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

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.