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THYROID CANCER
Quality of life considerations in patients treated for thyroid cancer

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BACKGROUND
Thyroid cancer has been one of the fastest rising cancers across the world. Indeed, the number of new cases of thyroid cancer in Mainland China has increased by a lot in recent years. In 2020, more than 200,000 patients in China were diagnosed with thyroid cancer. The treatment of thyroid cancer most often includes surgery to remove part or all of the thyroid gland. If the entire thyroid is removed (total thyroidectomy), patients will be on thyroid hormone replacement, usually levothyroxine, for life. While many patients that only have part of their thyroid removed (partial thyroidectomy) will not be on thyroid hormone, many also do need to be on levothyroxine. Finally, after surgery, some but not all patients may benefit from radioactive iodine treatment. All of these factors, as well as possible complication for surgery, can affect a person’s quality of life. However, little is known about the quality of life of thyroid cancer survivors from Mainland China.

In this study, the authors examined quality of life measures and identified associated factors in thyroid cancer survivors from Mainland China.

THE FULL ARTICLE TITLE
 Chen C et al 2023 Health-related quality of life and thyroid cancer-specific symptoms in patients treated for differentiated thyroid cancer: A single center, cross-sectional survey from Mainland China. Thyroid. Epub 2023 Feb 15. PMID: 36792949.

SUMMARY OF THE STUDY
The authors surveyed 373 thyroid cancer survivors from Mainland China. Most of the patients were female (77%), between the ages of 36 and 64 years old (65%) and employed at the time that the survey was completed (58%). In terms of treatment, most of the surveyed patients underwent a partial thyroidectomy (53%). Further, most patients did not receive radioactive iodine therapy (74%).

Health related quality of life was assessed using the “European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) Questionnaire”. This survey found that while patients reported an overall high quality of life, they also reported high levels of the following symptoms: fatigue, pain, insomnia, and financial difficulties.

Thyroid cancer-specific quality of life was assessed using the “Thyroid Cancer-Specific Quality of Life (THYCA-QOL) Questionnaire”. Patients reported high levels of the following symptoms: “psychological problems”, problems with the scar from thyroid surgery, and voice problems. Factors found to be associated with more thyroid cancer-specific symptoms included hypoparathyroidism, which is a complication of thyroid surgery, lower household income, and higher doses of radioactive iodine treatment.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The study demonstrates that many patients with thyroid cancer experience multiple health-related problems and symptoms after initial treatment for thyroid cancer. All of these factors impact patient’s quality of life. More research is needed to understand how to best support thyroid cancer survivor after their initial treatment.

— Debbie Chen, MD

ABBREVIATIONS & DEFINITIONS

Papillary thyroid cancer: the most common type of thyroid cancer. There are 4 variants of papillary thyroid cancer: classic, follicular, tall-cell and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP).

Radioactive iodine (RAI): this plays a valuable role in diagnosing and treating thyroid problems since it is taken up only by the thyroid gland. I-131 is the destructive form used to destroy thyroid tissue in the treatment of thyroid cancer and with an overactive thyroid. I-123 is the nondestructive form that does not damage the thyroid and is used in scans to take pictures of the thyroid (Thyroid Scan) or to take pictures of the whole body to look for thyroid cancer (Whole Body Scan).

Thyroidectomy: surgery to remove the entire thyroid gland. When the entire thyroid is removed it is termed a total thyroidectomy. When less is removed, such as in removal of a lobe, it is termed a partial thyroidectomy.

Thyroid hormone therapy: patients with hypothyroidism are most often treated with Levothyroxine in order to return their thyroid hormone levels to normal. Replacement therapy means the goal is a TSH in the normal range and is the usual therapy. Suppressive therapy means that the goal is a TSH below the normal range and is used in thyroid cancer patients to prevent growth of any remaining cancer cells.

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