Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation with recombinan

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Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation with recombinant human thyrotropin: a randomized controlled study.
Clin Endocrinol (Oxf). 2008 Sep 17;
Authors: Taïeb D, Sebag F, Cherenko M, Baumstarck-Barrau K, Fortanier C, Farman-Ara1 B, De Micco C, Vaillant J, Thomas S, Conte-Devolx B, Loundou A, Auquier P, Henry J, Mundler O
Background: Recombinant human TSH (rhTSH) has become the modality of choice for radioiodine remnant ablation (RRA) of residual thyroid cancer tissue in low-risk patients. Aims and methods: The aims of the present prospective randomized study were to evaluate the impact of TSH stimulation procedure (hypothyroidism versus rhTSH) on quality of life (QoL) of thyroid cancer patients undergoing RRA and to evaluate efficacy of both procedures. L-T4 was initiated in both groups after thyroidectomy. After randomization, L-T4 was discontinued in hypothyroid (hypo) group and continued in rhTSH group. 3.7 GBq of radioiodine was given in both groups. The FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue) was administered from the early postoperative period to 9 months. Socio-demographic parameters, anxiety and depression scales were also evaluated (CES-D, BDI and Spielberger state-trait questionnaires). At 9 months, patients underwent an rhTSH stimulation test, diagnostic 131-Iodine whole body scan (dxWBS) and neck ultrasonography. Results: 74 patients were enrolled in the study. There was a significant decrease in QoL from baseline (t0) to t1 (RRA period) in the hypothyroid group with significant differences in FACIT-F TOI (p<10-3), FACT-G total score (p= 0.005) and FACIT-F total score (p=0.003). By contrast, QoL was preserved in the rhTSH group. In the mulivariate analysis, FACIT-TOI changes were only affected by the modality of TSH stimulation performed for RRA. From 3 to 9 months, changes of QoL scales and subscales were no longer statistically different in both groups of patients. Based on serum rhTSH-stimulated Tg alone (Tg <0.8 mug/L, BRAHMS Tg Kryptor), no difference in ablation success was observed between rhTSH and hypothyroidism groups, 91.7% and 97.1% respectively. A higher rate of persistant thyroid remnants was observed in the rhTSH arm, although in most cases uptake was <0.1% and of no clinical significance. Conclusions: rhTSH preserves QoL of patients undergoing RRA with similar rates of ablation success compared to hypothyrodism. However, there is a wide heterogeneity in the clinical impact of hypothyroidism.
PMID: 18803678 [PubMed - as supplied by publisher] (Source: Clinical Endocrinology)