Title: Quality of life, social support, and adherence in female patients with thyroid disorders
Version: 1 Date: 20 Jul 2023
Reviewer's report:
REVIEW
In their study the authors investigated quality of life in women with certain thyroid diseases,
and its association with adherence and social support, giving valuable insight into psychological
aspects of these frequent chronic conditions.
The aim of the study is clear, although some clarification would be useful.
Please underpin with relevant literature why thyroid diseases were chosen to be investigated?
How exactly are thyroid diseases less surveyed than other conditions?
Please provide an explanation why men were excluded from this study.
Hashimoto's thyroiditis manifests mostly as hypothyroidism, Graves’ diseases mostly as
hyperthyroidism. Do these categories make sense? Which category should a patient with
hypothyroidism due to Hashimoto's thyroiditis choose? Should they tick both? Are patients
supposed to know these distinctions, terms?
Why were patients with nodules but with euthyroidism excluded?
Introduction
This section comprises more than three pages - it is way too long.
The authors claim that “According to a report by the 2010 EuroVaQ, the overall health status of
the Hungarian population is poorer than in other European countries”.
The citation provided is not a citation for the EuroVaQ report. Please correct it.
Is this claim correct, the overall health status is the poorest in Europe?
“ Some chronic diseases are regularly surveyed” how regularly and in what way are these
conditions surveyed?
Not easy to tell based on the provided literature (Cit 3: PhD thesis (??) in Hungarian, 4: article
in Hungarian, 5: book, PhD thesis (??) in Hungarian).
By the way, three unusual citations for the regularly surveyed chronic diseases, and also 3
citations for the “scarcely investigated” thyroid diseases does not support these statements.
Although these citations are also unorthodox (6: thyroiditis in Sjögren’s disease, 7: incidence of
thyroid diseases among children after the disaster of Chernobyl).
The last sentence of the second paragraph summarizes the previous two sentences although
phrased as if it would cite some other study. This sentence seems superfluous.
Citation 27 is not supporting the sentence where it is cited. Please replace it with a relevant
citation.
Please do not use brand names for medications, unless it is truly important to do so.
The Adherence section contains approximately two dozen lines. One study is cited that found
a connection between adherence and quality of life, the rest of these paragraphs are general
statements. The last sentence summarizes the previous sentence and neglects all the others.
Please provide more details about adherence and QoL (and less about treatment modalities), or
change the summarizing last sentence to reflect this whole section.
Methods
Why were patients with a psychiatric diagnosis in their history excluded?
There is a significant overlap between thyroid diseases and for example mood disorders - as
discussed exhaustively in the Introduction.
Moreover why is it an exclusion criterion not to have psychiatric treatment within six months?
Why six months? Ever a treatment = diagnosis of lifetime psychiatric disorder -> excluded
anyway…
Patients were enrolled from websites, Facebook, etc.. Their mean age was quite low, probably
due to this type of enrollment.
Is there any data about age-related differences in patients with chronic diseases regarding
adherence, support and quality of life?
Reference 61 seems to cite a cross-cultural validation of the  original version of the ThyPRO
questionnaire, not the shortened one. Please correct it.
Does this questionnaire have a Hungarian version?
Why should the Likert-scale answers be rescored to from 0-1-2-3-4 to 0-25-50-75-100? What
is the gain here, and what is it based on?
The authors claim that “In the present study, a further category “None” was added” to the
Support Dimension Scale. What was the reason for this unusual alteration of a questionnaire? If
all answers are 0-s, that would give this Nona category anyway.
Ref 55 is not about the Morisky Scales.
Statistical analysis is clear, well-founded.
How exactly was Mann Whitney test used for post hoc, all groups compared with p value set
to 0,05?
Ref 67 is not about the calculation of indirect effects.
Discussion
This section is clear, well-written and more concise. The sample size limitations in certain groups
are adequately addressed.
Ref 51 does not support the citing claim.
Ref 52 is a book (probably, no publisher, publishing site is provided). If it indeed supports what
it is cited for, please provide page numbers in the references.
Ref 72 does not support what it is cited for.
Ref 48 does not support what it is cited for.
References
This section needs serious amendments.
The number of Hungarian books and articles without English availability is higher than optimal.
The format of the references are often incorrect for journals.
Some journal articles are shown as webpages.
Book references often miss the publisher’s name and location.
Journal articles sometimes unnecessary provide the publisher's name.
Web-pages often miss the available from term, and quite often the date of access.
Plus typos, punctuation mistakes.
Providing the page numbers from book citations in the manuscript text is not necessary, it is
enough to indicate page numbers in the citations.
In the second paragraph of the discussion section please correct this format: (4,54) (45,47)
21: pediatric publication
22: this study enrolled men, I recommend not citing it.
Other comments
The first section of the abstract is Background, while it is Introduction in the main text. (could
be okay, though.)
Some ending brackets are missing, typically when starting with (e.g. … .