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

  • Pamela R. Schroeder
    Division of Endocrinology and Metabolism (P.R.S., P.W.L.), Johns Hopkins Medical Institutions, Baltimore, Maryland 21287
  • Bryan R. Haugen
    Division of Endocrinology (B.R.H., E.C.R.), University of Colorado Health Sciences Center, Denver, Colorado 80262
  • Furio Pacini
    Division of Endocrinology and Metabolism (F.P.), University of Siena, Siena 1-53100, Italy
  • Christoph Reiners
    Klinik und Poliklinik fuer Nuklearmedizin der Universitaet Wuerzburg (C.R., M.L.), Wuerzburg D-97070, Germany
  • Martin Schlumberger
    Service de Medecine Nucleaire (M.S.), Institut Gustave Roussy, 94805 Villejuif, France
  • Steven I. Sherman
    Department of Medical Specialties (S.I.S.), M. D. Anderson Cancer Center, Houston, Texas 77030
  • David S. Cooper
    Division of Endocrinology (D.S.C.), Sinai Hospital of Baltimore, Baltimore, Maryland 21215
  • Kathryn G. Schuff
    Division of Endocrinology (K.G.S., M.H.S.), Oregon Health and Science University, Portland, Oregon 97201
  • Lewis E. Braverman
    Section of Endocrinology, Diabetes, and Nutrition (L.E.B.), Boston University School of Medicine, Boston, Massachusetts 02118
  • Monica C. Skarulis
    Division of Intramural Research (M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892
  • Terry F. Davies
    Division of Endocrinology (T.F.D.), Mount Sinai School of Medicine, New York, New York 10029
  • Ernest L. Mazzaferri
    University of Florida Shands Hospital (E.L.M.), Division of Endocrinology, Gainesville, Florida 32610
  • Gilbert H. Daniels
    Thyroid Unit (G.H.D., D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114
  • Douglas S. Ross
    Thyroid Unit (G.H.D., D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114
  • Markus Luster
    Klinik und Poliklinik fuer Nuklearmedizin der Universitaet Wuerzburg (C.R., M.L.), Wuerzburg D-97070, Germany
  • Mary H. Samuels
    Division of Endocrinology (K.G.S., M.H.S.), Oregon Health and Science University, Portland, Oregon 97201
  • Bruce D. Weintraub
    Trophogen Inc. (B.D.W.), Rockville, Maryland 20850
  • E. Chester Ridgway
    Division of Endocrinology (B.R.H., E.C.R.), University of Colorado Health Sciences Center, Denver, Colorado 80262
  • Paul W. Ladenson
    Division of Endocrinology and Metabolism (P.R.S., P.W.L.), Johns Hopkins Medical Institutions, Baltimore, Maryland 21287

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<jats:title>Abstract</jats:title> <jats:p>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.</jats:p> <jats:p>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.</jats:p> <jats:p>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.</jats:p> <jats:p>Interventions: Interventions included administration of rhTSH on l-T4 and withdrawal from thyroid hormone.</jats:p> <jats:p>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.</jats:p> <jats:p>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 &lt; 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.</jats:p> <jats:p>Conclusions: Short-term hypothyroidism after l-T4 withdrawal is associated with a significant decline in quality of life that is abrogated by rhTSH use.</jats:p>

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