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Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine

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Abstract

Purpose

Previous studies demonstrated decreased quality of life (QoL) in differentiated thyroid cancer (DTC) survivors and suggested QoL variability related to time from thyroidectomy and levothyroxine dosage. The aims of this study were to evaluate QoL in thyroidectomized subjects in different levothyroxine states and to evaluate the association between TSH and thyroid hormones and QoL.

Methods

Prospective 5-year study enrolling 208 patients thyroidectomized for DTC, studied in one to four times according to levothyroxine dosage: withdrawal (WITHD), complete (C-SUPP) and mild TSH-suppression (M-SUPP), replacement (REPL). Each patient was allowed to participate into the study more than one time. A total of 300 evaluations were collected, consisting of detailed thyroid hormone profile and QoL assessment through the ThyPRO questionnaire.

Results

Comparing the four groups, significant differences were found for anxiety, impaired social and daily life and item 12 (overall impact of thyroid disease) domains (p < 0.05). Interestingly, C-SUPP subjects reported the best scores in almost all ThyPRO scales. Significant correlations were found between QoL and pituitary–thyroid axis function, as well as between QoL and gender, being females more affected. At multiple regression analyses fT3 demonstrated to be the best explanatory factor for overall impact of thyroid disease on the patient’s life, followed by gender.

Conclusions

TSH-suppressive doses of levothyroxine are more effective in improving QoL in DTC patients after thyroidectomy. These results confirm the urgent need of further studies aimed to define the best treatment of hypothyroidism, effective on well-being and harmless for patients.

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

The authors are grateful to Torquill Watt from the Department of Endocrinology, Copenhagen University Hospital Rigshospitalet (Copenhagen, Denmark) for providing the validated Italian version of ThyPRO questionnaires.

Funding

The study was supported by IBSA Institut Biochimique SA, without involvement in study design, collection, analysis, and interpretation of data, writing of the report, nor any restrictions regarding the submission of the report for publication. Giulia Brigante is supported by a grant of the Italian Ministry of University under the “Departments of Excellence” program.

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Authors and Affiliations

  1. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    M. L. Monzani, F. Piccinini, G. Boselli, R. Corleto, G. Margiotta, M. Simoni & G. Brigante

  2. Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero–Universitaria of Modena, OCSAE, Via P. Gardini 1355, 41126, Modena, Italy

    M. L. Monzani, F. Piccinini, G. Boselli, R. Corleto, G. Margiotta, M. Simoni & G. Brigante

  3. Department of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

    R. P. Peeters

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Contributions

GBr, MLM, RPP, and MS conceived and designed the study. FP, MLM, RC, and GM enrolled subjects and collected data. GBr and MLM performed the statistical analysis. GBr, MLM, and MS wrote the manuscript with input from all authors. All authors discussed the results and contributed to the final manuscript.

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Correspondence to G. Brigante.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare.

Ethics approval

The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The Institutional review board of Modena approved the study (protocol n.156/14).

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Written informed consent was obtained from all participants included in the study.

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Monzani, M.L., Piccinini, F., Boselli, G. et al. Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine. J Endocrinol Invest 46, 319–326 (2023). https://doi.org/10.1007/s40618-022-01903-6

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