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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

Division of Endocrinology and Metabolism (P.R.S., P.W.L.), Johns Hopkins Medical Institutions, Baltimore, Maryland 21287; Division of Endocrinology (B.R.H., E.C.R.), University of Colorado Health Sciences Center, Denver, Colorado 80262; Division of Endocrinology and Metabolism (F.P.), University of Siena, Siena 1-53100, Italy; Klinik und Poliklinik fuer Nuklearmedizin der Universitaet Wuerzburg (C.R., M.L.), Wuerzburg D-97070, Germany; Service de Medecine Nucleaire (M.S.), Institut Gustave Roussy, 94805 Villejuif, France; Department of Medical Specialties (S.I.S.), M. D. Anderson Cancer Center, Houston, Texas 77030; Division of Endocrinology (D.S.C.), Sinai Hospital of Baltimore, Baltimore, Maryland 21215; Division of Endocrinology (K.G.S., M.H.S.), Oregon Health and Science University, Portland, Oregon 97201; Section of Endocrinology, Diabetes, and Nutrition (L.E.B.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Intramural Research (M.C.S.), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; Division of Endocrinology (T.F.D.), Mount Sinai School of Medicine, New York, New York 10029; University of Florida Shands Hospital (E.L.M.), Division of Endocrinology, Gainesville, Florida 32610; Thyroid Unit (G.H.D., D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Trophogen Inc. (B.D.W.), Rockville, Maryland 20850

Address all correspondence and requests for reprints to: Paul W. Ladenson, M.D., Johns Hopkins Medical Institutions, Division of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287. E-mail: ladenson{at}jhmi.edu.

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-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.

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