disinfectants, disinfection of animals’ teats/udder, embalming fluids before cremation, etc.) that contain molecular iodine (I2), entirely neglecting [see the 2013 ECHA Regulation (EU) n°528/2012 describing iodine as being of “great importance for human health”. Clearly, the current sweeping and erroneous classification of “iodine” as an endocrine disruptor is ill-advised. We moreover call upon the scientific and medical community at large to use the accurate scientific nomenclature, i.e., iodide or iodate instead of “iodine” when referring to iodized salts and food prepared there with. Drugs, diagnostic agents, and synthetic chemicals containing the element iodine in the form of covalent bonds must be correctly labelled ‘’iodinated’’, if possible, using each time their distinctive and accurate chemical or pharmacological name.

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Rodrigo Moreno-Reyes Department of Nuclear Medicine, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium

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Ulla Feldt-Rasmussen Department of Endocrinology and Metabolism, University Hospital Rigshospitalet, and Faculty of Ηealth and Clinical Sciences, University of Copenhagen, Copenhagen, Denmark

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Agnieszka Piekiełko-Witkowska Centre of Postgraduate Medical Education, Centre of Translational Research, Department of Biochemistry and Molecular Biology, Warsaw, Poland: Basic Lead of the European Society of Endocrinology Focus Area on Thyroid

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Adriana Gaspar da Rocha Public Health Unit, ULS Baixo Mondego, Figueira da Foz, Portugal Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal Health Investigation and Innovation Institute (i3S), University of Porto, Porto, Portugal

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Corin Badiu National Institute of Endocrinology "C. Davila" University of Medicine and Pharmacy, Bucharest, Romania

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Josef Köhrle Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Experimentelle Endokrinologie, Berlin, Germany: Co-Lead of the European Society of Endocrinology Focus Area on Environmental Endocrinology

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Leonidas Duntas Evgenideion Hospital, Unit of Endocrinology, Metabolism and Diabetes, National Kapodistrian University of Athens, Athens, Greece

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Graphical abstract

Abstract

In 2022, the European Chemicals Agency (ECHA) made a statement concluding that iodine is an endocrine disruptor (ED). We stress the fact that the ECHA opinion ECHA/BPC/357/2022 is based on their misguidedly zooming in on exclusively the biocidal products (e.g. hand disinfectants, disinfection of animals’ teats/udder, embalming fluids before cremation) that contain molecular iodine (I2), entirely neglecting the 2013 ECHA Regulation (EU) no. 528/2012 describing iodine as being of ‘great importance for human health’. Clearly, the current sweeping and erroneous classification of ‘iodine’ as an endocrine disruptor is ill-advised. We moreover call upon the scientific and medical community at large to use the accurate scientific nomenclature, i.e. iodide or iodate instead of ‘iodine’ when referring to iodized salts and food prepared there with. Drugs, diagnostic agents, and synthetic chemicals containing the element iodine in the form of covalent bonds must be correctly labeled ‘iodinated’, if possible, using each time their distinctive and accurate chemical or pharmacological name.

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Kira Bang Bové Department of Endocrinology, Odense, Denmark

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Torquil Watt Department of Endocrinology, Odense, Denmark
Institute of Public Health, University of Copenhagen, Odense, Denmark

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Asmus Vogel Memory Disorders Research Group, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Odense, Denmark

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Laszlo Hegedüs Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Jakob Bue Bjoerner Institute of Public Health, University of Copenhagen, Odense, Denmark
National Research Centre for the Working Environment, Copenhagen, Odense, Denmark

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Mogens Groenvold Institute of Public Health, University of Copenhagen, Odense, Denmark
Department of Palliative Medicine, Bispebjerg Hospital, Odense, Denmark

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Steen Joop Bonnema Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark

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Åse Krogh Rasmussen Department of Endocrinology, Odense, Denmark

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Ulla Feldt-Rasmussen Department of Endocrinology, Odense, Denmark

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Background and Objective: Graves' disease has been associated with an increased psychiatric morbidity. It is unclarified whether this relates to Graves' disease or chronic disease per se. The aim of our study was to estimate the prevalence of anxiety and depression symptoms in patients with Graves' disease compared to patients with another chronic thyroid disease, nodular goitre, and to investigate determinants of anxiety and depression in Graves' disease. Methods: 157 cross-sectionally sampled patients with Graves' disease, 17 newly diagnosed, 140 treated, and 251 controls with nodular goitre completed the Hospital Anxiety and Depression Scale (HADS). The differences in the mean HADS scores between the groups were analysed using multiple linear regression, controlling for socio-demographic variables. HADS scores were also analysed dichotomized: a score >10 indicating probable ‘anxiety'/probable ‘depression'. Determinants of anxiety and depression symptoms in Graves' disease were examined using multiple linear regression. Results: In Graves' disease levels of anxiety (p = 0.008) and depression (p = 0.014) were significantly higher than in controls. The prevalence of depression was 10% in Graves' disease versus 4% in nodular goitre (p = 0.038), anxiety was 18 versus 13% (p = 0.131). Symptoms of anxiety (p = 0.04) and depression (p = 0.01) increased with comorbidity. Anxiety symptoms increased with duration of Graves' disease (p = 0.04). Neither thyroid function nor autoantibody levels were associated with anxiety and depression symptoms. Conclusions: Anxiety and depression symptoms were more severe in Graves' disease than in nodular goitre. Symptoms were positively correlated to comorbidity and duration of Graves' disease but neither to thyroid function nor thyroid autoimmunity.

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Luca Persani Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Georg Brabant Experimental and Clinical Endocrinology Medical Clinic I – University of Lübeck, Lübeck, Germany

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Mehul Dattani Genetics and Genomic Medicine Programme, UCL GOS Institute of Child Health, London, United Kingdom

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Marco Bonomi Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy

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Ulla Feldt-Rasmussen Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

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Eric Fliers Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Annette Gruters Department for Pediatric Endocrinology and Diabetes, Charité University Medicine, Berlin, Germany
University Hospital Heidelberg, Heidelberg, Germany

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Dominique Maiter Department of Endocrinology and Nutrition, UCL Cliniques Saint-Luc, Brussels, Belgium

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Nadia Schoenmakers University of Cambridge Metabolic Research Laboratories, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke’s Hospital and National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, United Kingdom

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A.S. Paul van Trotsenburg Department of Pediatric Endocrinology, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Objectives: Central hypothyroidism (CeH) is a rare form of hypothyroidism characterized by insufficient thyroid stimulation due to disturbed pituitary and/or hypothalamic functioning. Due to its origin and the whole clinical context, CeH represents a challenging condition in clinical practice as it is characterized by suboptimal accuracy of clinical and biochemical parameters for diagnosis and management. Since no expert consensus or guidance for this condition is currently available, a task force of experts received the commitment from the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. Study Design: The task force started to work in February 2017 and after a careful selection of appropriate references (cohort studies, case reports, expert opinions), a preliminary presentation and live discussion during the 2017 ETA meeting, and several revision rounds, has prepared a list of recommendations to support the diagnosis and management of patients with CeH. Results: Due to the particular challenges of this rare condition in the different ages, the target users of this guidance are pediatric and adult endocrinologists. Experts agreed on the need to recognize and treat overt CeH at all ages, whereas treatment of milder forms may be dispensable in the elderly (> 75 years). Conclusions: Despite the lack of randomized controlled clinical trials, the experts provide 34 recommendations supported by variable levels of strength that should improve the quality of life of the affected patients and reduce the metabolic and hormonal consequences of inadequate management.

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Camilla Larsen C Larsen, Department of Endocrinology, Odense University Hospital Department of Endocrinology, Odense, 5000, Denmark

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Kristian Hillert Winther K Winther, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Per Karkov Cramon P Cramon, Medical Endocrinology, Copenhagen University Hospital, Copenhagen, 2100, Denmark

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Åse Krogh Rasmussen Å Rasmussen, Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Ulla Feldt-Rasmusssen U Feldt-Rasmusssen, Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Nils Jakob Knudsen N Knudsen, Department of Endocrinology, Bispebjerg Hospital, Kobenhavn, Denmark

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Jakob Bue Bjorner J Bjorner , Department of Public Health, University of Copenhagen, Kobenhavn, Denmark

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Lutz Schomburg L Schomburg, Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany

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Kamil Demircan K Demircan, Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany

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Thilo Samson Chillon T Chillon, Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany

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Jeppe Gram J Gram, Medical Department, Endocrinology, Hospital South West Jutland, Esbjerg, Denmark

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Stinus Gadegaard Hansen S Hansen, Medical Department, Endocrinology, Hospital South West Jutland, Esbjerg, Denmark

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Frans Brandt F Brandt, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Birte Nygaard B Nygaard, Department of Endocrinology, Herlev and Gentofte Hospital, Herlev Hospital, Herlev, Denmark

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Torquil Watt T Watt, Medical Endocrinology, Copenhagen University Hospital, Copenhagen, Denmark

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Laszlo Hegedus L Hegedus, Department of Endocrinology, Odense University Hospital Department of Endocrinology, Odense, Denmark

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Steen Joop Bonnema S Bonnema, Odense University Hospital, Odense C, 5000, Denmark

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Purpose: We investigated whether selenium supplementation improves quality-of-life (QoL) in patients with autoimmune thyroiditis (ID:NCT02013479).

Methods: We included 412 patients ≥18 years with serum thyroid peroxidase antibody (TPOAb) level ≥100 IU/mL in a multicentre double-blinded randomised clinical trial. The patients were allocated 1:1 to daily supplementation with either 200 μg selenium as selenium-enriched yeast or matching placebo tablets for 12 months, as add-on to levothyroxine (LT4) treatment. QoL, assessed by the Thyroid-related Patient-Reported-Outcome questionnaire (ThyPRO-39), was measured at baseline, after six weeks, three, six, 12, and 18 months.

Results: In total, 332 patients (81%) completed the intervention period, of whom 82% were women. Although QoL improved during the trial, no difference in any of the ThyPRO-39 scales was found between the selenium group and the placebo group after 12 months of intervention. In addition, employing linear mixed model regression no difference between the two groups was observed in the ThyPRO-39 composite score (28.8 [95%CI:24.5-33.6] and 28.0 [24.5-33.1], respectively; P=0.602). Stratifying the patients according to duration of the disease at inclusion, ThyPRO-39 composite score, TPOAb level, or selenium status at baseline did not significantly change the results. TPOAb levels after 12 months of intervention were lower in the selenium group than in the placebo group (1995 [95%CI:1512-2512] vs. 2344 kIU/L [1862-2951]; P=0.016) but did not influence LT4 dosage or free triiodothyronine/free thyroxin ratio.

Conclusion: In hypothyroid patients on LT4 therapy due to autoimmune thyroiditis, daily supplementation with 200 μg selenium or placebo for 12 months improved QoL to the same extent.

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Camilla Bøgelund Larsen Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Kristian Hillert Winther Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Per Karkov Cramon Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

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Åse Krogh Rasmussen Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark

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Nils Jakob Knudsen Department of Endocrinology, Bispebjerg University Hospital, Copenhagen, Denmark

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Jakob Bue Bjorner Department of Public Health, Copenhagen University, Copenhagen, Denmark
QualityMetric Inc, Johnston, Lincoln, Rhode Island, USA

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Lutz Schomburg Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Kamil Demircan Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Thilo Samson Chillon Institute for Experimental Endocrinology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Jeppe Gram Medical Department, Endocrinology, University Hospital of South-West Jutland, Esbjerg, Denmark

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Stinus Gadegaard Hansen Medical Department, Endocrinology, University Hospital of South-West Jutland, Esbjerg, Denmark

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Frans Brandt Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Internal Medicine Research Unit, University Hospital of Southern Jutland, Aabenraa, Denmark

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Birte Nygaard Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

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Torquil Watt Department of Endocrinology and Metabolism, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
Institute of Clinical Medicine, Faculty of Health and Clinical Sciences, Copenhagen University, Copenhagen, Denmark

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Laszlo Hegedüs Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Steen Joop Bonnema Department of Endocrinology, Odense University Hospital, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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Purpose

We investigated whether selenium supplementation improves quality-of-life (QoL) in patients with autoimmune thyroiditis (ID:NCT02013479).

Methods

We included 412 patients ≥18 years with serum thyroid peroxidase antibody (TPOAb) level ≥100 IU/mL in a multicentre double-blinded randomised clinical trial. The patients were allocated 1:1 to daily supplementation with either 200 μg selenium as selenium-enriched yeast or matching placebo tablets for 12 months, as add-on to levothyroxine (LT4) treatment. QoL, assessed by the Thyroid-related Patient-Reported-Outcome questionnaire (ThyPRO-39), was measured at baseline, after 6 weeks, and after 3, 6, 12, and 18 months.

Results

In total, 332 patients (81%) completed the intervention period, of whom 82% were women. Although QoL improved during the trial, no difference in any of the ThyPRO-39 scales was found between the selenium group and the placebo group after 12 months of intervention. In addition, employing linear mixed model regression no difference between the two groups was observed in the ThyPRO-39 composite score (28.8 (95% CI: 24.5–33.6) and 28.0 (24.5–33.1), respectively; P = 0.602). Stratifying the patients according to duration of the disease at inclusion, ThyPRO-39 composite score, TPOAb level, or selenium status at baseline did not significantly change the results. TPOAb levels after 12 months of intervention were lower in the selenium group than in the placebo group (1995 (95% CI: 1512–2512) vs 2344 kIU/L (1862–2951); P = 0.016) but did not influence LT4 dosage or free triiodothyronine–free thyroxine ratio.

Conclusion

In hypothyroid patients on LT4 therapy due to autoimmune thyroiditis, daily supplementation with 200 μg selenium or placebo for 12 months improved QoL to the same extent.

Open access