The “Non-Treated” Versus “LT3-Treated” Protocols of Short-Term Hypothyroidism Induction in Differentiated Thyroid Cancer: An Analysis of Hypothyroid Complications, Mood Disorders, and Quality of Life

Abstract

This study aimed to compare “non-treated” versus “levotriiodothyronine (LT3)-treated” protocols of short-term hypothyroidism induction prior to radioactive iodine (RAI) ablation therapy in differentiated thyroid cancer (DTC). A total of 120 DTC patients who had thyroxine withdrawal either via 4-week hypothyroidism induction (non-treated group, n=60) or 2-week administration and then 2-week withdrawal of LT3 (LT3-treated group, n=60) to induce hypothyroid state prior to RAI ablation after initial surgery were included. Complications related to hypothyroidism-induction, Beck Depression Inventory (BDI), Hospital Anxiety-Depression Scale (HADS), and SF-36 health-related quality of life (HRQoL) scores were recorded. In the non-treated group, transition from euthyroid to hypothyroid state was associated with significant increase in the likelihood of moderate-to-severe depression on BDI (p<0.001), presence of depression on HADS-D (p<0.001), presence of anxiety on HADS-A (6.7% during euthyroid state vs. 33.3% during hypothyroid state, p<0.001), and major syndrome on BPRS (0.0 vs. 10.0%, p=0.001) as well as significant decrease in all SF-36 HRQoL domain scores (p<0.001 for each). In conclusion, our findings indicate the likelihood of L3-treatment to enable a more favorable transition period from euthyroid to hypothyroid state without experiencing a deterioration in depression, anxiety, or HRQoL.

Key words

differentiated thyroid carcinoma - hypothyroidism induction - LT3- protocol - depression - anxiety - quality of life

Publication History

Received: 22 January 2023

Accepted: 06 March 2023

Article published online:
14 April 2023

• References

• 1 Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg 2014; 140: 317-322
• 2 Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010; 102: 605-613
• 3 La Vecchia C, Malvezzi M, Bosetti C. et al. Thyroid cancer mortality and incidence: a global overview. Int J Cancer 2015; 136: 2187-2195
• 4 Duntas LH, Biondi B. Short-term hypothyroidism after levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences. Eur J Endocrinol 2007; 156: 13-19
• 5 Walshaw EG, Smith M, Kim D. et al. Systematic review of health-related quality of life following thyroid cancer. Tumori 2022; 108: 291-314
• 6 Fugazzola L, Elisei R, Fuhrer D. et al. 2019 European thyroid association guidelines for the treatment and follow-up of advanced radioiodine-refractory thyroid cancer. Eur Thyroid J 2019: 227-245
• 7 Zubeldia JM, Nabi HA, Jiménez del Río M. et al. Exploring new applications for Rhodiola rosea: can we improve the quality of life of patients with short-term hypothyroidism induced by hormone withdrawal?. J Med Food 2010; 13: 1287-1292
• 8 Rajamanickam S, Chaukar D, Siddiq S. et al. Quality of life comparison in thyroxine hormone withdrawal versus triiodothyronine supplementation prior to radioiodine ablation in differentiated thyroid carcinoma: a prospective cohort study in the Indian population. Eur Arch Otorhinolaryngol 2022; 279: 2011-2018
• 9 Botella-Carretero JI, Gómez-Bueno M, Barrios V. et al. Chronic thyrotropin-suppressive therapy with levothyroxine and short-term overt hypothyroidism after thyroxine withdrawal are associated with undesirable cardiovascular effects in patients with differentiated thyroid carcinoma. Endocr Relat Cancer 2004; 11: 345-356
• 10 Leboeuf R, Perron P, Carpentier AC. et al. L-T3 preparation for whole-body scintigraphy: a randomized-controlled trial. Clin Endocrinol (Oxf) 2007; 67: 839-844
• 11 Beck AT, Ward CH, Mendelson M. et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561-571
• 12 Hisli N. Validity and reliability of Beck depression inventory among university students. Psikoloji Dergisi 1989; 7: 3-13 [Turkish].
• 13 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370
• 14 Aydemir O, Guvenir T, Kuey L. et al. Reliability and validity of the Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 1997; 8: 280-287
• 15 Ware JE, Kosinski M, Bjorner JB. et al. User’s manual for the SF-36v2 health survey. Lincoln, RI: Quality Metric Incorporated,; 2007
• 16 Luster M, Felbinger R, Dietlein M. et al. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: a one hundred thirty-patient pilot survey on consequences of hypothyroidism and a pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid 2005; 15: 1147-1155
• 17 Schroeder PR, Haugen BR, Pacini F. et al. A comparison of short-term changes in health-related quality of life in thyroid carcinoma patients undergoing diagnostic evaluation with recombinant human thyrotropin compared with thyroid hormone withdrawal. J Clin Endocrinol Metab 2006; 91: 878-884
• 18 Badihian S, Jalalpour P, Mirdamadi M. et al. Quality of life, anxiety and depression in patients with differentiated thyroid cancer under short term hypothyroidism induced by levothyroxine withdrawal. Klin Onkol 2016; 29: 439-444
• 19 Tagay S, Herpertz S, Langkafel M. et al. Health-related quality of life, depression and anxiety in thyroid cancer patients. Qual Life Res 2006; 15: 695-703
• 20 Botella-Carretero JI, Galán JM, Caballero C. et al. Quality of life and psychometric functionality in patients with differentiated thyroid carcinoma. Endocr Relat Cancer 2003; 10: 601-610
• 21 Lv J, Zhu L, Wu X. et al. Study on the correlation between postoperative mental flexibility, negative emotions, and quality of life in patients with thyroid cancer. Gland Surg 2021; 10: 2471-2476
• 22 Buchmann L, Ashby S, Cannon RB. et al. Psychosocial distress in patients with thyroid cancer. Otolaryngol Head Neck Surg 2015; 152: 644-649
• 23 Larisch R, Kley K, Nikolaus S. et al. Depression and anxiety in different thyroid function states. Horm Metab Res 2004; 36: 650-653
• 24 Hoffmann D, Rask CU, Hedman-Lagerlöf E. et al. Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial. Psychol Med 2021; 51: 2685-2695
• 25 Hage MP, Azar ST. The link between thyroid function and depression. J Thyroid Res 2012; 2012: 590648
• 26 Lee J, Yun MJ, Nam KH. et al. Quality of life and effectiveness comparisons of thyroxine withdrawal, triiodothyronine withdrawal, and recombinant thyroid-stimulating hormone administration for low-dose radioiodine remnant ablation of differentiated thyroid carcinoma. Thyroid 2010; 20: 173-179
• 27 Chow SM, Au KH, Choy TS. et al. Health-related quality-of-life study in patients with carcinoma of the thyroid after thyroxine withdrawal for whole body scanning. Laryngoscope 2006; 116: 2060-2066
• 28 Piccardo A, Puntoni M, Ferrarazzo G. et al. Could short thyroid hormone withdrawal be an effective strategy for radioiodine remnant ablation in differentiated thyroid cancer patients?. Eur J Nucl Med Mol Imaging 2018; 45: 1218-1223