title: 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.
abstract: 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.
authors.affiliation: Johns Hopkins Medical Institutions, Division of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Schroeder
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Haugen
authors.forename: Furio
authors.initials: F
authors.lastname: Pacini
authors.forename: Christoph
authors.initials: C
authors.lastname: Reiners
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.forename: Steven I
authors.initials: SI
authors.lastname: Sherman
authors.forename: David S
authors.initials: DS
authors.lastname: Cooper
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Schuff
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Braverman
authors.forename: Monica C
authors.initials: MC
authors.lastname: Skarulis
authors.forename: Terry F
authors.initials: TF
authors.lastname: Davies
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Mazzaferri
authors.forename: Gilbert H
authors.initials: GH
authors.lastname: Daniels
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Ross
authors.forename: Markus
authors.initials: M
authors.lastname: Luster
authors.forename: Mary H
authors.initials: MH
authors.lastname: Samuels
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Weintraub
authors.forename: E Chester
authors.initials: EC
authors.lastname: Ridgway
authors.forename: Paul W
authors.initials: PW
authors.lastname: Ladenson
mesh_terms: 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
chemical_list: D011994:Recombinant Proteins; D013963:Thyroid Hormones; D013972:Thyrotropin