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Submitted on September 15, 2005
Accepted on December 23, 2005
Division of Endocrinology and Metabolism, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287; Division of Endocrinology, University of Colorado Health Sciences Center, Denver, Colorado 80262; the Division of Endocrinology and Metabolism, University of Siena, Siena, Italy; Klinik und Poliklinik fuer Nuklearmedizin der Universitaet Wuerzburg, Wuerzburg D-97070, Germany; Service de Medecine Nucleaire, Institut Gustave Roussy, 94805 Villejuif, France; the Department of Medical Specialties, M. D. Anderson Cancer Center, Houston, Texas 77030; the Division of Endocrinology, Sinai Hospital of Baltimore, Baltimore, Maryland 21215; the Division of Endocrinology, Oregon Health and Science University, Portland, Oregon 97201; Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston, Massachusetts, 02118; the Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892; the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York 10029; University of Florida Shands Hospital, Division of Endocrinology, Gainesville, Florida 32610; the Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts 02114; and Trophogen Inc., Rockville, Maryland 20850
Context Thyroid carcinoma requires lifelong monitoring with serum thyroglobulin (Tg), radioactive iodine whole body scanning (WBS) and other imaging modalities. Levothyroxine (L-T4) withdrawal for Tg measurement and WBS increases these tests' sensitivities but causes hypothyroidism. Recombinant TSH (rhTSH) enables testing without L-T4 withdrawal.
Objective 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, 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 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 to 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 6 of 8 domains at baseline on L-T4 and in 7 of 8 domains after rhTSH. Patients' scores declined significantly in all 8 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 8 domains. After L-T4 withdrawal, patients' HRQOL scores were significantly below CHF, depression, and migraine norms in 6, 3, and 6 of the 8 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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