Introduction: Hyperthyroidism is one of the common endocrine conditions in general pediatric practices. Several adult studies show that hyperthyroid affects health-related quality of life (HRQoL). However, information regarding HRQoL in the pediatric population is limited.
Objectives: To evaluate whether patients diagnosed with childhood hyperthyroidism have lower levels of HRQoL compared to healthy controls and to identify the possible risk factors of low HRQoL scores in these patients.
Methods: This cross-sectional study enrolled participants under 20 years diagnosed with hyperthyroidism before 18. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL4.0) self-report form was administered to participants for evaluating HRQoL. Parents were also asked to complete the PedsQL4.0 parent proxy-report form if participants were younger than 18. The strengths and difficulties questionnaire (SDQ) was used to screen the risk of mental health problems of all participants below 16. For comparison, the survey was also conducted on healthy children. The scores from both questionnaires were analyzed to evaluate the differences between patients and healthy controls.
Results: Fifty-two patients diagnosed with childhood hyperthyroidism (41 females) and fifty-one healthy controls (37 females) were included in this study. The mean age of hyperthyroidism patients was slightly higher than that of the controls (15.23 ± 2.89 vs. 13.72 ± 3.52 years, p=0.01). Hyperthyroidism had been diagnosed for a duration ranging from 1-146 months. Twenty patients had received definitive treatment (16 radioiodine therapy (RAI) and 4 total thyroidectomy). Of those who had received RAI, two third still required antithyroid drug (ATD) treatment. All four patients who had undergone total thyroidectomy were hypothyroid, three of which developed postoperative hypoparathyroidism. The total scores from self-report PedsQL4.0 were significantly lower than those of the healthy controls (74.87 ± 16.2 vs. 83.07 ± 12.88, p=0.006) after being adjusted by age, sex, parents’ educational status, and comorbidities. The self-report physical, psychological, emotional, and school function scores were also lower than those of the healthy controls. Generally, parents reported lower HRQoL scores compared to their children. The parent proxy-report HRQoL scores (total, psychosocial, and emotional domains) were lower than the controls. There was no difference in all HRQoL scores between patients treated with ATD, RAI, and thyroidectomy. Irregular menstruation (b -14.41 [-26.76, -2.05], p=0.023) and clinical diarrhea (b -13.49 [-26.17, -0.80], p=0.038) are factors related to lower HRQoL in hyperthyroid patients. The levels of anti-TSH receptor antibody (TRAb) were negatively correlated with self-report total HRQoL scores (r -0.32, p=0.021). Only the scores of the emotional subdomain from SDQ reported by patients were significantly higher than that reported by healthy controls (3.34 ± 2.3 vs. 2.21 ± 1.9, p=0.006).
Conclusions: This is the first cross-sectional study comparing the HRQoL and the risk of mental health problems between hyperthyroid children and healthy controls. We found that hyperthyroidism had a negative impact on the quality of life and emotional status of children. Therefore, in addition to physical health, physicians should also monitor the quality of life and emotional problems in children with hyperthyroidism.
Keywords: Childhood hyperthyroidism, Grave’s disease, Quality of life, Mental health
