The Effect of Thyroid Hormone Withdrawal, Performed to Evaluate the Success of I-131 Ablation on Quality of Life and Psychological Symptoms in Female Patients With Low-risk Differentiated Thyroid Cancer

Abstract Purpose: There is a need to evaluate the treatment response in patients who have undergone radioiodine treatment (RIT) for differentiated thyroid cancer. Our study aimed to show thyroid hormone withdrawal (THW) effects on quality of life and psychological symptoms in female patients with low-risk, well-differentiated papillary thyroid cancer. Methods: We applied the short form-36 (SF-36) and Symptom Checklist-90-R (SCL-90-R) questionnaires to the patients in the euthyroid state who have referred a median of 9 months (6-13 months) after RIT to perform a diagnostic whole-body scan (dWBS) and to evaluate stimulated Tg. We applied the same questionnaire again when thyroid-stimulating hormone (TSH) was > 30 μIU/mL 4 weeks after THW (hypothyroid state). We evaluated the changes in questionnaire scores using the paired-samples t-test or the Wilcoxon signed-rank test. Results: Our study included 52 patients (median age 48 years, range 23-65 years). There was a statistically significant worsening in anxiety, psychosis, additional items, and general symptom index symptoms with the SCL-90-R questionnaire, physical functioning, role limitation due to physical health, energy/fatigue, emotional well-being, social function, general health, and health change with the SF-36 questionnaire. Conclusions: THW worsened the patients' psychological symptoms and quality of life. Thyrotropin alfa is an alternative to reduce side effects, but it can be costly and difficult to obtain in developing countries. In order to reduce the side effects of hypothyroidism and avoid the high cost, treatment response assessment can be done only in selected patient groups.

Download Full-text

The Effect of Thyroid Hormone Withdrawal, Performed to Evaluate the Success of I-131 Ablation, On Quality of Life in Female Patients With Low-Risk Differentiated Thyroid Cancer

10.21203/rs.3.rs-684400/v1 ◽

2021 ◽

Author(s):

Osman Kupik ◽

Bayram Şen ◽

Medeni Arpa ◽

Levent Akça ◽

Uğur Avcı ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Thyroid Hormone ◽

Differentiated Thyroid Cancer ◽

Psychological Symptoms ◽

Thyroid Stimulating Hormone ◽

Low Risk ◽

Thyroid Hormone Withdrawal ◽

Sf 36

Abstract Objective: There is a need to evaluate the treatment response in patients who have undergone radioiodine treatment (RIT) for differentiated thyroid cancerDiagnostic tests that are used for this purpose include radioiodine whole body scan (sWBS) and serum thyroglobulin (Tg) measurement which are most accurate during thyroid-stimulating hormone (TSH) stimulation. However temporary discontinuation of thyroid hormone therapy to increase TSH (withdrawal) may be associated with the morbidity of hypothyroidism The aim of our study was to show the effects of thyroid hormone withdrawal (THW), on quality of life and psychological symptoms in female patients with low-risk, well-differentiated papillary thyroid cancer. Methods: We applied the short form-36 (SF-36) and Symptom Checklist-90-R (SCL-90-R) questionnaires to the patients in the euthyroid state who were referred a median of 9 months (6-13 months) after RIT, to perform a dWBS and to evaluate stimulated Tg. We applied the same questionnaire again when thyroid-stimulating hormone (TSH) was > 30 μIU/mL 4 weeks after THW (hypothyroid state). We evaluated the changes in questionnaire scores using the paired-samples t test or the Wilcoxon signed rank test. Results: Our study included 52 patients (median age 48 years, range 23-65 years) with differentiated cancer. Forthy –two (%) of these patients received 3700 MBq I-131 wheras 7 (%) patients received 1850 MBq. . Ablation success based on the dWBS only was 96.2%, based on Tg only was 98% and based on thyroglobulin antibodies (TgAb) only was 88.5%. There was statistically significant worsening in anxiety, psychosis, additional items and general symptom index symptoms with the SCL-90-R questionnaire, and physical functioning, role limitation due to physical health, energy/fatigue, emotional well-being, social function, general health and health change with the SF-36 questionnaire. Conclusions: THW worsened the patients’ psychological symptoms and quality of life. Our findings show that stimulated Tg and the dWBS may have side effects that outweigh benefits in patients with low-risk differentiated thyroid cancer without TgAb interference and access to ultrasonography.

Download Full-text

Thyroid hormone and its metabolites in relation to quality of life in patients treated for differentiated thyroid cancer

Clinical Endocrinology ◽

10.1111/cen.13101 ◽

2016 ◽

Vol 85 (5) ◽

pp. 781-788 ◽

Cited By ~ 17

Author(s):

E.T. Massolt ◽

M. van der Windt ◽

T.I.M. Korevaar ◽

B.L.R. Kam ◽

J.W. Burger ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Thyroid Hormone ◽

Differentiated Thyroid Cancer

Download Full-text

Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences

Acta Endocrinologica ◽

10.1530/eje.1.02310 ◽

2007 ◽

Vol 156 (1) ◽

pp. 13-19 ◽

Cited By ~ 46

Author(s):

Leonidas H Duntas ◽

Bernadette Biondi

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Cardiovascular Effects ◽

The Elderly ◽

Differentiated Thyroid Carcinoma ◽

Thyroid Hormone Withdrawal ◽

Multiple Organs ◽

Acute Hypothyroidism

Acute hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer during monitoring for remnant or metastatic disease, seriously affects multiple organs and systems, and especially in severe cases can impair quality of life. Indeed, it may induce untoward cardiovascular effects and can be hazardous in patients with underlying cardiovascular disease, particularly in the elderly. Moreover, acute hypothyroidism deranges the lipid profile and exacerbates neuropsychiatric illness. The introduction of recombinant human TSH (rhTSH) as a diagnostic and therapeutic tool in the care of patients with thyroid cancer has widened the scope of disease management. The use of rhTSH prevents derangement of various systems at approximately equivalent societal costs to that of withdrawal and promotes compliance while preserving the patient’s normal daily functioning and productivity. Its reliability allied with its safety render this compound a valid alternative in the monitoring of patients with differentiated thyroid carcinoma as well as providing an alternative therapeutic procedure whenever LT4-withdrawal may be hazardous or in cases of patient non-compliance.

Download Full-text

Recombinant human thyroid‐stimulating hormone versus thyroid hormone withdrawal preparation for radioiodine ablation in differentiated thyroid cancer in children, adolescents and young adults

Clinical Endocrinology ◽

10.1111/cen.14457 ◽

2021 ◽

Author(s):

Max A. Schumm ◽

Howard Q. Pyo ◽

Jiyoon Kim ◽

Chi‐Hong Tseng ◽

Michael W. Yeh ◽

...

Keyword(s):

Young Adults ◽

Thyroid Cancer ◽

Thyroid Hormone ◽

Differentiated Thyroid Cancer ◽

Thyroid Stimulating Hormone ◽

Adolescents And Young Adults ◽

Human Thyroid ◽

Thyroid Hormone Withdrawal ◽

Radioiodine Ablation ◽

Cancer In Children

Download Full-text

Health-Related Quality of Life in Asian Differentiated Thyroid Cancer Survivors

Cancer Control ◽

10.1177/10732748211029726 ◽

2021 ◽

Vol 28 ◽

pp. 107327482110297

Author(s):

Wing-Lok Chan ◽

Horace Cheuk-Wai Choi ◽

Brian Lang ◽

Kai-Pun Wong ◽

Kwok-Keung Yuen ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Cancer Survivors ◽

Differentiated Thyroid Cancer ◽

Summary Score ◽

Health Related Quality ◽

Factors Associated ◽

Related Quality ◽

Health Related

Background: Health-related quality of life (HRQoL) is important for differentiated thyroid cancer survivors, but data for Asian survivors is lacking. This study aimed to have an overview of, and identify any disease-or treatment-related factors associated with, HRQoL in Asian differentiated thyroid cancer survivors. Patients and Methods: Thyroid cancer survivors were recruited from the thyroid clinics at Queen Mary Hospital, Hong Kong from February 2016 to December 2016. All adult differentiated thyroid cancer patients with stable disease more than or equal to 1 year received a survey on HRQoL using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and Thyroid cancer specific quality of life (THYCA-QoL) questionnaire. Clinical information was collected retrospectively from the computerized clinical management system. To identify factors associated with poor HRQoL, univariable and stepwise multivariable regression analysis were performed. Results: A total of 613 survivors completed the questionnaires (response rate: 82.1%; female: 80.1%; median survivorship: 7.4 years (range: 1.0-48.2 years)). The QLQ-C30 summary score mean was 84.4 (standard deviation (SD): 12.7) while the THYCA-QoL summary score mean was 39.9 (SD: 9.7). The 2 highest symptom subscales were fatigue (mean: 26.4, SD: 20.6) and insomnia (mean: 26.2, SD: 27.6). Factors associated with worse HRQoL included serum thyrotropin (TSH) greater than 1.0 mIU/L, unemployment, and concomitant psychiatric disorders. Concomitant psychiatric illness (n = 40/613, 6.5%) also showed significant association with most of the symptom and functional subscales. Conclusions: Fatigue and insomnia were the 2 most common symptoms experienced by our differentiated thyroid cancer survivors. Long-term survivorship care with monitoring serum TSH level, supporting return-to-work and screening for concomitant psychiatric disorders should be offered.

Download Full-text

Quality of life during the first 6 months of interferon-b treatment in patients with MS

Multiple Sclerosis Journal ◽

10.1177/135245850000600508 ◽

2000 ◽

Vol 6 (5) ◽

pp. 338-342

Author(s):

J HA Arnoldus ◽

J Killestein ◽

L EMA Pfennings ◽

B Jelles ◽

B MJ Uitdehaag ◽

...

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Side Effects ◽

Physical Functioning ◽

Bodily Pain ◽

Significant Linear Trend ◽

Role Physical ◽

Sf 36 ◽

The Impact

Objectives: To determine the quality of life (QoL) of MS patients during the initial 6 months of treatment with interferon-b (IFN-b). Furthermore, to determine whether changes in QoL relate to disability, emotional state, therapeutic expectations or side effect profile. Background: IFN-b has been shown to have beneficial effects on the course of MS. Since the aim of IFN-b treatment is not to cure but to slow down the disease it is important to know how this treatment affects QoL. Surprisingly, the impact of treatment with IFN-b on QoL measures has not been extensively studied so far. Methods: Case report documentation, including EDSS, SF-36 and MADRAS scores, of 51 relapsing-remitting MS patients treated with IFN-b was obtained at baseline and at months 1, 3 and 6. Patients also filled in a form about their expectations of therapy and a questionnaire on side effects. Results: During treatment there was a significant linear trend indicating improvement in the role-physical functioning (RPF) scale of the SF-36 (F1,50=4.9, P=0.032). A transient decrease at month 1 was found in the scale for bodily pain, indicating more experienced pain (F1,50=19.8, P50.001). Subgroup analysis showed that patients with most depressive symptoms on the MADRAS at baseline contributed most to the increase in RPF scores over time (F1,24=5,6 P=0.026). Furthermore, we found associations between adverse event scores and several domains of QoL. Conclusions: Our findings suggest that IFN-b therapy has an impact on QoL of MS patients in that it improves role-physical functioning and transiently worsens experienced bodily pain. QoL during treatment with IFN-b is influenced by depressive symptoms at baseline as well as by treatment-associated side-effects.

Download Full-text

Quality of Life with Well-Differentiated Thyroid Cancer: Treatment Toxicities and Their Reduction

Thyroid ◽

10.1089/105072504322880373 ◽

2004 ◽

Vol 14 (2) ◽

pp. 133-140 ◽

Cited By ~ 39

Author(s):

April Mendoza ◽

Brian Shaffer ◽

Daniel Karakla ◽

M. Elizabeth Mason ◽

David Elkins ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Cancer Treatment ◽

Differentiated Thyroid Cancer ◽

Well Differentiated

Download Full-text

SUN-416 Fatigue and Quality of Life Among Thyroid Cancer Survivors

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1830 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Maki Yukari

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Cancer Survivors ◽

Papillary Thyroid ◽

Explanatory Variables ◽

Initial Surgery ◽

Sf 36

Abstract BACKGROUND Fatigue among thyroid cancer survivors is an important issue that needs to be appreciated and managed appropriately. Although several studies have reported potential factors that might be related to postoperative fatigue, the associations have yet to be inconclusive. The purpose of the present study was to estimate the prevalence of clinical fatigue in patients with papillary thyroid carcinoma and to reveal predictive factors, including their quality of life. METHODS A cross-sectional survey was conducted on patients with papillary thyroid carcinoma. Patients who underwent non-curative surgery, or those with recurrent or metastatic PTC, or those with other malignancies were excluded. The primary outcome was fatigue measured by the Cancer Fatigue Scale (CFS), and the secondary outcome was quality of life (QoL) quantified using the SF-36 v2. The following explanatory variables were collected; gender, age, employment status, marital status, co-morbidities, time since initial surgery, types of surgery, replacement of thyroid hormone, use of radioactive iodine, and the level of thyrotropin. The prevalence of clinical fatigue was estimated with the cut-off value of 18/19 of the CFS score. Correlations between the CFS score and the explanatory variables were examined using uni-variable analyses as well as multi-variable analysis. RESULTS Three hundred twenty-one patients participated in the survey. Of them, 258 respondents (80%) were female. The median age was 58 years, and the median time from initial surgery was 6.4 years. The mean and the standard deviation of the CFS score were 17.9 and 9.3, respectively (range: 0-48). The prevalence of clinical fatigue was 42% [95%CI: 36-47%]. Among the variables explored, having a job and scores of the mental component summary, the physical component summary, and the role/social component summary of the SF-36 were inversely associated with the CFS score in both uni- and multivariable analyses. CONCLUSION Postoperative fatigue was common in thyroid cancer survivors. Patients with a job and better QoL, in particular, those with good mental health, maybe at low-risk of developing the burden.

Download Full-text

Prophylactic prednisolone for the prevention of early and intermediate adverse effects of radioactive iodine therapy in patients with thyroid cancer: study protocol for a single-centre, phase II/III, randomized, double-blinded, placebo-controlled clinical trial

Trials ◽

10.1186/s13063-020-04744-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Umesh Jayarajah ◽

Mahilal Wijekoon ◽

Sanjeewa A. Seneviratne

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Thyroid Cancer ◽

Adverse Effects ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Oral Prednisolone ◽

Single Centre ◽

Double Blinded

Abstract Background Radioactive iodine (RAI) therapy is the standard adjuvant treatment for differentiated thyroid cancer (i.e. papillary and follicular). RAI is associated with troublesome early, intermediate and late adverse effects. Although glucocorticoids are used for the management of these adverse effects, there is little evidence regarding the effectiveness of prophylactic glucocorticoids to prevent these complications. This trial will evaluate the efficacy of a short course of prophylactic glucocorticoids in the prevention of adverse effects of RAI treatment in patients with differentiated thyroid cancer. Methods A phase II/III, single-centre, randomized, double-blinded, placebo-controlled, parallel-arm clinical trial will be conducted. Patients with differentiated thyroid cancer who are referred to RAI therapy at the National Cancer Institute, Sri Lanka, will be randomized into two arms consisting of 200 patients each. The experimental group will receive prophylactic oral prednisolone 0.5 mg/kg and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral prednisolone 0.5 mg/kg and omeprazole 20 mg daily for 3 days. The control group will receive oral placebo and omeprazole 20 mg single dose 6 h before RAI therapy followed by oral placebo and omeprazole 20 mg daily for 3 days. Clinically significant adverse effects assessed as related to RAI as well as prednisolone therapy and the quality of life parameters will be compared between the two groups. Discussion If proven beneficial, this intervention can be incorporated into the standard practice to reduce early and intermediate adverse effects of RAI for thyroid cancer with a potential improvement of quality of life. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2020/009. Registered prospectively on 23 February 2020. Items of the WHO Trial Registration Data Set are provided in the supplementary file.

Download Full-text