{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:49:09Z","timestamp":1785174549446,"version":"3.55.0"},"reference-count":94,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained persistent symptoms can be a sign of somatization. This is associated with distress and high health care resource use and can be classified as somatic symptom disorder (SSD). Prevalence rates for SSD differ depending on classification criteria and how they are ascertained, varying between 4% and 25%. As this has not been studied in hypothyroid patients before, the aim of this study was to document somatization in people with hypothyroidism and to explore associations with other patient characteristics and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Online, multinational cross-sectional survey of individuals with self-reported, treated hypothyroidism, which included the validated Patient Health Questionnaire-15 (PHQ-15) for assessment of somatization. Chi-squared tests with the Bonferroni correction were used to explore outcomes for respondents with a PHQ-15 score \u226510 (probable somatic symptom disorder [pSSD]) versus a PHQ-15 score &lt;10 (absence of SSD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 3915 responses were received, 3512 of which contained the valid PHQ-15 data (89.7%). The median score was 11.0 (range 0\u201330 [confidence interval 10.9\u201311.3]). The prevalence of pSSD was 58.6%. Associations were found between pSSD and young age (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), women (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), not working (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), having below average household income (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), being treated with levothyroxine (LT4) (rather than combination of LT4 and L-triiodothyronine [LT3], LT3 alone, or desiccated thyroid extract) (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), expression of the view that the thyroid medication taken did not control the symptoms of hypothyroidism well (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and with number of comorbidities (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). pSSD was associated with respondent attribution of most PHQ-15 symptoms to the hypothyroidism or its treatment (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), dissatisfaction with care and treatment of hypothyroidism (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), a negative impact of hypothyroidism on daily living (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and with anxiety and low mood\/depression (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study demonstrates a high prevalence of pSSD among people with hypothyroidism and associations between pSSD and negative patient outcomes, including a tendency to attribute persistent symptoms to hypothyroidism or its treatment. SSD may be an important determinant of dissatisfaction with treatment and care among some hypothyroid patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2022.0641","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T14:27:21Z","timestamp":1683124041000},"page":"927-939","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":29,"title":["Hypothyroidism and Somatization: Results from E-Mode Patient Self-Assessment of Thyroid Therapy, a Cross-Sectional, International Online Patient Survey"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-5574","authenticated-orcid":false,"given":"Petros","family":"Perros","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9286-6471","authenticated-orcid":false,"given":"Endre Vezekenyi","family":"Nagy","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4790-2733","authenticated-orcid":false,"given":"Enrico","family":"Papini","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6925-8956","authenticated-orcid":false,"given":"Christina Maria","family":"Van Der Feltz-Cornelis","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, HYMS, University of York, York, United Kingdom."},{"name":"Institute of Health Informatics, University College London, London, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5145-5385","authenticated-orcid":false,"given":"Anthony Peter","family":"Weetman","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University of Sheffield, Sheffield, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet Alexandra","family":"Hay","sequence":"additional","affiliation":[{"name":"Picker Institute Europe, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Abad-Madro\u00f1ero","sequence":"additional","affiliation":[{"name":"Picker Institute Europe, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy Johanna","family":"Tallett","sequence":"additional","affiliation":[{"name":"Picker Institute Europe, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Bilas","sequence":"additional","affiliation":[{"name":"Picker Institute Europe, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Lakwijk","sequence":"additional","affiliation":[{"name":"Thyroid Federation International, Transpolispark, Hoofddorp, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan J.","family":"Poots","sequence":"additional","affiliation":[{"name":"Picker Institute Europe, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9691-7619","authenticated-orcid":false,"given":"Laszlo","family":"Heged\u00fcs","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Odense University Hospital, Odense, Denmark."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2018.18"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb01894.x"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04318.x"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2002.01654.x"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.02025"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03521.x"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2002.01682.x"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02478.x"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.14473"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"e_1_3_6_12_2","volume-title":"Somatic Syndrome Disorders","author":"D'Souza RS","year":"2022","unstructured":"D'Souza RS, , Hooten WM. 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