Endocrine Abstracts

Background: The evaluation of health-related Quality of Life (QoL) is becoming a key component in clinical assessment of thyreopathic patients, especially those thyroidectomized for differentiated thyroid cancer (DTC) and treated with levothyroxine (LT4).

Aim: To evaluate QoL in different thyroid states in patients treated with total thyroidectomy for DTC and correlate it with thyroid function tests.

Methods: Two hundred subjects (137 F, 63 M, mean age: 50.3+14.4 years) waiting to be treated or treated with total thyroidectomy for DTC were enrolled in the study. Thyroid function was investigated by measuring TSH, fT4 and fT3, while symptoms related to hypothyroidism were evaluated through the analysis of three self-reported questionnaires, including the Italian version of the Multidimensional Fatigue Inventory (MFI), the thyroid-specific QoL patient-reported-outcome measure (ThyPRO) and the 36-item Short Form Health Survey (SF-36). According to time (before or after thyroidectomy) and LT4 therapy, patients were divided in 4 groups: euthyroid before total thyroidectomy (T0, n=17), hypothyroid before radioactive iodine (RAI) therapy (T1, n=69), hyperthyroid on LT4 TSH-suppressive therapy (T2, n=107), euthyroid on LT4 replacement therapy (T3, n=33). Considering that some patients were evaluated in more times a total of 226 samples and the corresponding questionnaires were analyzed. The non-parametric Kruskal-Wallis test was used for comparison among 4 groups.

Results: TSH, fT4 and fT3 changed among patients stratified in different times (P<0,05). However, TSH, fT4 and fT3 levels were not significantly different among patients before thyroidectomy (T0) and after thyroidectomy on LT4 replacement therapy (T3). Considering questionnaire results, the only statistically significant differences among the four groups were found in three domains of ThyPRO (anxiety, impaired social life and impaired daily life). The highest scores (worst QoL) were reported in hypothyroid patients (T1) and a positive correlation between TSH and impaired daily life has been documented. Comparing questionnaires’ results of euthyroid patients, before (T0) or after (T3) thyroidectomy, T0 patients presented poorer scores in psychological well-being items than T3 patients. The lowest scores (best QoL) were reported in patients on LT4 TSH-suppressive therapy (T2), documenting also a positive correlation between fT4 and low scores in items of impaired daily life and impaired social life.

Conclusions: In oncological patients, psychological well-being seems to be impaired because of recent diagnosis of DTC rather than for thyroid function alteration. After thyroidectomy and correction of pre-RAI hypothyroidism, QoL is restored. Thus, LT4 therapy seems to adequately replace endogenous thyroid hormone levels, guaranteeing good QoL.