Horm Metab Res 2012; 44(01): 54-59
DOI: 10.1055/s-0031-1295415
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

A Comparison of rh-TSH and Thyroid Hormone Withdrawal in Patients with Differentiated Thyroid Cancer: Preliminary Evidence for an Influence of Age on the Subjective Well-being in Hypothyroidism

A. Heinzel
1   Department of Nuclear Medicine, Heinrich Heine-University of Düsseldorf, Düsseldorf, Germany
,
K. Kley
1   Department of Nuclear Medicine, Heinrich Heine-University of Düsseldorf, Düsseldorf, Germany
,
H.-W. Mueller
1   Department of Nuclear Medicine, Heinrich Heine-University of Düsseldorf, Düsseldorf, Germany
,
H. Hautzel
1   Department of Nuclear Medicine, Heinrich Heine-University of Düsseldorf, Düsseldorf, Germany
› Author Affiliations
Further Information

Publication History

received 11 July 2011

accepted 26 October 2011

Publication Date:
22 November 2011 (online)

Abstract

We aimed to investigate the subjective well-being in patients with differentiated thyroid cancer after hormone withdrawal. Since this might be confounded by psycho-oncological processes unrelated to hypothyroidism we intended to minimize such factors by only including patients with a history of uneventful follow-up examinations for several years.

We investigated 67 patients applying the General Health Questionnaire (GHQ-12) at 3 time points t1, t2, and t3. The time point t2 represented an intensified follow-up examination 5 years after thyroidectomy, which was performed either on hormone withdrawal (49 patients) or using rh-TSH (18 patients). The time points t1 and t3 took place during follow-up examinations 6 months before and after t2 in a euthyroid state. Additionally, we assessed the impact of age, gender, family status, and education on the GHQ-12 score at all 3 time points. Within the hormone withdrawal group the analyses demonstrated a significant difference between t1 and t2 as well as t3 and t2. Additionally, there was a significant negative correlation of age with GHQ-12 sum scores at t2, but not at t1 or t3. Subgroup analyses at t2 indicated that the subjective well-being in younger patients was more impaired compared to elderly patients. The between-group analysis showed no significant differences. However, concerning the age effect there was a significant difference between the subgroup of young hypothyroid patients and the total rh-TSH group at t2. We demonstrated preliminary evidence for an influence of age on the subjective well-being in hypothyroidism suggesting that younger subjects are subjectively more impaired by hypothyroidism than elderly ones.

 
  • References

  • 1 Constant EL, de Volder AG, Ivanoiu A, Bol A, Labar D, Seghers A, Cosnard G, Melin J, Daumerie C. Cerebral blood flow and glucose metabolism in hypothyroidism: a positron emission tomography study. J Clin Endocrinol Metab 2001; 86: 3864-3870
  • 2 Dow KH, Ferrell BR, Anello C. Quality-of-life changes in patients with thyroid cancer after withdrawal of thyroid hormone therapy. Thyroid 1997; 7: 613-619
  • 3 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
  • 4 Gulseren S, Gulseren L, Hekimsoy Z, Cetinay P, Ozen C, Tokatlioglu B. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res 2006; 37: 133-139
  • 5 Larisch R, Kley K, Nikolaus S, Sitte W, Franz M, Hautzel H, Tress W, Muller HW. Depression and anxiety in different thyroid function states. Horm Metab Res 2004; 36: 650-653
  • 6 Schroeder PR, Haugen BR, Pacini F, Reiners C, Schlumberger M, Sherman SI, Cooper DS, Schuff KG, Braverman LE, Skarulis MC, Davies TF, Mazzaferri EL, Daniels GH, Ross DS, Luster M, Samuels MH, Weintraub BD, Ridgway EC, Ladenson PW. 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
  • 7 Haugen BR, Pacini F, Reiners C, Schlumberger M, Ladenson PW, Sherman SI, Cooper DS, Graham KE, Braverman LE, Skarulis MC, Davies TF, DeGroot LJ, Mazzaferri EL, Daniels GH, Ross DS, Luster M, Samuels MH, Becker DV, Maxon III HR, Cavalieri RR, Spencer CA, McEllin K, Weintraub BD, Ridgway EC. A comparison of recombinant human thyrotropin and thyroid hormone withdrawal for the detection of thyroid remnant or cancer. J Clin Endocrinol Metab 1999; 84: 3877-3885
  • 8 Luster M, Handkiewicz-Junak D, Grossi A, Zacharin M, Taieb D, Cruz O, Hitzel A, Casas JA, Mader U, Dottorini ME. Recombinant thyrotropin use in children and adolescents with differentiated thyroid cancer: a multicenter retrospective study. J Clin Endocrinol Metab 2009; 94: 3948-3953
  • 9 Dueren C, Dietlein M, Luster M, Plenzig F, Steinke R, Grimm J, Groth P, Eichhorn W, Reiners C. The Use of Thyrogen(R) in the Treatment of Differentiated Thyroid Carcinoma: An Intraindividual Comparison of Clinical Effects and Implications of Daily Life. Exp Clin Endocrinol Diabetes 2010; 118: 513-519
  • 10 Engum A, Bjoro T, Mykletun A, Dahl AA. An association between depression, anxiety and thyroid function – a clinical fact or an artefact?. Acta Psychiatr Scand 2002; 106: 27-34
  • 11 Links TP, van Tol KM, Jager PL, Plukker JT, Piers DA, Boezen HM, Dullaart RP, de Vries EG, Sluiter WJ. Life expectancy in differentiated thyroid cancer: a novel approach to survival analysis. Endocr Relat Cancer 2005; 12: 273-280
  • 12 Heinrich TW, Grahm G. Hypothyroidism Presenting as Psychosis: Myxedema Madness Revisited. Prim Care Companion J Clin Psychiatry 2003; 5: 260-266
  • 13 Goldberg DP, Rickels K, Downing R, Hesbacher P. A comparison of two psychiatric screening tests. Br J Psychiatry 1976; 129: 61-67
  • 14 Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L. Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 1994; 30A: 37-40
  • 15 Goldberg DP, Gater R, Sartorius N, Ustun TB, Piccinelli M, Gureje O, Rutter C. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychol Med 1997; 27: 191-197
  • 16 Schmitz N, Kruse J, Tress W. Psychometric properties of the General Health Questionnaire (GHQ-12) in a German primary care sample. Acta Psychiatr Scand 1999; 100: 462-468
  • 17 Bauer M, Silverman DH, Schlagenhauf F, London ED, Geist CL, van HK, Rasgon N, Martinez D, Miller K, van HA, Berman SM, Phelps ME, Whybrow PC. Brain glucose metabolism in hypothyroidism: a positron emission tomography study before and after thyroid hormone replacement therapy. J Clin Endocrinol Metab 2009; 94: 2922-2929
  • 18 Tagay S, Herpertz S, Langkafel M, Erim Y, Freudenberg L, Schopper N, Bockisch A, Senf W, Gorges R. Health-related quality of life, anxiety and depression in thyroid cancer patients under short-term hypothyroidism and TSH-suppressive levothyroxine treatment. Eur J Endocrinol 2005; 153: 755-763
  • 19 Tagay S, Senf W, Schöpper N, Mewes R, Bockisch A, Görges R. Protective factors for anxiety and depression in thyroid cancer patients. Z Psychosom Med Psychother 2007; 53: 62-74
  • 20 Papassotiropoulos A, Heun R, Maier W. Age and cognitive impairment influence the performance of the General Health Questionnaire. Compr Psychiatry 1997; 38: 335-340
  • 21 Mehlsen M, Jensen AB, Christensen S, Pedersen CG, Lassesen B, Zachariae R. A prospective study of age differences in consequences of emotional control in women referred to clinical mammography. Psychol Aging 2009; 24: 363-372