A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal.
BACKGROUND
Thyroid carcinoma requires lifelong monitoring with serum thyroglobulin, radioactive iodine whole body scanning, and other imaging modalities. Levothyroxine (L-T4) withdrawal for thyroglobulin measurement and whole body scanning increases these tests' sensitivities but causes hypothyroidism. Recombinant human TSH (rhTSH) enables testing without L-T4 withdrawal.


OBJECTIVE
Our objective was to examine the impact of short-term hypothyroidism on the health-related quality of life (HRQOL) of patients after rhTSH vs. L-T4 withdrawal.


METHODS
In this multicenter study, the SF-36 Health Survey was administered to 228 patients at three time points: on L-T4, after rhTSH, and after L-T4 withdrawal.


METHODS
INTERVENTIONS included administration of rhTSH on L-T4 and withdrawal from thyroid hormone.


METHODS
Mean SF-36 scores were compared during the two interventions and with the U.S. general population and patients with heart failure, depression, and migraine headache.


RESULTS
Patients had SF-36 scores at or above the norm for the general U.S. population in six of eight domains at baseline on L-T4 and in seven of eight domains after rhTSH. Patients' scores declined significantly in all eight domains after L-T4 withdrawal when compared with the other two periods (P < 0.0001). Patients' HRQOL scores while on L-T4 and after rhTSH were at or above those for patients with heart failure, depression, and migraine in all eight domains. After L-T4 withdrawal, patients' HRQOL scores were significantly below congestive heart failure, depression, and migraine headache norms in six, three, and six of the eight domains, respectively.


CONCLUSIONS
Short-term hypothyroidism after L-T4 withdrawal is associated with a significant decline in quality of life that is abrogated by rhTSH use.
Schroeder
Pamela R
PR
Johns Hopkins Medical Institutions, Division of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA.
Haugen
Bryan R
BR
Pacini
Furio
F
Reiners
Christoph
C
Schlumberger
Martin
M
Sherman
Steven I
SI
Cooper
David S
DS
Schuff
Kathryn G
KG
Braverman
Lewis E
LE
Skarulis
Monica C
MC
Davies
Terry F
TF
Mazzaferri
Ernest L
EL
Daniels
Gilbert H
GH
Ross
Douglas S
DS
Luster
Markus
M
Samuels
Mary H
MH
Weintraub
Bruce D
BD
Ridgway
E Chester
EC
Ladenson
Paul W
PW
D005260:Female; D006304:Health Status; D006801:Humans; D007037:Hypothyroidism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010146:Pain; D011788:Quality of Life; D011859:Radiography; D011994:Recombinant Proteins; D013963:Thyroid Hormones / Q000172:deficiency*; D013964:Thyroid Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D013972:Thyrotropin
D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin