Health-related quality of life in women with autoimmune thyroid disease during pregnancy and postpartum: systematic review including 321,850 pregnancies

ABSTRACT

Background

Utilities of the general population or expert estimates have been used for all published cost-effectiveness analyses of screening for thyroid disorders in pregnancy.

Methods

A systematic review CRD42019120897 of studies with patient-reported outcomes (PRO) and laboratory evidence of thyroid function/autoimmunity was conducted using PubMed, Cochrane Central, EconLit, SocIndex, DARE, NHS EEDS, Annual Reviews, and CINAHL. Quality was assessed using Joanna Briggs Institute appraisal tool.

Results

Of 664 abstracts screened, we analyzed 97 full texts. All studies describing the impact of thyroid disease on the generic QoL excluded pregnant and postpartum women. 21 reports of acceptable quality (321,850 pregnancies) determined depression and anxiety with validated tools and/or reported subjective symptoms. During pregnancy, contradictory conclusions were published on the impact of thyroid disease on PRO. Postpartum, antithyroid antibodies coincide with alexithymia and depression, postpartum thyroiditis negatively impacts mood. No conclusion could be drawn on the impact of thyroid hormonal levels.

Conclusions

The generic QoL in autoimmune thyroid disease during pregnancy has never been described, which represents an obstacle for the construction of economic models. We found contradictory information on the impact of thyroid disease on depression, anxiety, and specific symptoms.

KEYWORDS:

• Thyroid disease
• pregnancy
• postpartum
• quality of life
• depression
• anxiety
• utility
• thyroid autoimmunity
• thyroid disorder

Article Highlights

• Economic models related to thyroid disease in pregnancy and postpartum use quality of life estimates as the key input parameter

• Our exhaustive systematic review shows that the generic quality of life has never been described in this population

• Contradictory results are reported on the impact of thyroid disease on mood, depression, and anxiety. Many of the reports did not collect and adjust for other factors which are likely to confound the relationships.

• We identified an important gap in the current knowledge that represents an obstacle in the creation of valid economic models

Supplementary data

Supplemental data for this article can be accessed here

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contribution

JT prepared search strings, searched databases, JT and JB designed the research questions, prepared the protocol, screened abstracts, reviewed the full-texts, and prepared the first draft version of the manuscript. TD continuously reviewed the manuscript and performed HTA and medical review. TW performed revisions of the manuscript and of the selected studies from the perspective of endocrinologist and expert on the quality of life in thyroid disorders. JT has the ultimate responsibility for the manuscript preparation and integrity of the findings and conclusions.

Additional information

Funding

This project was not funded.