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Nuklearmedizin 2024; 63(03): 176-187
DOI: 10.1055/a-2240-8087
Original Article

Effect of Radioiodine Treatment on Quality of Life in Patients with Subclinical Hyperthyroidism: A Prospective Controlled Study

Einfluss einer Radiojodtherapie auf die Lebensqualität von Patienten mit latenter Hyperthyreose: Eine prospektive kontrollierte Studie
Rolf Larisch
1   Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
,
John E. M. Midgley
2   North Lakes Clinical, Ilkley LS29 8PT, United Kingdom of Great Britain and Northern Ireland
,
Johannes W. Dietrich
3   Medical Hospital I, Endocrinology and Diabetes Department, Ruhr University of Bochum, Bochum, Germany
4   Ruhr Center for Rare Diseases (CeSER), Bochum, Germany
,
Rudolf Hoermann
1   Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
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Abstract

Radioiodine treatment (RIT) has a high success rate in both the treatment of hyperthyroidism and improving the quality of life (QoL) of symptomatic patients. In asymptomatic patients with subclinical hyperthyroidism thyroid related QoL outcomes are less well known.

Methods Study aim was to evaluate thyroid-related QoL in patients with subclinical hyperthyroidism mostly due to toxic nodular goitre undergoing RIT, compared to a control group of euthyroid subjects. Study design was monocentric, prospective, controlled. Fifty control subjects were enrolled and 51 RIT patients. Most subjects were examined at least twice at an interval of 6 months, with visits immediately before and 6 months after treatment in the RIT group. QoL was estimated with the ThyPRO questionnaire, using its composite scale as primary outcome. Treatment effect was the mean adjusted difference (MAD) between groups over time, using repeated? measures mixed? effects models.

Results TSH concentrations were lower in the RIT group prior to treatment and recovered thereafter slightly above the level of the control group. Correspondingly, QoL improved significantly after 6 months from a worse level in the RIT group, compared to controls (MAD –10.3 [95% CI –14.9, –5.7], p<0.001). QoL improvements were strong for general items, but less pronounced for the hyperthyroid domain. Compared to controls, thyroid volume, thyroid functional capacity (SPINA-GT) and deiodinase activity (SPINA-GD) were significantly reduced in the RIT group.

Conclusion Patients with subclinical hyperthyroidism improve both biochemically and in their QoL after RIT, compared to controls. QoL assessment should have a wider role in clinical practice to complement biochemical tests and help with treatment decisions.

Keywords

subclinical hyperthyroidism - quality of live - radioiodine treatment - prospective study


Publication History

Received: 16 September 2023

Accepted after revision: 08 January 2024

Article published online:
23 January 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Taylor PN, Albrecht D, Scholz A. et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018; 14: 301-316
    CrossrefPubMedSearch in Google Scholar
  • 2 Biondi B, Kahaly GJ. Cardiovascular involvement in patients with different causes of hyperthyroidism. Nat Rev Endocrinol 2010; 6: 431-443
    CrossrefPubMedSearch in Google Scholar
  • 3 Wiersinga WM, Poppe KG, Effraimidis G. Hyperthyroidism: Aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol 2023; 11: 282-298
    CrossrefPubMedSearch in Google Scholar
  • 4 Sjölin G, Holmberg M, Törring O. et al. The long-term outcome of treatment for Graves’ hyperthyroidism. Thyroid 2019; 29: 1545-1557
    CrossrefPubMedSearch in Google Scholar
  • 5 Heeringa J, Hoogendoorn EH, Van Der Deure WM. et al. High-normal thyroid function and risk of atrial fibrillation: The Rotterdam study. Arch Int Med 2008; 168: 2219-2224
    CrossrefPubMedSearch in Google Scholar
  • 6 Chaker L, Heeringa J, Dehghan A. et al. Normal thyroid function and the risk of atrial fibrillation: The Rotterdam study. J Clin Endocrinol Metab 2015; 100: 3718-3724
    CrossrefPubMedSearch in Google Scholar
  • 7 Baumgartner C, Da Costa BR, Collet TH. et al. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. Circulation 2017; 136: 2100-2116
    CrossrefPubMedSearch in Google Scholar
  • 8 Müller P, Leow MK, Dietrich JW. Minor perturbations of thyroid homeostasis and major cardiovascular endpoints-physiological mechanisms and clinical evidence. Front Cardiovasc Med 2022; 9: 942971
    CrossrefPubMedSearch in Google Scholar
  • 9 Phowira J, Coffey KL, Bartholomew PH. et al. Radioactive iodine for the treatment of subclinical thyrotoxicosis GRADE 1 and 2: Outcome of up to 18-year follow up. Front Endocrinol (Lausanne) 2022; 13: 843857
    CrossrefPubMedSearch in Google Scholar
  • 10 Stadje R, Dornieden K, Baum E. et al. The differential diagnosis of tiredness: A systematic review. BMC Fam Pract 2016; 17: 147
    CrossrefPubMedSearch in Google Scholar
  • 11 Larisch R, Schulte S, Hildenbrand G. et al. The role of thyroid hormones in anxiety and depression (abstract). Nuklearmedizin 2015; 53: V162
    Search in Google Scholar
  • 12 Hoermann R, Midgley JEM, Larisch R. et al. Relational stability of thyroid hormones in euthyroid subjects and patients with autoimmune thyroid disease. Eur Thyroid J 2016; 5: 171-179
    CrossrefPubMedSearch in Google Scholar
  • 13 Hedman C, Djärv T, Strang P. et al. Effect of thyroid-related symptoms on long-term quality of life in patients with differentiated thyroid carcinoma: A population-based study in Sweden. Thyroid 2017; 27: 1034-1042
    CrossrefPubMedSearch in Google Scholar
  • 14 Wekking EM, Appelhof BC, Fliers E. et al. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol 2005; 153: 747-753
    CrossrefPubMedSearch in Google Scholar
  • 15 Larisch R, Midgley JEM, Dietrich JW. et al. Symptomatic relief is related to serum free triiodothyronine concentrations during follow-up in levothyroxine-treated patients with differentiated thyroid cancer. Exp Clin Endocrinol Diabetes 2018; 126: 546-552
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Fitzgerald SP, Bean NG, Falhammar H. et al. Clinical parameters are more likely to be associated with thyroid hormone levels than with thyrotropin levels: A systematic review and meta-analysis. Thyroid 2020; 30: 1695-1709
    CrossrefPubMedSearch in Google Scholar
  • 17 Hoermann R, Midgley JEM, Larisch R. et al. Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment. Eur J Endocrinol 2013; 168: 271-280
    CrossrefPubMedSearch in Google Scholar
  • 18 Hoermann R, Pekker MJ, Midgley JEM. et al. The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic-pituitary-thyroid axis. Ther Adv Endocrinol Metab 2023; 14
    CrossrefPubMedSearch in Google Scholar
  • 19 Watt T, Cramon P, Hegedüs L. et al. The thyroid-related quality of life measure ThyPRO has good responsiveness and ability to detect relevant treatment effects. J Clin Endocrinol Metab 2014; 99: 3708-3717
    CrossrefPubMedSearch in Google Scholar
  • 20 Cramon PK, Bjorner JB, Groenvold M. et al. Implementation of thyroid-related patient-reported outcomes in routine clinical practice. Front Endocrinol (Lausanne) 2022; 13: 1000682
    CrossrefPubMedSearch in Google Scholar
  • 21 Watt T, Hegedüs L, Groenvold M. et al. Validity and reliability of the novel thyroid-specific quality of life questionnaire, thypro. Eur J Endocrinol 2010; 162: 161-167
    CrossrefPubMedSearch in Google Scholar
  • 22 Tabriz N, Gloy K, Schantzen A. et al. Validity and reliability of the German version of the shortened thyroid-specific quality of life questionnaire (ThyPRO-39de). Endocr Connect 2021; 10: 1065-1072
    CrossrefPubMedSearch in Google Scholar
  • 23 Chan EKH, Edwards TC, Haywood K. et al. Implementing patient-reported outcome measures in clinical practice: A companion guide to the isoqol user’s guide. Quality of Life Research 2019; 28: 621-627
    CrossrefPubMedSearch in Google Scholar
  • 24 Watt T, Bjorner JB, Groenvold M. et al. Development of a short version of the thyroid-related patient-reported outcome ThyPRO. Thyroid 2015; 25: 1069-1079
    CrossrefPubMedSearch in Google Scholar
  • 25 Cramon P, Bonnema SJ, Bjorner JB. et al. Quality of life in patients with benign nontoxic goiter: Impact of disease and treatment response, and comparison with the general population. Thyroid 2015; 25: 284-291
    CrossrefPubMedSearch in Google Scholar
  • 26 Larisch R, Giacobino A, Eckl WA. et al. Reference range for thyrotropin. Post hoc assessment. Nuklearmedizin 2015; 54: 112-117
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Dietrich JW, Landgrafe-Mende G, Wiora E. et al. Calculated parameters of thyroid homeostasis: Emerging tools for differential diagnosis and clinical research. Front Endocrinol (Lausanne) 2016; 7: 57
    CrossrefPubMedSearch in Google Scholar
  • 28 Hoermann R, Midgley JEM, Larisch R. et al. Relational stability in the expression of normality, variation, and control of thyroid function. Front Endocrinol (Lausanne) 2016; 7: 142
    CrossrefPubMedSearch in Google Scholar
  • 29 Dietlein M, Grünwald F, Schmidt M. et al. Radioiodine therapy for benign thyroid diseases (version 5). Nuklearmedizin 2016; 55: 213-220
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Marinelli LD, Quimby EH, Hine GJ. Dosage determination with radioactive isotopes; practical considerations in therapy and protection. Am J Roentgenol Radium Ther 1948; 59: 260-281
    PubMedSearch in Google Scholar
  • 31 Bates D, Kliegl R, Vasishth S. et al. Parsimonious mixed models. arXivorg 2015; 1-27
    Search in Google Scholar
  • 32 Allison DB, Brown AW, George BJ. et al. Reproducibility: A tragedy of errors. Nature 2016; 530: 27-29
    CrossrefPubMedSearch in Google Scholar
  • 33 De Rosario-Martinez H. Phia: Post-hoc interaction analysis. R package version 0.2–1. 2015 https://cran.r-project.org/package=phia
    PubMedSearch in Google Scholar
  • 34 R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2023; ISBN 3–900051–07–0. https://www.R-project.org/
  • 35 Bates D, Mächler M, Bolker B. et al. Fitting linear mixed-effects models using lme4. J Stat Softw 2015; 67: 1-48
    CrossrefSearch in Google Scholar
  • 36 Jonklaas J, Bianco AC, Bauer AJ. et al. Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid Association task force on thyroid hormone replacement. Thyroid 2014; 24: 1670-1751
    CrossrefPubMedSearch in Google Scholar
  • 37 Midgley JEM, Toft AD, Larisch R. et al. Time for a reassessment of the treatment of hypothyroidism. BMC Endocr Disord 2019; 19: 37
    CrossrefPubMedSearch in Google Scholar
  • 38 Fitzgerald SP, Bean NG, Hennessey JV. et al. Thyroid testing paradigm switch from thyrotropin to thyroid hormones-future directions and opportunities in clinical medicine and research. Endocrine 2021; 74: 285-289
    CrossrefPubMedSearch in Google Scholar
  • 39 Poertl S, Kirner J, Saller B. et al. T3-release from autonomously functioning thyroid nodules in vitro. Exp Clin Endocrinol Diabetes 1998; 106: 489-493
    Thieme ConnectPubMedSearch in Google Scholar
  • 40 Vassart G, Dumont JE. The thyrotropin receptor and the regulation of thyrocyte function and growth. Endocr Rev 1992; 13: 596-611
    CrossrefPubMedSearch in Google Scholar
  • 41 Andersen S, Pedersen KM, Bruun NH. et al. Narrow individual variations in serum T4 and T3 in normal subjects: A clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab 2002; 87: 1068-1072
    CrossrefPubMedSearch in Google Scholar
  • 42 Hoermann R, Midgley JEM, Larisch R. et al. Individualised requirements for optimum treatment of hypothyroidism: Complex needs, limited options. Drugs Context 2019; 8: 212597
    CrossrefPubMedSearch in Google Scholar
  • 43 Hoermann R, Midgley JEM, Larisch R. et al. Functional and symptomatic individuality in the response to levothyroxine treatment. Front Endocrinol (Lausanne) 2019; 10: 664
    CrossrefPubMedSearch in Google Scholar
  • 44 Brown VA. An introduction to linear mixed-effects modeling in r. Adv Meth Pract Psychol Sci 2021; 4 (01)
    CrossrefSearch in Google Scholar
  • 45 Hoermann R, Pekker M, Midgley JE. et al. Principles of endocrine regulation: Reconciling tensions between robustness in performance and adaptation to change. Front Endocrinol 2022; 13: 825107
    CrossrefPubMedSearch in Google Scholar
  • 46 Wong CK, Lang BH, Lam CL. A systematic review of quality of thyroid-specific health-related quality-of-life instruments recommends ThyPRO for patients with benign thyroid diseases. J Clin Epidemiol 2016; 78: 63-72
    CrossrefPubMedSearch in Google Scholar
  • 47 Stott DJ, Rodondi N, Kearney PM. et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017; 376: 2534-2544
    CrossrefPubMedSearch in Google Scholar
  • 48 Heald AH, Premawardhana L, Taylor P. et al. Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series. Int J Clin Pract 2021; 75: e14967
    CrossrefPubMedSearch in Google Scholar
  • 49 Törring O, Watt T, Sjölin G. et al. Impaired quality of life after radioiodine therapy compared to antithyroid drugs or surgical treatment for Graves’ hyperthyroidism: A long-term follow-up with the thyroid-related patient-reported outcome questionnaire and 36-item short form health status survey. Thyroid 2019; 29: 322-331
    CrossrefPubMedSearch in Google Scholar