Ove Törring1,2, Torquil Watt3,4, Gabriel Sjölin5, Kristina Byström6, Mirna Abraham-Nordling7, Jan Calissendorff7,8, Per Karkov Cramon3,4, Helena Filipsson Nyström9,10, Bengt Hallengren11,12, Mats Holmberg9,13, Selwan Khamisi14,15, Mikael Lantz11,12, Göran Wallin5,7. 1. 1 Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden. 2. 2 Division of Endocrinology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden. 3. 3 Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark. 4. 4 Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark. 5. 5 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 6. 6 Department of Medicine, University Hospital and Örebro University, Örebro, Sweden. 7. 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 8. 8 Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital, Stockholm, Sweden. 9. 9 Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. 10. 10 Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden. 11. 11 Department of Endocrinology, Skåne University Hospital, Malmö, Sweden. 12. 12 Department of Clinical Sciences, Lund University, Malmö, Sweden. 13. 13 ANOVA, Karolinska University Hospital, Stockholm, Sweden. 14. 14 Department of Endocrinology, Uppsala University Hospital, Uppsala, Sweden. 15. 15 Institution of Internal Medicine, Uppsala University, Uppsala, Sweden.
Abstract
BACKGROUND: Hyperthyroidism is known to have a significant impact on quality of life (QoL), at least in the short term. The purpose of the present study was to assess QoL in patients 6-10 years after treatment for Graves' disease (GD) with radioiodine (RAI) compared to those treated with thyroidectomy or antithyroid drugs (ATD) as assessed with both thyroid-specific Thyroid-Related Patient-Reported Outcome (ThyPRO) questionnaire and general (36-item Short Form Health Status) QoL survey. METHODS: The study evaluated 1186 GD patients in a sub-cohort from an incidence study 2003-2005 who had been treated according to routine clinical practice at seven participating centers. Patients were included if they had returned the ThyPRO (n = 975) and/or the 36-item Short Form Health Status survey questionnaire (n = 964) and informed consent at follow-up. Scores from ThyPRO were compared to scores from a general population sample (n = 712) using multiple linear regression adjusting for age and sex as well as multiple testing. Treatment-related QoL outcome for ATD, RAI, and surgery were compared, including adjustment for the number of treatments received, sex, age, and comorbidity. RESULTS: Regardless of treatment modality, patients with GD had worse thyroid-related QoL 6-10 years after diagnosis compared to the general population. Patients treated with RAI had worse thyroid-related and general QoL than patients treated with ATD or thyroidectomy on the majority of QoL scales. Sensitivity analyses supported the relative negative comparative effects of RAI treatment on QoL in patients with hyperthyroidism. CONCLUSIONS: GD is associated with a lower QoL many years after treatment compared to the general population. In a previous small randomized controlled trial, no difference was found in patient satisfaction years after ATD, RAI, or surgery. Now, it is reported that in a large non-randomized cohort, patients who received RAI had adverse scores on ThyPRO and 36-item Short Form Health Status survey. These findings in a Swedish population are limited by comparison to normative data from Denmark, older age, and possibly a more prolonged course in those patients who received RAI, and a lack of information regarding thyroid status at the time of evaluation. The way RAI may adversely affect QoL is unknown, but since the results may be important for future considerations regarding treatment options for GD, they need to be substantiated in further studies.
BACKGROUND:Hyperthyroidism is known to have a significant impact on quality of life (QoL), at least in the short term. The purpose of the present study was to assess QoL in patients 6-10 years after treatment for Graves' disease (GD) with radioiodine (RAI) compared to those treated with thyroidectomy or antithyroid drugs (ATD) as assessed with both thyroid-specific Thyroid-Related Patient-Reported Outcome (ThyPRO) questionnaire and general (36-item Short Form Health Status) QoL survey. METHODS: The study evaluated 1186 GDpatients in a sub-cohort from an incidence study 2003-2005 who had been treated according to routine clinical practice at seven participating centers. Patients were included if they had returned the ThyPRO (n = 975) and/or the 36-item Short Form Health Status survey questionnaire (n = 964) and informed consent at follow-up. Scores from ThyPRO were compared to scores from a general population sample (n = 712) using multiple linear regression adjusting for age and sex as well as multiple testing. Treatment-related QoL outcome for ATD, RAI, and surgery were compared, including adjustment for the number of treatments received, sex, age, and comorbidity. RESULTS: Regardless of treatment modality, patients with GD had worse thyroid-related QoL 6-10 years after diagnosis compared to the general population. Patients treated with RAI had worse thyroid-related and general QoL than patients treated with ATD or thyroidectomy on the majority of QoL scales. Sensitivity analyses supported the relative negative comparative effects of RAI treatment on QoL in patients with hyperthyroidism. CONCLUSIONS:GD is associated with a lower QoL many years after treatment compared to the general population. In a previous small randomized controlled trial, no difference was found in patient satisfaction years after ATD, RAI, or surgery. Now, it is reported that in a large non-randomized cohort, patients who received RAI had adverse scores on ThyPRO and 36-item Short Form Health Status survey. These findings in a Swedish population are limited by comparison to normative data from Denmark, older age, and possibly a more prolonged course in those patients who received RAI, and a lack of information regarding thyroid status at the time of evaluation. The way RAI may adversely affect QoL is unknown, but since the results may be important for future considerations regarding treatment options for GD, they need to be substantiated in further studies.
Authors: Alexander H Gunn; Nicholas Frisco; Samantha M Thomas; Michael T Stang; Randall P Scheri; Hadiza S Kazaure Journal: Thyroid Date: 2021-12-03 Impact factor: 6.568
Authors: Tim D Cheetham; Michael Cole; Mario Abinun; Amit Allahabadia; Tim Barratt; Justin H Davies; Paul Dimitri; Amanda Drake; Zainaba Mohamed; Robert D Murray; Caroline A Steele; Nicola Zammitt; Sonya Carnell; Jonathan Prichard; Gillian Watson; Sophie Hambleton; John N S Matthews; Simon H S Pearce Journal: J Clin Endocrinol Metab Date: 2022-02-17 Impact factor: 5.958