Quality-of-Life Changes in Patients with Thyroid Cancer After Withdrawal of Thyroid Hormone Therapy

Dow, Karen Hassey; Ferrell, Betty; Anello, Carol

doi:10.1089/thy.1997.7.613

Cited by 269 publications

(190 citation statements)

References 7 publications

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“…Most studies on thyroid cancer survivorship in North America have reported a modest decrease in quality of life (QoL) after treatment (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). However, careful review of these data shows that the study populations were small, the tools were inconsistent and not tailored for thyroid cancer survivors, the sampling techniques did not take into account the varied survivor populations found in modern society, and only five small studies were conducted in the United States (12,14,16,18,19).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study

Aschebrook‐Kilfoy

James

Nagar

et al. 2015

Thyroid

140

118

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Background: The prevalence of thyroid cancer survivors is rising rapidly due to the combination of an increasing incidence, high survival rates, and a young age at diagnosis. The physical and psychosocial morbidity of thyroid cancer has not been adequately described, and this study therefore sought to improve the understanding of the impact of thyroid cancer on quality of life (QoL) by conducting a large-scale survivorship study. Methods: Thyroid cancer survivors were recruited from a multicenter collaborative network of clinics, national survivorship groups, and social media. Study participants completed a validated QoL assessment tool that measures four morbidity domains: physical, psychological, social, and spiritual effects. Data were also collected on participant demographics, medical comorbidities, tumor characteristics, and treatment modalities. Results: A total of 1174 participants with thyroid cancer were recruited. Of these, 89.9% were female, with an average age of 48 years, and a mean time from diagnosis of five years. The mean overall QoL was 5.56/10, with 0 being the worst. Scores for each of the sub-domains were 5.83 for physical, 5.03 for psychological, 6.48 for social, and 5.16 for spiritual well-being. QoL scores begin to improve five years after diagnosis. Female sex, young age at diagnosis, and lower educational attainment were highly predictive of decreased QoL. Conclusion: Thyroid cancer diagnosis and treatment can result in a decreased QoL. The present findings indicate that better tools to measure and improve thyroid cancer survivor QoL are needed. The authors plan to follow-up on these findings in the near future, as enrollment and data collection are ongoing.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study

Aschebrook‐Kilfoy

James

Nagar

et al. 2015

Thyroid

140

118

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“…Furthermore, during withdrawal, patients show associated psychological symptoms and social changes, such as family distress or decreased motivation to work. Patients suffering from non-metastatic DTC have been shown to have worse HRQL during peak thyroid withdrawal (5,6). Several years ago, recombinant human TSH (rhTSH) was introduced and this avoids the side-effects of thyroid hormone withdrawal (4).…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment

Tagay¹,

Herpertz

Langkafel³

et al. 2005

eur j endocrinol

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Objective: Very few previous studies have compared the degree of health-related quality of life (HRQL), depression and anxiety of differentiated thyroid cancer patients (DTC) under short-term hypothyroidism and levothyroxine treatment. Methods: Using patient-completed instruments, we examined the frequency of physical complaints, HRQL, anxiety and depression in 130 DTC patients hospitalized for radioiodine therapy or wholebody diagnostics (age 52 years, female 71%) under short-term hypothyroidism (4 weeks of levothyroxine withdrawal; DTC-H) and in 100 DTC out-patients under TSH-suppressive doses of levothyroxine subsequent to radioiodine therapy (DTC-L; age 49 years, female 81%). Results: Compared with the German general population, DTC-H as well as DTC-L patients had significantly impaired HRQL. Notably, the decrease in HRQL was significantly higher in DTC-H than in DTC-L patients. Surprisingly, the prevalence of anxiety (44.6%) but not depression (17.7%) was much higher in the DTC-H patients than in the general population. In contrast to expectations, similar results for anxiety (44.0%) and depression (17.6%) were observed in the DTC-L patients. Conclusions: This mounting evidence suggests that a consistent pattern of HRQL impairment is experienced by patients with DTC. The high frequency of anxiety and the significantly reduced HRQL should be considered in the aftercare of DTC patients.

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“…L-T4 withdrawal also results in a lengthy period of hypothyroidism of variable, but often marked, severity (1). This metabolic impairment may lead to adverse clinical consequences such as occasional cases of ischaemic heart disease or dementia, and, particularly when bone metastases are present, compressive symptoms due to tumour growth stimulation (2).…”

Section: Introductionmentioning

confidence: 99%

Radioiodine treatment of metastatic differentiated thyroid cancer in patients on L-thyroxine, using recombinant human TSH

Lippi

Capezzone

Angelini

et al. 2001

European Journal of Endocrinology

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Objective: This study tested the hypothesis that administration of human recombinant thyroidstimulating hormone (rhTSH: Thyrogen, thyrotropin alpha) could promote iodine-131 ( 131 I) uptake in the therapy for metastatic or locally invasive differentiated thyroid cancer (DTC), obviating Lthyroxine suppressive therapy (L-T4) withdrawal and hypothyroidism in patients with advanced disease. Methods: Twelve totally (or almost completely) thyroidectomized adults, nine of whom had received earlier therapy after L-T4 withdrawal, underwent 131 I treatment while euthyroid on L-T4, after rhTSH administration. Nine underwent diagnostic whole-body scanning (WBS) after two consecutive daily i.m. injections (0.9 mg) of rhTSH. They then received an identical second course of rhTSH to promote therapeutic 131 I uptake. Post-therapy WBS was performed one week later. Three patients received only rhTSH 131 I therapy. Results: Administration of rhTSH promoted 131 I uptake in all patients, as demonstrated by posttherapy WBS. Administration of rhTSH also promoted a significant increase in serum thyroglobulin (Tg) concentrations. According to the most recent measurements, 3±12 months after therapy, serum Tg levels fell in four, and stabilized in two out of eleven patients. Upon additional rhTSH-WBS 8 months post-study, a reduction in one metastatic site was noted in one patient. The rhTSH was well tolerated, with mild, transient fever and/or nausea occurring in only a minority of patients. Individuals with bone metastases experienced degrees of peritumoral pain and swelling that were similar (though more short-lived) to those seen in the same or other patients after L-T4 withdrawal. Conclusions: Administration of rhTSH is a safe, successful tool for inducing 131 I uptake in local and metastatic DTC lesions, and avoids L-T4 withdrawal, preserving metabolic homeostasis and preventing the debilitating effects of hypothyroidism.

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Quality-of-Life Changes in Patients with Thyroid Cancer After Withdrawal of Thyroid Hormone Therapy

Cited by 269 publications

References 7 publications

Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study

Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors: Initial Findings from the North American Thyroid Cancer Survivorship Study

Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment

Radioiodine treatment of metastatic differentiated thyroid cancer in patients on L-thyroxine, using recombinant human TSH

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