# Anxiety in Hypothyroidism: High Prevalence and Significant Treatment Response in a Rural Nepalese Cohort

## TL;DR

This study finds high anxiety rates in hypothyroid patients in rural Nepal, with significant improvement after levothyroxine treatment.

## Contribution

The study is the first to evaluate anxiety prevalence and treatment response in hypothyroid patients in rural Nepal.

## Key findings

- Levothyroxine therapy significantly reduced anxiety scores in hypothyroid patients.
- Severe anxiety was present in 54.5% of patients before treatment.
- Higher dietary iodine intake correlated with higher post-treatment anxiety scores.

## Abstract

Objectives: The association between hypothyroidism and anxiety symptoms is well-established. However, there is limited research on this comorbidity in resource-constrained rural settings, such as Nepal, where delayed diagnosis may exacerbate psychiatric burden. This study aimed to assess the prevalence of anxiety among hypothyroid patients in rural Nepal and evaluate the impact of levothyroxine therapy on their symptoms. A key secondary objective was to explore the association between dietary iodine intake and residual post-treatment anxiety.

Methods: This cross-sectional study included 101 hypothyroid patients (mean age: 53.7±1.4 years; 88 (86.3%) female) receiving levothyroxine therapy (median dose: 37.5 mcg (IQR 25-62.5); median duration: 5 years) at a primary health center in Shringa, Nepal. Anxiety severity was assessed using the Hamilton Anxiety Rating Scale (HAM-A) before and after levothyroxine treatment. Dietary iodine intake was also evaluated.

Results: Post-treatment HAM-A scores were significantly lower than pre-treatment scores, with a median decrease of 14 points (P<0.0001; Wilcoxon matched-pairs signed-rank test). Severe anxiety (HAM-A ≥19) was present in 55 (54.5%) patients, moderate in 19 (18.8%) patients, mild in 14 (13.9%) patients, and none in 13 (12.9%) patients. Mean daily salt intake was 10.47±2.57 g, and median daily iodine intake was 340 mcg (IQR 306-408). Dietary iodine intake correlated positively with post-treatment HAM-A scores (r=0.23, P=0.02).

Conclusions: Anxiety is highly prevalent among hypothyroid patients in this rural Nepalese setting. Levothyroxine therapy substantially alleviates these anxiety symptoms. For practitioners in rural and remote settings, these findings underscore the importance of managing the psychiatric dimensions of hypothyroidism. Integrating anxiety assessment into routine hypothyroidism care is essential for improving patient outcomes in rural settings.