Thyroid Research and Practice

EDITORIAL
Year
: 2020  |  Volume : 17  |  Issue : 1  |  Page : 2--3

Redefining euthyroidism: A biopsychosocial construct


Sanjay Kalra1, AG Unnikrishnan2, Atul Kalhan3,  
1 Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
2 Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India
3 Department of Endocrinology, Royal Glamorgan Hospital, Cardiff, Wales, United Kingdom

Correspondence Address:
Dr. Sanjay Kalra
Department of Endocrinology, Bharti Hospital, Karnal, Haryana
India




How to cite this article:
Kalra S, Unnikrishnan A G, Kalhan A. Redefining euthyroidism: A biopsychosocial construct.Thyroid Res Pract 2020;17:2-3


How to cite this URL:
Kalra S, Unnikrishnan A G, Kalhan A. Redefining euthyroidism: A biopsychosocial construct. Thyroid Res Pract [serial online] 2020 [cited 2020 May 29 ];17:2-3
Available from: http://www.thetrp.net/text.asp?2020/17/1/2/283215


Full Text



 Symptomatic Health in Thyroid Disorders



Euthyroidism, in endocrine circles, is defined as “normal” thyroid function test values. This construct of biochemical euthyroidism supposedly helps in differentiating “subclinical” (? asymptomatic) from “clinical” (symptomatic) hypothyroidism. However, persons who seek treatment for thyroid disorders expect much more than biochemical normality from their physicians.[1] Apart from biochemical euthyroidism, patients expect (and deserve) symptomatic relief. Frequently encountered symptoms, such as fatigue, may require extra attention. While hypothyroidism at the cellular and tissue level has been proposed as a possible aetiology for lack of clinical relief, in the setting of biochemical euthyroidism,[2] such symptoms might be due to an associated co-morbid conditions such as anaemia[3] and/or a co-existing autoimmune or rheumatological condition.

 Viscerometabolic Health



Apart from focusing on clinical improvement and attainment of normalcy of biochemical parameters, the treating endocrinologist has to aim for viscerometabolic relief as well. Thyroid hormones impact the physiology of virtually every organ system, and thyroid dysfunction may lead to other disorders as well. The term “viscerometabolic euthyroidism” can be used to describe a state characterized by normal biochemical parameters related to the health of all organ systems which may otherwise be influenced by thyroid dysfunction. Examples of surrogate markers of thyroid function include hemoglobin, transaminase levels, and lipid profile.[3] Thus, a comprehensive biomedical construct of euthyroidism includes alleviation of symptoms achievement and maintenance of biochemical euthyroidism, and optimal viscerometabolism.

 Thyrostress



Even this tripronged model of care does not fully represent the needs of many persons living with hypothyroidism. Many patients complain of dissatisfaction with therapy and find it difficult to cope with suoerimposed or concurrent illness. There are significant subtle psycho-somatic implications associated with primary hypothyroidism. Thyro-stress, as we term it, does not necessarily meet the diagnostic criteria of major depressive disorder or anxiety neurosis. It may overlap the clinical features of adjustment disorder. Thyro-stress is defined as an emotional state, characterized by extreme apprehension, discomfort, or dejection caused by the challenges and demand of living with thyroid disorders.[4]

The biopsychosocial model of health states that equal attention should be paid to psychological and social health while managing the disease.[5] It is important, therefore, to assess and optimize the mood of persons being treated for thyroid disorders.

 Awareness and Information



There is ample misinformation regarding thyroid health in the community and on social media. This has to be addressed through individual thyroid counseling and quinary prevention[6],[7] which is the concept of preventing health-related fake news or misinformation or preventing the impact of misinformation on human health. Specific concerns, such as fear of infertility, or fear of cancer, must be addressed. Issues raised by relative and other close ones, for example, fear of communicability of thyroid disease, or risk of vertical transmission from mother to offspring, must be clarified as well. Thus, psychological and social modulation should occur together. These can be facilitated by proper communication between health-care providers, their patients, and the community at large.

 Comprehensive Approach



Although the management of hypothyroidism appears simple, it is far from so. The choice of initial dose of thyroxine, its monitoring, and titration are just one aspect of thyroid management. It is not enough to target just biochemical euthyroidism. While only evidence-backed and evidence-approved therapy must be used to keep thyroid levels normal, other aspects of health must also be addressed.

A comprehensive definition of euthyroidism, which includes symptomatic cure, biochemical euthyroidism, viscerometabolic optimization, and psychological well-being, along with the creation of a thyroid-friendly social environment, should be aimed for [Table 1]. Measurement and monitoring of thyroid hormones should be accompanied by assessment and addressal of symptoms, surrogate markers of hypothyroidism, and well-being.{Table 1}

Only when we define euthyroidism correctly, and measure it from all dimensions of the biopsychosocial model of health, will we be able to achieve our goal of providing health to all persons living with thyroid disease.

References

1Bhutani S, Bhutani J, Balhara YP, Kalra S. Patient concerns in treated hypothyroidism: A cross-sectional evaluation. Thyroid Res Pract 2013;10:72-7.
2Kalra S, Khandelwal SK. Why are our hypothyroid patients unhappy? Is tissue hypothyroidism the answer? Indian J Endocrinol Metab 2011;15:S95-8.
3Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ 2008;337:a801.
4Kalra S, Verma K, Balhara YP. Thyro-stress. Indian J Endocrinol Metab 2017;21:632-3.
5Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-44.
6Kalra S, Kumar A. Quinary prevention: Defined and conceptualized. J Pak Med Assoc 2019;69:1765-1766.
7Kalra S, Unnikrishnan AG, Tiwaskar M, Sahay R, Saboo B, Negalur V, et al. Medication Counseling for Thyroxine. Indian J Endocrinol Metab 2017;21:630-1.