{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:03:10Z","timestamp":1791000190288,"version":"4.1.0"},"reference-count":69,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002332","name":"Semmelweis University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002332","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A significant number of patients with primary hypothyroidism report persistent symptoms and decreased quality of life (QoL) despite biochemically adequate levothyroxine replacement. Individual variations in thyroxine conversion, autoimmune inflammation, and psychological factors have all been implicated as a potential cause.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study we have examined the association of numerous demographic, disease-specific, and laboratory parameters as well as three patient reported outcome measures with thyroid-dependent QoL as measured by the Underactive Thyroid-Dependent Quality of Life Questionnaire. Patients were stringently selected to minimize the confounding effect of comorbidities or inadequate hormone replacement. We used validated questionnaires to assess somatosensory amplification, depression, and symptom number. Determinants of QoL were evaluated using uni- and multivariable linear modeling, and mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our final sample consisted of 157 patients. 70.7% had Hashimoto\u2019s, whereas 29.3% had iatrogenic hypothyroidism. Mean age was 49.5\u2009\u00b1\u200914.5\u00a0years, disease duration: 11.2\u2009\u00b1\u20098.2\u00a0years, thyroxine dose: 1.2 ug\/kg bodyweight, TSH: 1.8\u2009\u00b1\u20090.9 mIU\/L. Thyroid-specific biomarkers including TSH, FT3, FT4, rT3, SPINA-GD, anti-TPO, and SHBG had no association with thyroid-dependent QoL. Somatosensory amplification was a strong predictor of the presence and perceived bother of the most common hypothyroidism-associated symptoms. In our final multivariable model (r\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.31) the factors associated with thyroid-dependent QoL were somatosensory amplification (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), BMI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021), and depression (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These results suggest that psychological factors, particularly somatosensory amplification, might play a major role in influencing QoL in hypothyroid individuals on adequate levothyroxine replacement. Our findings do not corroborate a significant role for autoimmune inflammation or tissue-level hypothyroidism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-025-01962-9","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T02:51:37Z","timestamp":1748227897000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Psychological factors and obesity, not thyroid biomarkers, predict thyroid-dependent quality of life in treated hypothyroidism: a cross-sectional study"],"prefix":"10.1186","volume":"25","author":[{"given":"Bence","family":"Bakos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Solymosi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bal\u00e1zs","family":"Szili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1gnes","family":"Vincze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szilvia","family":"M\u00e9sz\u00e1ros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rk","family":"Stempler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich\u00e1rd","family":"\u00c1rm\u00f3s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e1s","family":"Kiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bakos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolette","family":"Sz\u00fccs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Reismann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit","family":"T\u0151ke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Pusztai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"Lakatos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Istv\u00e1n","family":"Tak\u00e1cs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"issue":"12","key":"1962_CR1","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1089\/thy.2014.0028","volume":"24","author":"J Jonklaas","year":"2014","unstructured":"Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670\u2013751.","journal-title":"Thyroid"},{"issue":"4","key":"1962_CR2","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1038\/s41574-021-00625-8","volume":"18","author":"L Hegedus","year":"2022","unstructured":"Hegedus L, Bianco AC, Jonklaas J, Pearce SH, Weetman AP, Perros P. Primary hypothyroidism and quality of life. Nat Rev Endocrinol. 2022;18(4):230\u201342.","journal-title":"Nat Rev Endocrinol"},{"issue":"1","key":"1962_CR3","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1210\/edrv.23.1.0455","volume":"23","author":"AC Bianco","year":"2002","unstructured":"Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocr Rev. 2002;23(1):38\u201389.","journal-title":"Endocr Rev"},{"issue":"2","key":"1962_CR4","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1172\/JCI77588","volume":"125","author":"JP Werneck de Castro","year":"2015","unstructured":"Werneck de Castro JP, Fonseca TL, Ueta CB, McAninch EA, Abdalla S, Wittmann G, et al. Differences in hypothalamic type 2 deiodinase ubiquitination explain localized sensitivity to thyroxine. J Clin Invest. 2015;125(2):769\u201381.","journal-title":"J Clin Invest."},{"issue":"6","key":"1962_CR5","doi-asserted-by":"publisher","first-page":"2828","DOI":"10.1172\/JCI118353","volume":"96","author":"HF Escobar-Morreale","year":"1995","unstructured":"Escobar-Morreale HF, Obreg\u00f3n MJ, Escobar del Rey F, Morreale de Escobar G. Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest. 1995;96(6):2828\u201338.","journal-title":"J Clin Invest."},{"issue":"8","key":"1962_CR6","doi-asserted-by":"publisher","first-page":"e22552","DOI":"10.1371\/journal.pone.0022552","volume":"6","author":"D Gullo","year":"2011","unstructured":"Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R. Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS ONE. 2011;6(8):e22552.","journal-title":"PLoS ONE"},{"issue":"9","key":"1962_CR7","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1055\/s-0043-125064","volume":"126","author":"R Larisch","year":"2018","unstructured":"Larisch R, Midgley JEM, Dietrich JW, Hoermann R. Symptomatic Relief is Related to Serum Free Triiodothyronine Concentrations during Follow-up in Levothyroxine-Treated Patients with Differentiated Thyroid Cancer. Exp Clin Endocrinol Diabetes. 2018;126(9):546\u201352.","journal-title":"Exp Clin Endocrinol Diabetes"},{"issue":"5","key":"1962_CR8","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1097\/MED.0000000000000428","volume":"25","author":"AC Bianco","year":"2018","unstructured":"Bianco AC, Kim BS. Pathophysiological relevance of deiodinase polymorphism. Curr Opin Endocrinol Diabetes Obes. 2018;25(5):341\u20136.","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"issue":"2","key":"1962_CR9","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1089\/thy.2020.0253","volume":"31","author":"MM Fran\u00e7a","year":"2021","unstructured":"Fran\u00e7a MM, German A, Fernandes GW, Liao XH, Bianco AC, Refetoff S, et al. Human Type 1 Iodothyronine Deiodinase (DIO1) Mutations Cause Abnormal Thyroid Hormone Metabolism. Thyroid. 2021;31(2):202\u20137.","journal-title":"Thyroid"},{"issue":"3","key":"1962_CR10","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s40618-024-02480-6","volume":"48","author":"T Piticchio","year":"2024","unstructured":"Piticchio T, Luongo C, Trimboli P, Salvatore D, Frasca F. Rebound effect of hypothalamic-pituitary thyreotropic activity: a new model to better understand hypothyroidism. J Endocrinol Invest. 2024;48(3):587\u201396.","journal-title":"J Endocrinol Invest."},{"issue":"2","key":"1962_CR11","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1089\/thy.2020.0720","volume":"31","author":"J Jonklaas","year":"2021","unstructured":"Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, et al. Evidence-Based Use of Levothyroxine\/Liothyronine Combinations in Treating Hypothyroidism: A Consensus Document. Thyroid. 2021;31(2):156\u201382.","journal-title":"Thyroid"},{"issue":"7","key":"1962_CR12","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1089\/thy.2017.0645","volume":"28","author":"RL Schmidt","year":"2018","unstructured":"Schmidt RL, LoPresti JS, McDermott MT, Zick SM, Straseski JA. Does Reverse Triiodothyronine Testing Have Clinical Utility? An Analysis of Practice Variation Based on Order Data from a National Reference Laboratory. Thyroid. 2018;28(7):842\u20138.","journal-title":"Thyroid"},{"issue":"3","key":"1962_CR13","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1159\/000342623","volume":"1","author":"T Watt","year":"2012","unstructured":"Watt T, Hegedus L, Bjorner JB, Groenvold M, Bonnema SJ, Rasmussen AK, et al. Is Thyroid Autoimmunity per se a Determinant of Quality of Life in Patients with Autoimmune Hypothyroidism? Eur Thyroid J. 2012;1(3):186\u201392.","journal-title":"Eur Thyroid J"},{"key":"1962_CR14","doi-asserted-by":"publisher","first-page":"934003","DOI":"10.3389\/fendo.2022.934003","volume":"13","author":"J Jonklaas","year":"2022","unstructured":"Jonklaas J. Restoration of euthyroidism with levothyroxine: implications of etiology of hypothyroidism and the degree of residual endogenous thyroid function. Front Endocrinol (Lausanne). 2022;13:934003.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"2","key":"1962_CR15","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1089\/thy.2010.0191","volume":"21","author":"J Ott","year":"2011","unstructured":"Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, et al. Hashimoto\u2019s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid. 2011;21(2):161\u20137.","journal-title":"Thyroid"},{"issue":"6","key":"1962_CR16","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1530\/EJE-12-0501","volume":"167","author":"M Louwerens","year":"2012","unstructured":"Louwerens M, Appelhof BC, Verloop H, Medici M, Peeters RP, Visser TJ, et al. Fatigue and fatigue-related symptoms in patients treated for different causes of hypothyroidism. Eur J Endocrinol. 2012;167(6):809\u201315.","journal-title":"Eur J Endocrinol"},{"issue":"7","key":"1962_CR17","doi-asserted-by":"publisher","first-page":"453","DOI":"10.7326\/M18-0284","volume":"170","author":"I Guldvog","year":"2019","unstructured":"Guldvog I, Reitsma LC, Johnsen L, Lauzike A, Gibbs C, Carlsen E, et al. Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial. Ann Intern Med. 2019;170(7):453\u201364.","journal-title":"Ann Intern Med"},{"issue":"4","key":"1962_CR18","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1210\/jcem.87.4.8421","volume":"87","author":"R G\u00e4rtner","year":"2002","unstructured":"G\u00e4rtner R, Gasnier BC, Dietrich JW, Krebs B, Angstwurm MW. Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations. J Clin Endocrinol Metab. 2002;87(4):1687\u201391.","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"1962_CR19","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1111\/j.1365-2265.2006.02478.x","volume":"64","author":"AP Weetman","year":"2006","unstructured":"Weetman AP. Whose thyroid hormone replacement is it anyway? Clin Endocrinol (Oxf). 2006;64(3):231\u20133.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"1962_CR20","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1089\/thy.2017.0681","volume":"28","author":"SJ Peterson","year":"2018","unstructured":"Peterson SJ, Cappola AR, Castro MR, Dayan CM, Farwell AP, Hennessey JV, et al. An Online Survey of Hypothyroid Patients Demonstrates Prominent Dissatisfaction. Thyroid. 2018;28(6):707\u201321.","journal-title":"Thyroid"},{"issue":"681","key":"1962_CR21","doi-asserted-by":"publisher","first-page":"e246","DOI":"10.3399\/bjgp19X701249","volume":"69","author":"K Lamahewa","year":"2019","unstructured":"Lamahewa K, Buszewicz M, Walters K, Marston L, Nazareth I. Persistent unexplained physical symptoms: a prospective longitudinal cohort study in UK primary care. Br J Gen Pract. 2019;69(681):e246\u201353.","journal-title":"Br J Gen Pract"},{"key":"1962_CR22","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s12529-012-9245-2","volume":"20","author":"K Klaus","year":"2013","unstructured":"Klaus K, Rief W, Br\u00e4hler E, Martin A, Glaesmer H, Mewes R. The distinction between \u201cmedically unexplained\u201d and \u201cmedically explained\u201d in the context of somatoform disorders. Int J Behav Med. 2013;20:161\u201371.","journal-title":"Int J Behav Med"},{"issue":"1","key":"1962_CR23","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1002\/mpr.140","volume":"12","author":"K Kroenke","year":"2003","unstructured":"Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management. Int J Methods Psychiatr Res. 2003;12(1):34\u201343.","journal-title":"Int J Methods Psychiatr Res"},{"issue":"1","key":"1962_CR24","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1001\/jamainternmed.2013.11312","volume":"174","author":"PN Taylor","year":"2014","unstructured":"Taylor PN, Iqbal A, Minassian C, Sayers A, Draman MS, Greenwood R, et al. Falling threshold for treatment of borderline elevated thyrotropin levels-balancing benefits and risks: evidence from a large community-based study. JAMA Intern Med. 2014;174(1):32\u20139.","journal-title":"JAMA Intern Med"},{"issue":"5","key":"1962_CR25","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1093\/fampra\/cmv065","volume":"32","author":"P J\u00f8rgensen","year":"2015","unstructured":"J\u00f8rgensen P, Langhammer A, Krokstad S, Forsmo S. Diagnostic labelling influences self-rated health. A prospective cohort study: the HUNT Study. Norway Fam Pract. 2015;32(5):492\u20139.","journal-title":"Norway. Fam Pract."},{"issue":"4","key":"1962_CR26","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1111\/cen.14473","volume":"98","author":"P Perros","year":"2021","unstructured":"Perros P, Van Der Feltz-Cornelis C, Papini E, Nagy EV, Weetman AP, Heged\u00fcs L. The enigma of persistent symptoms in hypothyroid patients treated with levothyroxine: A narrative review. Clin Endocrinol (Oxf). 2021;98(4):461\u20138.","journal-title":"Clin Endocrinol (Oxf)."},{"key":"1962_CR27","doi-asserted-by":"publisher","first-page":"57","DOI":"10.3389\/fendo.2016.00057","volume":"7","author":"JW Dietrich","year":"2016","unstructured":"Dietrich JW, Landgrafe-Mende G, Wiora E, Chatzitomaris A, Klein HH, Midgley JE, et al. Calculated Parameters of Thyroid Homeostasis: Emerging Tools for Differential Diagnosis and Clinical Research. Front Endocrinol (Lausanne). 2016;7:57.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"2","key":"1962_CR28","doi-asserted-by":"publisher","first-page":"R21","DOI":"10.1530\/JOE-21-0364","volume":"253","author":"HI Jansen","year":"2022","unstructured":"Jansen HI, Bruinstroop E, Heijboer AC, Boelen A. Biomarkers indicating tissue thyroid hormone status: ready to be implemented yet? J Endocrinol. 2022;253(2):R21\u201345.","journal-title":"J Endocrinol"},{"issue":"2","key":"1962_CR29","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1111\/j.1524-4733.2007.00232.x","volume":"11","author":"C McMillan","year":"2008","unstructured":"McMillan C, Bradley C, Razvi S, Weaver J. Evaluation of new measures of the impact of hypothyroidism on quality of life and symptoms: the ThyDQoL and ThySRQ. Value Health. 2008;11(2):285\u201394.","journal-title":"Value Health"},{"issue":"5","key":"1962_CR30","doi-asserted-by":"publisher","first-page":"e357","DOI":"10.1002\/edm2.357","volume":"5","author":"V Uslar","year":"2022","unstructured":"Uslar V, Becker C, Weyhe D, Tabriz N. Thyroid disease-specific quality of life questionnaires - A systematic review. Endocrinol Diabetes Metab. 2022;5(5):e357.","journal-title":"Endocrinol Diabetes Metab"},{"key":"1962_CR31","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/1477-7525-4-40","volume":"4","author":"A Riazi","year":"2006","unstructured":"Riazi A, Bradley C, Barendse S, Ishii H. Development of the Well-being questionnaire short-form in Japanese: the W-BQ12. Health Qual Life Outcomes. 2006;4:40.","journal-title":"Health Qual Life Outcomes"},{"key":"1962_CR32","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/1477-7525-11-68","volume":"11","author":"EM Quinque","year":"2013","unstructured":"Quinque EM, Villringer A, Kratzsch J, Karger S. Patient-reported outcomes in adequately treated hypothyroidism - insights from the German versions of ThyDQoL, ThySRQ and ThyTSQ. Health Qual Life Outcomes. 2013;11:68.","journal-title":"Health Qual Life Outcomes"},{"issue":"9","key":"1962_CR33","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","volume":"16","author":"K Kroenke","year":"2001","unstructured":"Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606\u201313.","journal-title":"J Gen Intern Med"},{"issue":"4","key":"1962_CR34","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1016\/0022-3956(90)90004-A","volume":"24","author":"AJ Barsky","year":"1990","unstructured":"Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res. 1990;24(4):323\u201334.","journal-title":"J Psychiatr Res"},{"issue":"4","key":"1962_CR35","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1556\/Mental.10.2009.4.3","volume":"10","author":"F K\u00f6teles","year":"2009","unstructured":"K\u00f6teles F, G\u00e9mes H, Papp G, T\u00far\u00f3czi P, P\u00e1sztor A, Freyler A, et al. Validation of the Hungarian version of the Somatosensory Amplification Scale (SSAS). Ment\u00e1lhigi\u00e9n\u00e9 \u00e9s Pszichoszomatika. 2009;10(4):321\u201335.","journal-title":"Ment\u00e1lhigi\u00e9n\u00e9 \u00e9s Pszichoszomatika"},{"key":"1962_CR36","unstructured":"Spitzer RL, Williams JBW, Kroenke K. PHQ Screeners website 2022. Available from: www.phqscreeners.com\/. Accessed 30 July 2021."},{"key":"1962_CR37","volume-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach","author":"AF Hayes","year":"2017","unstructured":"Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford publications; 2017."},{"issue":"3","key":"1962_CR38","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1530\/EJE-11-1029","volume":"167","author":"M Ito","year":"2012","unstructured":"Ito M, Miyauchi A, Morita S, Kudo T, Nishihara E, Kihara M, et al. TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy. Eur J Endocrinol. 2012;167(3):373\u20138.","journal-title":"Eur J Endocrinol"},{"issue":"2","key":"1962_CR39","doi-asserted-by":"publisher","first-page":"e406","DOI":"10.1002\/edm2.406","volume":"6","author":"R Le Moli","year":"2023","unstructured":"Le Moli R, Malandrino P, Russo M, Tumino D, Piticchio T, Naselli A, et al. Levothyroxine therapy, calculated deiodinases activity and basal metabolic rate in obese or nonobese patients after total thyroidectomy for differentiated thyroid cancer, results of a retrospective observational study. Endocrinol Diab Metabol. 2023;6(2):e406.","journal-title":"Endocrinol Diab Metabol"},{"issue":"1","key":"1962_CR40","doi-asserted-by":"publisher","first-page":"239","DOI":"10.3390\/biomedicines12010239","volume":"12","author":"T Piticchio","year":"2024","unstructured":"Piticchio T, Savarino F, Volpe S, Prinzi A, Costanzo G, Gamarra E, et al. Inflammatory Profile Assessment in a Highly Selected Athyreotic Population Undergoing Controlled and Standardized Hypothyroidism. Biomedicines. 2024;12(1):239.","journal-title":"Biomedicines"},{"issue":"10154","key":"1962_CR41","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1016\/S0140-6736(18)32356-0","volume":"392","author":"E Bullmore","year":"2018","unstructured":"Bullmore E. The art of medicine: Inflamed depression. Lancet. 2018;392(10154):1189\u201390.","journal-title":"Lancet"},{"issue":"12","key":"1962_CR42","doi-asserted-by":"publisher","first-page":"5076","DOI":"10.1210\/jc.2006-1075","volume":"91","author":"S Taddei","year":"2006","unstructured":"Taddei S, Caraccio N, Virdis A, Dardano A, Versari D, Ghiadoni L, et al. Low-grade systemic inflammation causes endothelial dysfunction in patients with Hashimoto\u2019s thyroiditis. J Clin Endocrinol Metab. 2006;91(12):5076\u201382.","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"1962_CR43","first-page":"425","volume":"33","author":"A M\u00e1rquez","year":"2001","unstructured":"M\u00e1rquez A, Finol HJ, De Blanco MC, Adjounian H, Pulido-M\u00e9ndez M. Skeletal muscle microvascular alterations in euthyroid and hypothyroid patients with autoimmune thyroid disease. J Submicrosc Cytol Pathol. 2001;33(4):425\u201332.","journal-title":"J Submicrosc Cytol Pathol"},{"key":"1962_CR44","doi-asserted-by":"publisher","first-page":"108519","DOI":"10.1016\/j.clineuro.2024.108519","volume":"245","author":"B Strza\u0142kowska","year":"2024","unstructured":"Strza\u0142kowska B, Strzelczyk J, Dawidowicz M, Kula A, Mielcarska S, Szarek R, et al. Brain disorders in euthyroid Hashimoto\u2019s thyroiditis patients. Clin Neurol Neurosurg. 2024;245:108519.","journal-title":"Clin Neurol Neurosurg"},{"issue":"1","key":"1962_CR45","doi-asserted-by":"publisher","first-page":"12358","DOI":"10.1038\/s41598-024-63158-w","volume":"14","author":"B Bazika-Gerasch","year":"2024","unstructured":"Bazika-Gerasch B, Kumowski N, Enax-Krumova E, Kaisler M, Eitner LB, Maier C, et al. Impaired autonomic function and somatosensory disturbance in patients with treated autoimmune thyroiditis. Sci Rep. 2024;14(1):12358.","journal-title":"Sci Rep"},{"issue":"2","key":"1962_CR46","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1093\/fampra\/cmr059","volume":"29","author":"H Bould","year":"2012","unstructured":"Bould H, Panicker V, Kessler D, Durant C, Lewis G, Dayan C, et al. Investigation of thyroid dysfunction is more likely in patients with high psychological morbidity. Fam Pract. 2012;29(2):163\u20137.","journal-title":"Fam Pract"},{"issue":"3","key":"1962_CR47","doi-asserted-by":"publisher","first-page":"E191","DOI":"10.1503\/cmaj.110829","volume":"184","author":"L Manea","year":"2012","unstructured":"Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012;184(3):E191\u20136.","journal-title":"CMAJ"},{"key":"1962_CR48","doi-asserted-by":"publisher","first-page":"590648","DOI":"10.1155\/2012\/590648","volume":"2012","author":"MP Hage","year":"2012","unstructured":"Hage MP, Azar ST. The Link between Thyroid Function and Depression. J Thyroid Res. 2012;2012:590648.","journal-title":"J Thyroid Res"},{"issue":"6","key":"1962_CR49","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1001\/jamapsychiatry.2018.0190","volume":"75","author":"EM Siegmann","year":"2018","unstructured":"Siegmann EM, M\u00fcller HHO, Luecke C, Philipsen A, Kornhuber J, Gr\u00f6mer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiat. 2018;75(6):577\u201384.","journal-title":"JAMA Psychiat"},{"issue":"4","key":"1962_CR50","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/j.1365-2265.2008.03521.x","volume":"71","author":"V Panicker","year":"2009","unstructured":"Panicker V, Evans J, Bj\u00f8ro T, Asvold BO, Dayan CM, Bjerkeset O. A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin Endocrinol (Oxf). 2009;71(4):574\u201380.","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"6","key":"1962_CR51","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1192\/bjp.bp.115.175059","volume":"209","author":"S Kolovos","year":"2016","unstructured":"Kolovos S, Kleiboer A, Cuijpers P. Effect of psychotherapy for depression on quality of life: meta-analysis. Br J Psychiatry. 2016;209(6):460\u20138.","journal-title":"Br J Psychiatry"},{"key":"1962_CR52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jpsychores.2017.07.011","volume":"101","author":"F K\u00f6teles","year":"2017","unstructured":"K\u00f6teles F, Witth\u00f6ft M. Somatosensory amplification - An old construct from a new perspective. J Psychosom Res. 2017;101:1\u20139.","journal-title":"J Psychosom Res"},{"key":"1962_CR53","doi-asserted-by":"publisher","first-page":"110131","DOI":"10.1016\/j.jpsychores.2020.110131","volume":"135","author":"H Barends","year":"2020","unstructured":"Barends H, Claassen-van Dessel N, van der Wouden JC, Twisk JW, Terluin B, van der Horst HE, et al. Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study. J Psychosom Res. 2020;135:110131.","journal-title":"J Psychosom Res"},{"issue":"1","key":"1962_CR54","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/S0033-3182(92)72018-0","volume":"33","author":"AJ Barsky","year":"1992","unstructured":"Barsky AJ. Amplification, somatization, and the somatoform disorders. Psychosomatics. 1992;33(1):28\u201334.","journal-title":"Psychosomatics"},{"issue":"1","key":"1962_CR55","doi-asserted-by":"publisher","first-page":"e40","DOI":"10.1176\/appi.neuropsych.13070170","volume":"27","author":"DL Perez","year":"2015","unstructured":"Perez DL, Barsky AJ, Vago DR, Baslet G, Silbersweig DA. A neural circuit framework for somatosensory amplification in somatoform disorders. J Neuropsychiatry Clin Neurosci. 2015;27(1):e40-50.","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"1962_CR56","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.nicl.2016.04.001","volume":"11","author":"M Boeckle","year":"2016","unstructured":"Boeckle M, Schrimpf M, Liegl G, Pieh C. Neural correlates of somatoform disorders from a meta-analytic perspective on neuroimaging studies. Neuroimage Clin. 2016;11:606\u201313.","journal-title":"Neuroimage Clin"},{"issue":"1","key":"1962_CR57","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1038\/ajg.2017.421","volume":"113","author":"I Aziz","year":"2018","unstructured":"Aziz I, Palsson OS, T\u00f6rnblom H, Sperber AD, Whitehead WE, Simr\u00e9n M. The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization, Quality of Life, and Healthcare Utilization: A Cross-Sectional General Population Study in Three Countries. Am J Gastroenterol. 2018;113(1):86\u201396.","journal-title":"Am J Gastroenterol"},{"issue":"20","key":"1962_CR58","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.1097\/00007632-200110150-00020","volume":"26","author":"R Nickel","year":"2001","unstructured":"Nickel R, Egle UT, Eysel P, Rompe JD, Z\u00f6llner J, Hoffmann SO. Health-related quality of life and somatization in patients with long-term low back pain: a prospective study with 109 patients. Spine (Phila Pa 1976). 2001;26(20):2271\u20137.","journal-title":"Spine (Phila Pa 1976)."},{"issue":"10","key":"1962_CR59","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1002\/gps.1387","volume":"20","author":"B Sheehan","year":"2005","unstructured":"Sheehan B, Lall R, Bass C. Does somatization influence quality of life among older primary care patients? Int J Geriatr Psychiatry. 2005;20(10):967\u201372.","journal-title":"Int J Geriatr Psychiatry"},{"key":"1962_CR60","doi-asserted-by":"crossref","unstructured":"Perros P, Nagy EV, Papini E, Van Der Feltz-Cornelis CM, Weetman AP, Hay HA, et al. Hypothyroidism and Somatization: Results from E-Mode Patient Self-Assessment of Thyroid Therapy, a Cross-Sectional, International Online Patient Survey. Thyroid. 2023;33(8):927\u201339.","DOI":"10.1089\/thy.2022.0641"},{"key":"1962_CR61","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jpsychores.2020.110131","volume":"135","author":"H Barends","year":"2020","unstructured":"Barends H, Claassen-van Dessel N, van der Wouden JC, Twisk JWR, Terluin B, van der Horst HE, et al. Impact of symptom focusing and somatosensory amplification on persistent physical symptoms: A three-year follow-up study. J Psychosom Res. 2020;135:110\u201331.","journal-title":"J Psychosom Res"},{"key":"1962_CR62","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s12529-016-9536-0","volume":"23","author":"BK Doering","year":"2016","unstructured":"Doering BK, Sz\u00e9csi J, B\u00e1rdos G, K\u00f6teles F. Somatosensory amplification is a predictor of self-reported side effects in the treatment of primary hypertension: a pilot study. Int J Behav Med. 2016;23:327\u201332.","journal-title":"Int J Behav Med"},{"issue":"3","key":"1962_CR63","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.genhosppsych.2008.01.001","volume":"30","author":"B L\u00f6we","year":"2008","unstructured":"L\u00f6we B, Spitzer RL, Williams JB, Mussell M, Schellberg D, Kroenke K. Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment. Gen Hosp Psychiatry. 2008;30(3):191\u20139.","journal-title":"Gen Hosp Psychiatry"},{"issue":"1","key":"1962_CR64","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/S0022-3999(01)00216-1","volume":"51","author":"KR Aronson","year":"2001","unstructured":"Aronson KR, Barrett LF, Quigley KS. Feeling your body or feeling badly: evidence for the limited validity of the Somatosensory Amplification Scale as an index of somatic sensitivity. J Psychosom Res. 2001;51(1):387\u201394.","journal-title":"J Psychosom Res"},{"issue":"4","key":"1962_CR65","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1530\/EJE-15-0395","volume":"173","author":"N Kelderman-Bolk","year":"2015","unstructured":"Kelderman-Bolk N, Visser TJ, Tijssen JP, Berghout A. Quality of life in patients with primary hypothyroidism related to BMI. Eur J Endocrinol. 2015;173(4):507\u201315.","journal-title":"Eur J Endocrinol"},{"issue":"12","key":"1962_CR66","doi-asserted-by":"publisher","first-page":"3864","DOI":"10.3390\/jcm9123864","volume":"9","author":"B Romero-G\u00f3mez","year":"2020","unstructured":"Romero-G\u00f3mez B, Guerrero-Alonso P, Carmona-Torres JM, Pozuelo-Carrascosa DP, Laredo-Aguilera JA, Cobo-Cuenca AI. Health-Related Quality of Life in Levothyroxine-Treated Hypothyroid Women and Women without Hypothyroidism: A Case-Control Study. J Clin Med. 2020;9(12):3864.","journal-title":"J Clin Med"},{"issue":"5","key":"1962_CR67","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1111\/cob.12203","volume":"7","author":"RL Kolotkin","year":"2017","unstructured":"Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273\u201389.","journal-title":"Clin Obes"},{"key":"1962_CR68","doi-asserted-by":"crossref","unstructured":"Medici BB, Lerche la Cour J, Knop FK, Krakauer M, Michaelsson LF, Faber J, et al. Predictors of improvement in quality of life when treating hypothyroidism. J Thyroid Res. 2021;2021:5577217.","DOI":"10.1155\/2021\/5577217"},{"issue":"1","key":"1962_CR69","doi-asserted-by":"publisher","first-page":"13","DOI":"10.7861\/clinmed.2020-0947","volume":"21","author":"M Husain","year":"2021","unstructured":"Husain M, Chalder T. Medically unexplained symptoms: assessment and management. Clin Med (Northfield Il). 2021;21(1):13.","journal-title":"Clin Med (Northfield Il)"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-01962-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-025-01962-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-01962-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T04:03:11Z","timestamp":1748232191000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcendocrdisord.biomedcentral.com\/articles\/10.1186\/s12902-025-01962-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":69,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1962"],"URL":"https:\/\/doi.org\/10.1186\/s12902-025-01962-9","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]},"assertion":[{"value":"16 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the National Scientific and Ethical Committee of the Hungarian Medical Research Council (No.: 38233\u20131\/2019\/EKU) and was conducted in accordance with the World Medical Association\u2019s Declaration of Helsinki.Written informed consent was obtained from all participants before entering and prior to all study-related procedures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"136"}}