Differences in Physicians' and Patients' Perception of Acute Hypothyroid Symptoms Induced by Thyroid Hormone Withdrawal in Thyroid Cancer Patients: A Multicenter Survey in Korea

Abstract

Background: Acute short-term hypothyroidism induced by thyroid hormone withdrawal (THW) for follow-up surveillance or therapeutic radioiodine causes patients with differentiated thyroid cancer to suffer from a myriad of deleterious symptoms. Objectives: To know how patient recognition of hypothyroid symptoms compares to physician perception of patient symptoms. Methods: The survey was performed in 10 referral hospitals throughout Korea from December 2010 to May 2011 and targeted patients with total thyroidectomy and remnant ablation. The survey consisted of questions regarding the effect of THW on patient symptoms, the duration of symptoms, impact on social life, and patient complaints. The physicians treating thyroid cancer patients also responded to the survey and provided their perceptions of patient symptoms and treatment decisions. Results: About 70% of the patients responded that they experienced a negative physical or psychological impact on their life and work due to hypothyroid symptoms. However, 76% of doctors thought hypothyroidism could negatively impact a patient's daily life but would be endurable. Two thirds of physicians do not routinely recommend recombinant human TSH (rhTSH) to their patients. Multivariate analysis showed patients with female sex, stronger educational background, emotionally negative experiences of hypothyroidism, and younger age were more willing to pay for therapy that could prevent hypothyroidism symptoms. Conclusions: There was a substantial gap in the perception of hypothyroid symptoms during THW between physicians and patients. Physicians who are aware of the seriousness of hypothyroidism in their patients were more likely to recommend the use of rhTSH for their patients.

Recombinant human TSH stimulated thyroglobulin levels at remnant ablation predict structural incomplete response to treatment in patients with differentiated thyroid cancer

“…Thyroid hormone withdrawal (THW) causes many acute symptoms of hypothyroidism, including fatigue, weight gain, edema, depressive mood, constipation, and sleep disturbance, whereas rhTSH can be safely applied without concerns about symptoms of hypothyroidism. [ 5 , 6 ]…”

The Influence of Energy Depletion by Metformin or Hypocaloric Diet on Thyroid Iodine Uptake in Healthy Volunteers: a Randomized Trial

“…Preparation for RAI treatment in DTC consists of either thyroid hormone withdrawal for 3–4 weeks or administration of recombinant human TSH (rhTSH) in order to stimulate thyroid iodine uptake 2 . Thyroid hormone withdrawal is associated with symptomatic hypothyroidism and reduced caloric intake due to appetite loss, fatigue, weight changes, gastro-intestinal complaints and depression 16,17 . In addition, an iodine depleted diet which is often used in preparation for RAI therapy, is also accompanied by decreased appetite and caloric intake 18 .…”