Assessment of health-related quality of life in people with newly identified thyroid dysfunction and subclinical coronary atherosclerosis

Studying the quality of life is a topical issue in managing a multidisciplinary patient. A patient with comorbidity requires an individual approach, taking into account all the features of the combined pathology when choosing treatment, diagnostic and preventive tactics for cardiovascular complications. Thyroid pathology is often characterized by the development of cardiovascular complications in the absence of previous ischemic symptoms. The aim of the study was to study clinical and instrumental data, evaluate health-related quality of life and compliance with antiatherogenic therapy in individuals with newly diagnosed thyroid dysfunction and subclinical coronary atherosclerosis.

Materials and methods. A prospective cohort study was conducted with the analysis of data from 200 working-age individuals (66 men and 134 women) with different hormonal status of the thyroid gland without clinical signs and history of coronary heart disease (CHD): 120 with subclinical hypothyroidism (SH), 30 with hyperthyroidism and 50 patients with euthyroidism. The patients were followed up for 1 year (12 months ± 30 days). The assessment of tolerance to physical activity, laboratory diagnostics of the lipid spectrum, computed tomographic angiography of the heart (CCTA) were performed. The SF-36 questionnaire (Medical Outcomes Study Short-Form 36) was chosen to assess the health-related quality of life. We assessed adherence to treatment using the Morisky-Green compliance scale. The obtained data were interpreted as reliable, and differences between indicators were considered significant at p < 0.05.

Results. In the groups of patients with thyroid dysfunction (hypo- and hyperthyroidism), the average group results of the 6-minute walk test were significantly lower, and the proportion of individuals with NYHA II was higher than similar results in the euthyroid group. Multivessel atherosclerotic lesions (2 or more) of the coronary arteries were detected in 6.7 % (n = 1) of patients with hyperthyroidism, 36.1 % (n = 30) of individuals with SH versus 3.2 % (n = 1) in individuals with normal thyroid hormonal status (F = 0.108; p < 0.001). An analysis of the components of the quality of life of patients with different hormonal status of the thyroid gland depending on clinical data demonstrated that the shorter the distance covered in the 6-minute walk test and the higher the NYHA FC, the lower the level of physical functioning and mental health according to the results of the SF-36 questionnaire, which led to lower indicators of general health in this category of individuals.

Conclusions. The obtained results indicate a more aggressive course of dyslipidemia and coronary atherosclerosis in individuals with thyroid pathology, require the closest attention from the entire therapeutic service to the issues of medical examination of the working-age population: raising awareness; introducing mandatory laboratory screening for thyroid dysfunction during routine medical examinations; even in individuals who feel “absolutely healthy” with newly verified thyroid pathology – the use of an algorithm for non-invasive diagnostics of preclinical stages of atherosclerosis. Underestimation of cardiovascular risks in multidisciplinary patients, due to the absence of “specific” complaints or clinical equivalents of coronary heart disease is fraught with the development of atherosclerosisassociated complications, early disability and death of patients due to coronary heart disease. The SF-36 quality of life questionnaire is a simple, accessible and validated instrument for assessing the main components of physical and mental health in multidisciplinary patients in clinical practice.

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