The effect of thyroid hormone withdrawal performed to evaluate the success of I-131 ablation on quality of life and psychological symptoms in female patients with low-risk differentiated thyroid cancer

Year 2023, Volume: 6 Issue: 1, 66 - 72, 12.01.2023

Osman Kupık , Bayram Şen , Medeni Arpa , Uğur Avcı , Hasan Gündoğdu , Süleyman Kalcan , Hasan Güçer , Şafak Akın , Murat Tuncel

https://doi.org/10.32322/jhsm.1196968

Abstract

Aim: There is a need to evaluate the treatment response in patients who have undergone radioiodine treatment (RIT) for differentiated thyroid cancer. Diagnostic tests that are used for this purpose include radioiodine whole-body scan (WBS) and serum thyroglobulin (Tg) measurement, which are most accurate during thyroid-stimulating hormone (TSH) stimulation. However, temporary discontinuation of thyroid hormone therapy to increase TSH (withdrawal) may be associated with the morbidity of hypothyroidism. The study aimed to show the effects of thyroid hormone withdrawal (THW) on quality of life and psychological symptoms in female patients with low-risk, well-differentiated papillary thyroid cancer.
Material and Method: We applied the short form-36 (SF-36) and Symptom Checklist-90-R (SCL-90-R) questionnaires to the patients in the euthyroid state who have referred a median of 9 months (6-13 months) after RIT to perform a dWBS and to evaluate stimulated Tg. We applied the same questionnaire again when thyroid-stimulating hormone (TSH) was > 30 μIU/mL 4 weeks after THW (hypothyroid state).
Results: 52 patients were evaluated (median age 48 years, range 23-65 years). There was a statistically significant worsening in anxiety, psychosis, additional items, and general symptoms of the SCL-90-R questionnaire. With the SF-36 questionnaire, we observed statistically significant worsening in physical functioning, role limitation due to physical health, energy/fatigue, emotional well-being, social functioning, and general health change.
Conclusion: THW worsened the patients’ psychological symptoms and quality of life. To reduce the side effects of hypothyroidism, treatment response assessment with TSH stimulation should be used only in a selected group of patients. 

Keywords

Thyroid cancer, hypothyroidism, life quality, psychological symptom

References

• Mazzaferri EL. An overview of the management of papillary and follicular thyroid carcinoma. Thyroid 1999; 9: 421-7.
• Tan LG, Nan L, Thumboo J, Sundram F, Tan LK. Health‐related quality of life in thyroid cancer survivors. Laryngoscope 2007; 117: 507-10.
• Lamartina L, Leboulleux S, Terroir M, Hartl D, Schlumberger M. An update on the management of low-risk differentiated thyroid cancer. Endocr Relat Cancer 2019; 26: R597-R610.
• Reiners C, Dietlein M, Luster M. Radio-iodine therapy in differentiated thyroid cancer: indications and procedures. Best Pract Res Clin Endocrinol Metab 2008; 22: 989-1007.
• Torlontano M, Crocetti U, D'Aloiso L, et al. Serum thyroglobulin and 131I whole body scan after recombinant human TSH stimulation in the follow-up of low-risk patients with differentiated thyroid cancer. Eur J Endocrinol 2003; 148: 19-24.
• Berger F, Friedrich U, Knesewitsch P, Hahn K. Diagnostic 131 I whole-body scintigraphy 1 year after thyroablative therapy in patients with differentiated thyroid cancer: correlation of results to the individual risk profile and long-term follow-up. Eur J Nucl Med Mol Imaging 2011; 38: 451-8.
• Torlontano, M, Attard, M, Crocetti, U, et al. Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab 2004; 89: 3402-7.
• Pacini F, Capezzone M, Elisei R, Ceccarelli C, Taddei D, Pinchera A. Diagnostic 131-iodine whole-body scan may be avoided in thyroid cancer patients who have undetectable stimulated serum Tg levels after initial treatment. J Clin Endocrinol Metab 2002; 87: 1499-501.
• Mazzaferri EL, Robbins RJ, Spencer CA, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab 2003; 88: 1433-41.
• Haugen BR, Alexander EK, Bible KC, et al. 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 2016; 26: 1-133.
• Lee J, Yun MJ, Nam KH, Chung WY, Soh E-Y, Park CS. 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 2010; 20: 173-9.
• Schroeder PR, Haugen B, Pacini R, et al. 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. J Clin Endocrinol Metab 2006; 91: 878-84.
• Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 1997; 7: 613-9.
• Luster M, Felbinger R, Dietlein M, Reiners C. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid 2005; 15: 1147-55.
• Wang T, Jiang M, Ren Y, et al. Health-related quality of life of community thyroid cancer survivors in Hangzhou, China. Thyroid 2018; 28: 1013-23.
• Nygaard B, Jensen EW, Kvetny J, Jarløv A, Faber J. 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 2009; 161: 895-902.
• Samuels MH, Schuff KG, Carlson NE, Carello P, Janowsky JS. Health status, psychological symptoms, mood, and cognition in L-thyroxine-treated hypothyroid subjects. Thyroid 2007; 17: 249-58.
• Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care 1995; 33: AS264-79.
• Kocyigit H. Kisa Form-36 (KF-36)'nm versiyonunun guvenilirligi ve gecerliligi. Ilaç ve Tedavi Derg 1999; 12: 102-6.
• Derogatis LR, Cleary PA. Confirmation of the dimensional structure of the SCL‐90: A study in construct validation. J Clin Psychol 1977; 33: 981-9.
• Dag I. Belirti tarama listesinin (SCL-90-R) üniversite ögrencileri için geçerligi ve güvenirligi. Türk Psikiyatri Derg 1991; 2: 5-12.
• Banihashem S, Arabzadeh M, Jafarian Bahri RS, Qutbi M. Psychological Status and Quality of Life Associated with Radioactive Iodine Treatment of Patients with Differentiated Thyroid Cancer: Results of Hospital Anxiety and Depression Scale and Short-Form (36) Health Survey. Indian J Nucl Med 2020; 35: 216-21.
• Botella-Carretero J, Gal J, Caballero C, Sancho J, Escobar-Morreale H. Quality of life and psychometric functionality in patients with differentiated thyroid carcinoma. Endocr Relat Cancer 2003; 10: 601-10.
• Tagay, S, Herpertz, S, Langkafel, et al. Health-related quality of life, depression and anxiety in thyroid cancer patients. Qual Life Res 2006; 15: 695-703.
• Mallick, U, Harmer, C, Yap, B, et al. Ablation with low-dose radioiodine and thyrotropin alfa in thyroid cancer. N Engl J Med 2012; 366: 1674-85.
• Nygaard B, Bastholt L, Bennedbæk FN, Klausen TW, Bentzen J. A A placebo-controlled, blinded and randomised study on the effects of recombinant human thyrotropin on quality of life in the treatment of thyroid cancer. Eur Thyroid J 2013; 2: 195-202.
• Husson O, Haak HR, Oranje WA, Mols F, Reemst PH, van de Poll‐Franse LV. Health‐related quality of life among thyroid cancer survivors: a systematic review. Clin Endocrinol 2011; 75: 544-54.
• Schlumberger M, Catargi B, Borget I, et al. Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 2012; 366: 1663-73.
• Rosario PW, Mourão GF, Calsolari MR. Definition of the response to initial therapy with radioiodine in patients with differentiated thyroid carcinoma: basal or stimulated thyroglobulin? Horm Metab Res 2019; 51: 634-8.
• Shen F-C, Hsieh C-J, Huang I-C, Chang Y-H, Wang P-W. Dynamic risk estimates of outcome in Chinese patients with well-differentiated thyroid cancer after total thyroidectomy and radioactive iodine remnant ablation. Thyroid 2017; 27: 531-6
• Rosario PW, Furtado MdS, Mourão GF, Calsolari MR. Patients with papillary thyroid carcinoma at intermediate risk of recurrence according to American Thyroid Association criteria can be reclassified as low risk when the postoperative thyroglobulin is low. Thyroid 2015; 25: 1243-8.
• Schlumberger M, Leboulleux S, Catargi B, et al. Outcome after Ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial. Lancet Diabetes Endocrinol 2018; 6: 618-26.
• Dehbi H-M, Mallick U, Wadsley J, Newbold K, Harmer C, Hackshaw A. Recurrence after low-dose radioiodine ablation and recombinant human thyroid-stimulating hormone for differentiated thyroid cancer (HiLo): long-term results of an open-label, non-inferiority randomized controlled trial. Lancet Diabetes Endocrinol 2019; 7: 44-51.
• Ellegård L, Krantz E, Trimpou P, Landin‐Wilhelmsen K. Health‐related quality of life in hypothyroidism—A population‐based study, the WHO MONICA Project. Clin Endocrinol (Oxf) 2021; 95: 197-208.
• Shivaprasad C, Rakesh B, Anish K, Annie P, Amit G, Dwarakanath C. Impairment of health-related quality of life among Indian patients with hypothyroidism. Indian J Endocrinol Metab 2018; 22: 335.