Higher serum thyrotropin levels among patients on hemodialysis (HD) are associated with impaired health-related quality of life (HRQoL), according to a new study.

Connie M. Rhee, MD, MSc, of the University of California-Irvine, and colleagues examined serum thyrotropin levels (TSH) from 450 HD patients from 17 outpatient dialysis facilities in southern California as well as patients’ responses to Short-Form 36 questionnaires. Patients completed questionnaires every 6 months from May 2013 to May 2015.

In categorical analyses, the highest baseline thyrotropin tertile was associated with a 5-point lower Short-Form 36 domain score for energy/fatigue compared with the lowest tertile, the investigators reported online ahead of print in the Clinical Journal of the American Society of Nephrology (CJASN). The highest time-dependent tertile was associated with a 5-point lower physical function score.

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Similarly, in continuous analyses, higher baseline thyrotropin levels were associated with worse scores in role limitations due to physical health, energy/fatigue, and pain by 3 to 5 points for every standard deviation (SD) increase in thyrotropin. Higher time-dependent thyrotropin also was associated with worse physical health scores (-3 points for every SD increase in thyrotropin).

Although these associations cannot prove causation, the investigators theorized that myalgia, reduced muscle strength, higher oxygen requirements, and refractory anemia from hypothyroidism might contribute to worse physical function.

“Given the high prevalence of thyroid dysfunction and low levels of quality of life in dialysis patients, future research is needed to determine the underlying mechanisms of these associations, and whether thyroid hormone replacement can improve the health-related quality of life of this population,” Dr Rhee stated in a news release issued by the American Society of Nephrology, which publishes CJASN. “In addition, as the first study in dialysis patients to document an association between higher thyrotropin levels and low levels of physical function, a strong predictor of death, future studies are needed to determine whether correction of thyroid status with exogenous thyroid hormone can improve physical function in this population.”

The team found no significant association between thyrotropin levels and Beck Depression Inventory-II questionnaire scores.

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1. Rhee CM, Chen Y, You AS, et al. Thyroid Status, Quality of Life, and Mental Health in Patients on Hemodialysis. Clin J Am Soc Nephrol. doi: 10.2215/CJN.13211216 [Epub ahead of print]

2. Poor Thyroid Function May Affect Dialysis Patients’ Quality of Life and Daily Living. American Society of Nephrology; July 13, 2017 [news release]