Somatic symptom burden in patients with euthyroid Hashimoto’s thyroiditis compared with healthy and non-autoimmune thyroid disease controls
Ümit Çavdar1, Dilek Ayakdaş Dağlı2, Ece Mutlu Satıl2, Leyla Baysan Arabacı2, Mehmet Sercan Ertürk1, Özlem Eren1, Barış Önder Pamuk11Department of Endocrinology and Metabolism, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Türkiye2Department of Mental Health and Psychiatry Nursing, İzmir Katip Çelebi University, İzmir, Türkiye
INTRODUCTION: To evaluate whether somatic symptom burden is elevated in euthyroid patients with Hashimoto’s thyroiditis compared with two control groups: healthy controls (HC) and patients with non-autoimmune thyroid diseases (NATD), including those with euthyroid nodular goiter and those who underwent thyroidectomy for benign indications.
METHODS: This cross-sectional study included 90 adults (38 HC, 28 HT, and 24 NATD). The Patient Health Question-naire-15 (PHQ-15) and Hospital Anxiety and Depression Scale-Total (HADS-Total) were used for psychometric assessment. Group differences were assessed using the Chi-square and Kruskal–Wallis tests with Bonferroni-adjusted posthoc comparisons. Three linear regression models were used to evaluate the independent predictors of somatic burden. Spearman correlation analysis was used to examine the associations between thyroid markers (TSH, FT3, FT4, anti-TPO, and anti-TG) and symptom scores within the HT group.
RESULTS: Somatic symptom burden differed significantly across the groups (p<0.001). The HT group showed higher PHQ-15 scores than both HC (p=0.002) and NATD patients (p=0.031). HADS-Total scores also differed overall (p=0.0019); however, only the comparison between patients with HT and HC remained significant after adjustment (p<0.001), whereas patients with HT and NATD did not differ. In multivariable regression analysis, Hashimoto’s thyroiditis remained independently associated with higher somatic symptom burden (β=2.84, p=0.013), alongside psychological distress (β=0.25, p<0.001). Thyroid markers, including TSH, FT3, FT4, anti-TPO, and anti-TG, showed no significant correlations with PHQ-15 or HADS-Total scores within the HT group.
DISCUSSION AND CONCLUSION: In euthyroid Hashimoto’s thyroiditis, somatic symptom burden is elevated and appears to be driven mainly by psychological distress rather than by thyroid hormone levels or autoantibody titers. These findings suggest that the PHQ-15 may help identify patients who are more likely to benefit from psychosocial rather than endocrine-focused interventions.
Keywords: Anxiety, depression, Hashimoto disease, psychological distress, somatic symptom disorder
Manuscript Language: English