TY - JOUR
T1 - 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
AU - Schroeder, Pamela R.
AU - Haugen, Bryan R.
AU - Pacini, Furio
AU - Reiners, Christoph
AU - Schlumberger, Martin
AU - Sherman, Steven I.
AU - Cooper, David S.
AU - Schuff, Kathryn G.
AU - Braverman, Lewis E.
AU - Skarulis, Monica C.
AU - Davies, Terry F.
AU - Mazzaferri, Ernest L.
AU - Daniels, Gilbert H.
AU - Ross, Douglas S.
AU - Luster, Markus
AU - Samuels, Mary H.
AU - Weintraub, Bruce D.
AU - Ridgway, E. Chester
AU - Ladenson, Paul W.
PY - 2006/3
Y1 - 2006/3
N2 - Context: 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. Design, Setting, and Patients: 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. Interventions: Interventions included administration of rhTSH on L-T4 and withdrawal from thyroid hormone. Main Outcome Measures: 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-T 4 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.
AB - Context: 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. Design, Setting, and Patients: 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. Interventions: Interventions included administration of rhTSH on L-T4 and withdrawal from thyroid hormone. Main Outcome Measures: 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-T 4 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.
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U2 - 10.1210/jc.2005-2064
DO - 10.1210/jc.2005-2064
M3 - Article
C2 - 16394083
AN - SCOPUS:33644824080
SN - 0021-972X
VL - 91
SP - 878
EP - 884
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 3
ER -