Download PDF
Nuklearmedizin 2017; 56(05): 177-183
DOI: 10.3413/Nukmed-0898-17-05
Original Article
Schattauer GmbH

Impact of age and sex on the quality of life following radioactive iodine ablation in patients with thyroid cancer

Einfluss von Alter und Geschlecht auf die Lebensqualität nach ablativer Radioiodtherapie bei Patienten mit Schilddrüsenkrebs
Kyoungjune Pak   *
1   Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
So Jung Kim   *
1   Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
Seunghyeon Shin
1   Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
Keunyoung Kim
1   Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
Bum Soo Kim
2   Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Seong Jang Kim
2   Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
,
Wonjae Cha
3   Department of Otorhinolaryngology and Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
,
Jeon Yeob Jang
3   Department of Otorhinolaryngology and Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
,
Byung Joo Lee
3   Department of Otorhinolaryngology and Head and Neck Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
,
Yun Kyung Jeon
4   Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
Sang Soo Kim
4   Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
Bo Hyun Kim
4   Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
,
In Joo Kim
1   Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
› Author Affiliations
Further Information

Publication History

received: 03 May 2017

accepted in revised form: 21 August 2017

Publication Date:
04 January 2018 (online)

    Permissions and Reprints

Summary

Purpose: We assessed patient discomfort and identified factors predictive of discomfort while receiving radioactive iodine (RAI) ablation.Methods: Between August 2015 and April 2016, 52 patients with differentiated thyroid cancer were enrolled in this study. All patients received recombinant human thyroid stimulating hormone (rhTSH) aided RAI ablation using 3.7 GBq or 5.55 GBq of RAI. Discomfort during their stay for RAI ablation was evaluated using a symptom questionnaire. We analyzed the relationship between the patient’s clinical data and the scores for the 15 items of the symptom questionnaire. We compared scores of questionnaires between male and female, under 45 years old and 45 and older, RAI activity of 3.7 GBq and 5.55 GBq. Also, scores of daily questionnaires were tested for differences.Results: Most patients did not have severe discomfort, but some patients had mild discomfort during their stay for RAI ablation, despite using rhTSH. Important determinants of discomfort were sex and age. Female patients reported more symptoms of fatigue, facial edema, cold intolerance, and nausea. Older patients (45 and older) complained of insomnia more often. However, the dose of RAI ablation (3.7 GBq vs 5.55 GBq) did not affect the scores of questionnaires.Conclusions: Sex and age were important predictors of patient’s discomfort during RAI ablation. Clinicians need to explain more about treatment and predicted discomforts to such patients before RAI ablation.

Zusammenfassung

Zweck: Wir untersuchten unter ablativer Ra- dioiodtherapie (RIT) auftretende Beschwerden und identifizierten prognostische Faktoren für Beschwerden bei den Patienten.Methoden: Von August 2015 bis April 2016 wurden 52 Patienten mit differenziertem Schilddrüsenkarzinom in die Studie aufgenommen. Alle Patienten erhielten eine durch rekombinantes humanes Thyreoidea-stimulierendes Hormon (rhTSH) gestützte ablative RIT mit 3,7 GBq oder 5,55 GBq. Die Beschwerden während des Aufenthaltes wegen der RIT wurden anhand eines Symptom-Fragebogens evaluiert. Wir analysierten den Zusammenhang zwischen den klinischen Daten der Patienten und den Scores in den 15 Items des Fragebogens. Die Fragebogen-Scores wurden wie folgt verglichen: Männer vs. Frauen, < 45-jährige vs. ≥ 45-jährige sowie RIT-Aktivität von 3,7 GBq vs. 5,55 GBq. Außerdem wurden die Scores der täglichen Fragebögen auf Unterschiede getestet.Ergebnisse: Die meisten Patienten hatten keine wesentlichen Beschwerden, bei manchen traten im Laufe des RIT- Aufenthaltes trotz rhTSH-Gabe leichte Beschwerden auf. Wichtige Determinanten für Beschwerden waren das Alter und das Geschlecht. Patientinnen berichteten häufiger über Symptome wie Müdigkeit, Gesichtsödem, Kälteunverträglichkeit und Übelkeit. Ältere Patienten (≥ 45 Jahre) klagten häufiger über Schlaflosigkeit. Die Dosis der ablativen RIT (3,7 GBq vs. 5,55 GBq) hatte jedoch keinen Einfluss auf die Fragebogen-Scores.Schlussfolgerungen: Geschlecht und Alter waren wichtige Prädiktoren für Beschwerden unter einer ablativen RIT. Daher sollten Ärzte die Patienten vor einer ablativen RIT besser über die Behandlung und vorhersehbare Beschwerden aufklären.

Keywords

Thyroid cancer - quality of life - recombinant human thyroid stimulating hormone

Schlüsselwörter

Schilddrüsenkrebs - Lebensqualität - rekombinantes humanes Thyreoidea-stimulierendes Hormon

* Kyoungjune Pak and So Jung Kim contributed equally to this work as first authors.


 

  • References

  • 1 Ahn HS, Kim HJ, Welch HG. Koreas thyroid-cancer” epidemic”: screening and overdiagnosis. N Engl J Med 2014; 371 (19) 1765-1767.
    CrossrefPubMedGoogle Scholar
  • 2 Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. British journal of anaesthesia 2013; 111 (01) 52-58.
    CrossrefPubMedGoogle Scholar
  • 3 Billewicz W, Chapman R, Crooks J, Day M, Gossage J, Wayne SE. et al. Statistical methods applied to the diagnosis of hypothyroldism QJM. An International Journal of Medicine 1969; 38 (02) 255-266.
    Google Scholar
  • 4 Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer 2009; 115 (16) 3801-3807.
    CrossrefPubMedGoogle Scholar
  • 5 Conover WJ, Conover WJ. Practical nonparametric statistics. 1980
    PubMedGoogle Scholar
  • 6 Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19 (11) 1167-1214.
    CrossrefPubMedGoogle Scholar
  • 7 Craft RM. Modulation of pain by estrogens. Pain 2007; 132: S3-S12.
    CrossrefPubMedGoogle Scholar
  • 8 Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA 2006; 295 (18) 2164-2167.
    CrossrefPubMedGoogle Scholar
  • 9 Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 1997; 7 (04) 613-619.
    CrossrefPubMedGoogle Scholar
  • 10 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 (01) 13-19.
    CrossrefPubMedGoogle Scholar
  • 11 Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE. et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980-2005. Cancer Epidemiol Biomarkers Prev 2009; 18 (03) 784-791.
    CrossrefPubMedGoogle Scholar
  • 12 Goldfarb M, Casillas J. Thyroid Cancer-Specific Quality of Life and Health-Related Quality of Life in Young Adult Thyroid Cancer Survivors. Thyroid 2016; 26 (07) 923-932.
    CrossrefPubMedGoogle Scholar
  • 13 Hoftijzer HC, Heemstra KA, Corssmit EP, van der Klaauw AA, Romijn JA, Smit JW. Quality of life in cured patients with differentiated thyroid carcinoma. The Journal of Clinical Endocrinology & Metabolism 2008; 93 (01) 200-203.
    CrossrefPubMedGoogle Scholar
  • 14 Husson O, Haak HR, Mols F, Nieuwenhuijzen GA, Nieuwlaat W-A, Reemst PH. et al. Development of a disease-specific health-related quality of life questionnaire (THYCA-QoL) for thyroid cancer survivors. Acta Oncologica 2013; 52 (02) 447-454.
    CrossrefPubMedGoogle Scholar
  • 15 Kellner R, Sheffield BF. A self-rating scale of distress. Psychological medicine 1973; 3 (01) 88-100.
    CrossrefPubMedGoogle Scholar
  • 16 Ladenson PW, Braverman LE, Mazzaferri EL, Brucker-Davis F, Cooper DS, Garber JR. et al. Comparison of administration of recombinant human thyrotropin with withdrawal of thyroid hormone for radioactive iodine scanning in patients with thyroid carcinoma. New England Journal of Medicine 1997; 337 (13) 888-896.
    CrossrefPubMedGoogle Scholar
  • 17 Lee J, Yun MJ, Nam KH, Chung WY, Soh EY, Park CS. 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 (02) 173-179.
    CrossrefPubMedGoogle Scholar
  • 18 Lee JI, Kim SH, Tan AH, Kim HK, Jang HW, Hur KY. et al. Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea. Health and quality of life outcomes 2010; 8 (01) 1.
    CrossrefPubMedGoogle Scholar
  • 19 Luster M, Felbinger R, Dietlein M, Reiners C. 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 (10) 1147-1155.
    CrossrefPubMedGoogle Scholar
  • 20 Luster M, Lippi F, Jarzab B, Perros P, Lassmann M, Reiners C. et al. rhTSH-aided radioiodine ablation and treatment of differentiated thyroid carcinoma: a comprehensive review. Endocr Relat Cancer 2005; 12 (01) 49-64.
    CrossrefPubMedGoogle Scholar
  • 21 Luster M, Reinhardt W, Körber C, Lassmann M, Haenscheid H, Michalowski U. et al. The use of recombinant human TSH in a patient with metastatic follicular carcinoma and insufficient endogenous TSH production. Journal of endocrinological investigation 2000; 23 (07) 473-475.
    CrossrefPubMedGoogle Scholar
  • 22 Mariani G, Ferdeghini M, Augeri C, Villa G, Taddei GZ, Scopinaro G. et al. Clinical experience with recombinant human thyrotrophin (rhTSH) in the management of patients with differentiated thyroid cancer. Cancer biotherapy & radiopharmaceuticals 2000; 15 (02) 211-217.
    CrossrefPubMedGoogle Scholar
  • 23 Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. European journal of endocrinology 2006; 154 (06) 787-803.
    CrossrefPubMedGoogle Scholar
  • 24 Robinson ME, Riley JL, Myers CD, Papas RK, Wise EA, Waxenberg LB. et al. Gender role expectations of pain: relationship to sex differences in pain. The journal of pain 2001; 2 (05) 251-257.
    CrossrefPubMedGoogle Scholar
  • 25 Silberstein E, Alavi A, Balon H, Becker D, Brill D, Clarke S. et al. Society of Nuclear Medicine Procedure Guideline for Therapy of Thyroid Disease with Iodine-131 (Sodium Iodide) Version 2.0. Society of Nuclear Medicine. 2005
    PubMedGoogle Scholar
  • 26 Singer S, Jordan S, Locati LD, Pinto M, Tomaszewska IM, Araújo C. et al. The EORTC module for quality of life in patients with thyroid cancer: phase III. Endocrine-Related Cancer. 2017 ERC-16-0530.
    PubMedGoogle Scholar
  • 27 Smith YR, Stohler CS, Nichols TE, Bueller JA, Koeppe RA, Zubieta J-K. Pronociceptive and antinociceptive effects of estradiol through endogenous opioid neurotransmission in women. The Journal of Neuroscience 2006; 26 (21) 5777-5785.
    CrossrefPubMedGoogle Scholar
  • 28 Taieb D, Sebag F, Cherenko M, Baumstarck-Barrau K, Fortanier C, Farman-Ara B. et al. Quality of life changes and clinical outcomes in thyroid cancer patients undergoing radioiodine remnant ablation (RRA) with recombinant human TSH (rhTSH): a randomized controlled study. Clin Endocrinol (Oxf) 2009; 71 (01) 115-123.
    CrossrefPubMedGoogle Scholar
  • 29 Tuttle RM, Haddad RI, Ball DW, Byrd D, Dickson P, Duh QY. et al. Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw 2014; 12 (12) 1671-1680 quiz 80.
    CrossrefPubMedGoogle Scholar
  • 30 Wiesenfeld-Hallin Z. Sex differences in pain perception. Gender medicine 2005; 2 (03) 137-145.
    CrossrefPubMedGoogle Scholar
  • 31 Wise EA, Price DD, Myers CD, Heft MW, Robinson ME. Gender role expectations of pain: relationship to experimental pain perception. Pain 2002; 96 (03) 335-342.
    CrossrefPubMedGoogle Scholar
  • 32 Won Y-J, Sung J, Jung K-W, Kong H-J, Park S, Shin H-R. et al. Nationwide cancer incidence in Korea, 2003-2005. Cancer Research and Treatment 2009; 41 (03) 122-131.
    CrossrefPubMedGoogle Scholar
  • 33 Zubieta J-K, Smith YR, Bueller JA, Xu Y, Kilbourn MR, Jewett DM. et al. μ-Opioid receptor-mediated antinociceptive responses differ in men and women. The journal of neuroscience 2002; 22 (12) 5100-5107.
    CrossrefPubMedGoogle Scholar