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Clin Endocrinol (Oxf). 2016 Nov;85(5):781-788. doi: 10.1111/cen.13101. Epub 2016 Jun 13.

Thyroid hormone and its metabolites in relation to quality of life in patients treated for differentiated thyroid cancer.

Author information

1
Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands. e.massolt@erasmusmc.nl.
2
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands. e.massolt@erasmusmc.nl.
3
Division of Endocrinology, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
4
Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands.
5
Department of Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands.
6
Division of Surgical Oncology, Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
7
Institute of Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Abstract

BACKGROUND:

Levothyroxine (LT4) is the standard of care in patients with hypothyroidism. Despite this replacement therapy, quality of life (QoL) remains impaired in a substantial amount of patients. The reasons for this are still a matter of debate. Suggested causes include lack of endogenous T3 secretion by the thyroid, changes in other thyroid hormone metabolites and interference by autoimmune processes.

OBJECTIVE:

To investigate the association between thyroid function tests (TFTs) and QoL in patients with a history of differentiated thyroid cancer on LT4 monotherapy. These patients lack endogenous thyroidal T3 secretion in the absence of autoimmune disease.

MATERIALS AND METHODS:

This is a cross-sectional study in 143 patients (69·2% female). Initial therapy consisted of total thyroidectomy followed by radioiodine ablation minimally one year before inclusion. We assessed health-related QoL (RAND-36), thyroid-specific QoL (ThyPRO) and fatigue with the Multidimensional Fatigue Inventory. Extensive TFTs were assessed, including 3,5-diiodo-L-thyronine (3,5-T2).

RESULTS:

Mean age was 50·2 years and mean time since diagnosis was 8·4 years. Median TSH was 0·042 mU/l, total T4 145·0 nmol/l, free T4 25·6 pmol/l, total T3 1·93 nmol/l, reverse T3 0·53 nmol/l and 3,5-T2 0·86 nmol/l. Multiple linear regression analyses did not show any association between QoL and the different TFTs, including T4/T3 and 3,5-T2/T3 ratios reflecting peripheral metabolism.

CONCLUSION:

We did not find any association between TFTs and QoL in athyreotic patients on LT4 monotherapy. Our data do not provide evidence that a slight increase in dose improves fatigue or well-being in hypothyroid patients on LT4 therapy.

PMID:
27175823
DOI:
10.1111/cen.13101
[Indexed for MEDLINE]

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