Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine.
Differentiated thyroid cancer
Levothyroxine
Quality of life
TSH
ThyPRO
Journal
Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
04
12
2021
accepted:
11
08
2022
pubmed:
22
8
2022
medline:
25
1
2023
entrez:
21
8
2022
Statut:
ppublish
Résumé
Previous studies demonstrated decreased quality of life (QoL) in differentiated thyroid cancer (DTC) survivors and suggested QoL variability related to time from thyroidectomy and levothyroxine dosage. The aims of this study were to evaluate QoL in thyroidectomized subjects in different levothyroxine states and to evaluate the association between TSH and thyroid hormones and QoL. Prospective 5-year study enrolling 208 patients thyroidectomized for DTC, studied in one to four times according to levothyroxine dosage: withdrawal (WITHD), complete (C-SUPP) and mild TSH-suppression (M-SUPP), replacement (REPL). Each patient was allowed to participate into the study more than one time. A total of 300 evaluations were collected, consisting of detailed thyroid hormone profile and QoL assessment through the ThyPRO questionnaire. Comparing the four groups, significant differences were found for anxiety, impaired social and daily life and item 12 (overall impact of thyroid disease) domains (p < 0.05). Interestingly, C-SUPP subjects reported the best scores in almost all ThyPRO scales. Significant correlations were found between QoL and pituitary-thyroid axis function, as well as between QoL and gender, being females more affected. At multiple regression analyses fT3 demonstrated to be the best explanatory factor for overall impact of thyroid disease on the patient's life, followed by gender. TSH-suppressive doses of levothyroxine are more effective in improving QoL in DTC patients after thyroidectomy. These results confirm the urgent need of further studies aimed to define the best treatment of hypothyroidism, effective on well-being and harmless for patients.
Identifiants
pubmed: 35988109
doi: 10.1007/s40618-022-01903-6
pii: 10.1007/s40618-022-01903-6
doi:
Substances chimiques
Thyroxine
Q51BO43MG4
Thyroid Hormones
0
Thyrotropin
9002-71-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
319-326Informations de copyright
© 2022. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).
Références
Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid Off J Am Thyroid Assoc 26(1):1–133. https://doi.org/10.1089/thy.2015.0020
doi: 10.1089/thy.2015.0020
Bãrbuş E, Peştean C, Larg MI (1957) Piciu D (2017) Quality of life in thyroid cancer patients: a literature review. Clujul Med 90(2):147–153. https://doi.org/10.15386/cjmed-703
doi: 10.15386/cjmed-703
Husson O, Haak HR, Oranje WA, Mols F, Reemst PH, van de Poll-Franse LV (2011) Health-related quality of life among thyroid cancer survivors: a systematic review. Clin Endocrinol 75(4):544–554. https://doi.org/10.1111/j.1365-2265.2011.04114.x
doi: 10.1111/j.1365-2265.2011.04114.x
Sawka AM, Goldstein DP, Brierley JD, Tsang RW, Rotstein L, Ezzat S, Straus S, George SR, Abbey S, Rodin G, O’Brien MA, Gafni A, Thabane L, Goguen J, Naeem A, Magalhaes L (2009) The impact of thyroid cancer and post-surgical radioactive iodine treatment on the lives of thyroid cancer survivors: a qualitative study. PLoS ONE 4(1):e4191. https://doi.org/10.1371/journal.pone.0004191
doi: 10.1371/journal.pone.0004191
Crevenna R, Zettinig G, Keilani M, Posch M, Schmidinger M, Pirich C, Nuhr M, Wolzt M, Quittan M, Fialka-Moser V, Dudczak R (2003) Quality of life in patients with non-metastatic differentiated thyroid cancer under thyroxine supplementation therapy. Support Care Cancer 11(9):597–603. https://doi.org/10.1007/s00520-003-0474-4
doi: 10.1007/s00520-003-0474-4
Do Cao C, Wémeau JL (2015) Risk-benefit ratio for TSH- suppressive Levothyroxine therapy in differentiated thyroid cancer. Annales d'endocrinologie 76 (1 Suppl 1):1s47–52. doi: https://doi.org/10.1016/s0003-4266(16)30014-2
Biondi B, Cooper DS (2018) Subclinical hyperthyroidism. N Engl J Med 378(25):2411–2419. https://doi.org/10.1056/NEJMcp1709318
doi: 10.1056/NEJMcp1709318
Perros P, Nirantharakumar K, Hegedüs L (2021) Recent evidence sets therapeutic targets for levothyroxine-treated patients with primary hypothyroidism based on risk of death. Eur J Endocrinol 184(2):C1. https://doi.org/10.1530/eje-20-1229
doi: 10.1530/eje-20-1229
Lee J, Yun MJ, Nam KH, Chung WY, Soh EY, Park CS (2010) Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid: Off J Am Thyroid Assoc 20(2):173–179. https://doi.org/10.1089/thy.2009.0187
doi: 10.1089/thy.2009.0187
Aschebrook-Kilfoy B, James B, Nagar S, Kaplan S, Seng V, Ahsan H, Angelos P, Kaplan EL, Guerrero MA, Kuo JH, Lee JA, Mitmaker EJ, Moalem J, Ruan DT, Shen WT, Grogan RH (2015) Risk factors for decreased quality of life in thyroid cancer survivors: initial findings from the North American Thyroid Cancer Survivorship Study. Thyroid: Off J Am Thyroid Assoc 25(12):1313–1321. https://doi.org/10.1089/thy.2015.0098
doi: 10.1089/thy.2015.0098
Giusti M, Gay S, Conte L, Cecoli F, Mortara L, Vera L, Monti E (2020) Evaluation of quality of life in patients with differentiated thyroid cancer by means of the thyroid-specific patient-reported outcome questionnaire: a 5-year longitudinal study. Eur Thyroid J 9(5):247–255. https://doi.org/10.1159/000501201
doi: 10.1159/000501201
Watt T, Bjorner JB, Groenvold M, Rasmussen AK, Bonnema SJ, Hegedüs L, Feldt-Rasmussen U (2009) Establishing construct validity for the thyroid-specific patient reported outcome measure (ThyPRO): an initial examination. Qual Life Res 18(4):483–496. https://doi.org/10.1007/s11136-009-9460-8
doi: 10.1007/s11136-009-9460-8
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214. https://doi.org/10.1089/thy.2009.0110
doi: 10.1089/thy.2009.0110
Hegedüs L, Bianco AC, Jonklaas J, Pearce SH, Weetman AP, Perros P (2022) Primary hypothyroidism and quality of life. Nat Rev Endocrinol 18(4):230–242. https://doi.org/10.1038/s41574-021-00625-8
doi: 10.1038/s41574-021-00625-8
Massolt ET, van der Windt M, Korevaar TI, Kam BL, Burger JW, Franssen GJ, Lehmphul I, Köhrle J, Visser WE, Peeters RP (2016) Thyroid hormone and its metabolites in relation to quality of life in patients treated for differentiated thyroid cancer. Clin Endocrinol 85(5):781–788. https://doi.org/10.1111/cen.13101
doi: 10.1111/cen.13101
Gou J, Cheng W, Lei J, Pan Q, You W, Cai M, Tang H, Lei Y, Li Z, Gong R, Zhu J (2017) Health-related quality-of-life assessment in surgical patients with papillary thyroid carcinoma: a single-center analysis from Mainland China. Medicine 96(38):e8070. https://doi.org/10.1097/md.0000000000008070
doi: 10.1097/md.0000000000008070
Dow KH, Ferrell BR, Anello C (1997) Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 7(4):613–619. https://doi.org/10.1089/thy.1997.7.613
doi: 10.1089/thy.1997.7.613
Badihian S, Jalalpour P, Mirdamadi M, Moslehi M (2016) Quality of Life, Anxiety and Depression in Patients with Differentiated Thyroid Cancer under Short Term Hypothyroidism Induced by Levothyroxine Withdrawal. Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti 29(6):439–444
doi: 10.14735/amko2016439
van Velsen EFS, Massolt ET, Heersema H, Kam BLR, van Ginhoven TM, Visser WE, Peeters RP (2019) Longitudinal analysis of quality of life in patients treated for differentiated thyroid cancer. Eur J Endocrinol 181(6):671–679. https://doi.org/10.1530/eje-19-0550
doi: 10.1530/eje-19-0550
Miccoli P, Minuto MN, Paggini R, Rucci P, Oppo A, Donatini G, Golia F, Novelli L, Carlini M, Dell’Osso L (2007) The impact of thyroidectomy on psychiatric symptoms and quality of life. J Endocrinol Invest 30(10):853–859. https://doi.org/10.1007/bf03349227
doi: 10.1007/bf03349227
Larisch R, Midgley JEM, Dietrich JW, Hoermann R (2018) Symptomatic Relief is Related to Serum Free Triiodothyronine Concentrations during Follow-up in Levothyroxine-Treated Patients with Differentiated Thyroid Cancer. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association 126 (9):546–552. doi: https://doi.org/10.1055/s-0043-125064
Ito M, Miyauchi A, Morita S, Kudo T, Nishihara E, Kihara M, Takamura Y, Ito Y, Kobayashi K, Miya A, Kubota S, Amino N (2012) TSH-suppressive doses of levothyroxine are required to achieve preoperative native serum triiodothyronine levels in patients who have undergone total thyroidectomy. Eur J Endocrinol 167(3):373–378. https://doi.org/10.1530/eje-11-1029
doi: 10.1530/eje-11-1029
Gullo D, Latina A, Frasca F, Le Moli R, Pellegriti G, Vigneri R (2011) Levothyroxine monotherapy cannot guarantee euthyroidism in all athyreotic patients. PLoS ONE 6(8):e22552. https://doi.org/10.1371/journal.pone.0022552
doi: 10.1371/journal.pone.0022552
Jonklaas J, Davidson B, Bhagat S, Soldin SJ (2008) Triiodothyronine levels in athyreotic individuals during levothyroxine therapy. JAMA 299(7):769–777. https://doi.org/10.1001/jama.299.7.769
doi: 10.1001/jama.299.7.769
Santini F, Ceccarini G, Pelosini C, Giannetti M, Ricco I, Querci G, Grossi E, Saponati G, Vitti P (2019) Treatment of Hypothyroid Patients With L-Thyroxine (L-T4) Plus Triiodothyronine Sulfate (T3S). A Phase II, Open-Label, Single Center, Parallel Groups Study on Therapeutic Efficacy and Tolerability. Frontiers in endocrinology 10:826. doi: https://doi.org/10.3389/fendo.2019.00826
Jonklaas J, Bianco AC, Cappola AR, Celi FS, Fliers E, Heuer H, McAninch EA, Moeller LC, Nygaard B, Sawka AM, Watt T, Dayan CM (2021) Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism: a consensus document. Thyroid 31(2):156–182. https://doi.org/10.1089/thy.2020.0720
doi: 10.1089/thy.2020.0720
Nygaard B, Jensen EW, Kvetny J, Jarløv A, Faber J (2009) Effect of combination therapy with thyroxine (T4) and 3,5,3’-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study. Eur J Endocrinol 161(6):895–902. https://doi.org/10.1530/eje-09-0542
doi: 10.1530/eje-09-0542
Tariq A, Wert Y, Cheriyath P, Joshi R (2018) Effects of Long-Term Combination LT4 and LT3 therapy for improving hypothyroidism and overall quality of life. South Med J 111(6):363–369. https://doi.org/10.14423/smj.0000000000000823
doi: 10.14423/smj.0000000000000823
Bunevicius R, Kazanavicius G, Zalinkevicius R, Prange AJ Jr (1999) Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med 340(6):424–429. https://doi.org/10.1056/nejm199902113400603
doi: 10.1056/nejm199902113400603
Michaelsson LF, la Cour JL, Medici BB, Watt T, Faber J, Nygaard B (2018) Levothyroxine/Liothyronine Combination Therapy and Quality of Life: Is It All about Weight Loss? European thyroid journal 7(5):243–250. https://doi.org/10.1159/000490383
doi: 10.1159/000490383
Lillevang-Johansen M, Abrahamsen B, Jørgensen HL, Brix TH, Hegedüs L (2018) Over- and under-treatment of hypothyroidism is associated with excess mortality: a register-based cohort study. Thyroid 28(5):566–574. https://doi.org/10.1089/thy.2017.0517
doi: 10.1089/thy.2017.0517