BACKGROUND
Thyroid cancer is a common cancer, especially among women. The vast majority of patients with the most common thyroid of thyroid cancer (papillary thyroid cancer) do very well as thyroid cancer generally tends to have very good outcomes. This is because there are very effective treatments for thyroid cancer. Initially, most patients have surgery to remove part (lobectomy) or all (total thyroidectomy) of the thyroid. Depending on the risk of thyroid cancer recurrence, some patients that had a total thyroidectomy are also treated with radioactive iodine therapy, which is a magic bullet that destroys any remaining thyroid tissue, normal or cancerous, in the body. With these treatment options, most patients live just as long as patients without this cancer.

Because patients with thyroid cancer do so well, in recent years there has been an important discussion about the impact on the quality of life of these patients after thyroid surgery and radioactive iodine treatment for thyroid cancer. This study was done to look at the standardized quality of life scores in patients with thyroid cancer.

THE FULL ARTICLE TITLE
Winter J et al. Five-year follow-up of health-related quality of life in differentiated thyroid cancer patients treated with total thyroidectomy and radioiodine in Sweden: A nationwide prospective cohort study. Thyroid 2024 Apr 5. Epub ahead of print; doi: 10.1089/thy.2023.0691. PMID: 38526369.

SUMMARY OF THE STUDY
This study was performed on patients with thyroid cancer that had their entire thyroid removed (total thyroidectomy) and also received radioactive iodine therapy in Sweden between the years of 2012 and 2017.

A specific survey looking at physical and mental well-being, called the Short Form – 36 health survey (SF-36) was answered by these patients at 1 year, 3 years and five years after treatment. In addition to the patient answers, the patient’s thyroid hormone levels were measured.

A total of 351 patients completed the study, 71% were female. It was noted that at 5 years there was no difference in the physical quality of life compared to baseline, while mental well-being improved. Compared to the general population, both the physical and mental components of the quality of life survey were different at 5 years, but the effect sizes were small. The survey domains for general health, vitality, social functioning, and mental health were significantly lower in patients with thyroid cancer than the general population but there was no association of the physical or mental quality of life scores to thyroid hormone levels.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that there seems to be improvement of the mental health well-being of patients treated with thyroid cancer at 5 years compared to their first year of diagnosis. This study also shows a significant decrease in the perceived quality of life compared to the general population which is not related to thyroid hormone levels, for which screening for psychosocial health issues may be important in the follow-up of Thyroid Cancer patients. This research suggests that adjusting thyroid medication outside of the recommended guidelines is unlikely to help improve the perceived decline in quality of life, as there is no relationship between the thyroid hormone levels and the quality of life scores in this study.

— Maria Brito, MD, ECNU

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