Schroeder Pamela R, Haugen Bryan R, Pacini Furio, Reiners Christoph, Schlumberger Martin, Sherman Steven I, Cooper David S, Schuff Kathryn G, Braverman Lewis E, Skarulis Monica C, Davies Terry F, Mazzaferri Ernest L, Daniels Gilbert H, Ross Douglas S, Luster Markus, Samuels Mary H, Weintraub Bruce D, Ridgway E Chester, Ladenson Paul W
Johns Hopkins Medical Institutions, Division of Endocrinology and Metabolism, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA.
J Clin Endocrinol Metab. 2006 Mar;91(3):878-84. doi: 10.1210/jc.2005-2064. Epub 2006 Jan 4.
Thyroid carcinoma requires lifelong monitoring with serum thyroglobulin, radioactive iodine whole body scanning, and other imaging modalities. Levothyroxine (L-T4) withdrawal for thyroglobulin measurement and whole body scanning increases these tests' sensitivities but causes hypothyroidism. Recombinant human TSH (rhTSH) enables testing without L-T4 withdrawal.
Our objective was to examine the impact of short-term hypothyroidism on the health-related quality of life (HRQOL) of patients after rhTSH vs. L-T4 withdrawal.
DESIGN, SETTING, AND PATIENTS: In this multicenter study, the SF-36 Health Survey was administered to 228 patients at three time points: on L-T4, after rhTSH, and after L-T4 withdrawal.
INTERVENTIONS included administration of rhTSH on L-T4 and withdrawal from thyroid hormone.
Mean SF-36 scores were compared during the two interventions and with the U.S. general population and patients with heart failure, depression, and migraine headache.
Patients had SF-36 scores at or above the norm for the general U.S. population in six of eight domains at baseline on L-T4 and in seven of eight domains after rhTSH. Patients' scores declined significantly in all eight domains after L-T4 withdrawal when compared with the other two periods (P < 0.0001). Patients' HRQOL scores while on L-T4 and after rhTSH were at or above those for patients with heart failure, depression, and migraine in all eight domains. After L-T4 withdrawal, patients' HRQOL scores were significantly below congestive heart failure, depression, and migraine headache norms in six, three, and six of the eight domains, respectively.
Short-term hypothyroidism after L-T4 withdrawal is associated with a significant decline in quality of life that is abrogated by rhTSH use.
甲状腺癌需要通过血清甲状腺球蛋白、放射性碘全身扫描及其他成像方式进行终身监测。为了进行甲状腺球蛋白测量和全身扫描而停用左甲状腺素（L-T4）可提高这些检查的敏感性，但会导致甲状腺功能减退。重组人促甲状腺素（rhTSH）可在不停用L-T4的情况下进行检测。
我们的目的是研究短期甲状腺功能减退对接受rhTSH检测与停用L-T4检测的患者健康相关生活质量（HRQOL）的影响。
设计、地点和患者：在这项多中心研究中，对228例患者在三个时间点进行了SF-36健康调查：服用L-T4时、接受rhTSH检测后以及停用L-T4后。
干预措施包括在服用L-T4时给予rhTSH以及停用甲状腺激素。
比较了两种干预措施期间以及与美国普通人群、心力衰竭患者、抑郁症患者和偏头痛患者的SF-36平均得分。
在服用L-T4的基线时，患者在八个领域中的六个领域的SF-36得分达到或高于美国普通人群的正常水平，在接受rhTSH检测后，八个领域中的七个领域得分如此。与其他两个时期相比，停用L-T4后患者在所有八个领域的得分均显著下降（P<0.0001）。患者在服用L-T4时和接受rhTSH检测后的HRQOL得分在所有八个领域均达到或高于心力衰竭患者、抑郁症患者和偏头痛患者的得分。停用L-T4后，患者的HRQOL得分在八个领域中的六个、三个和六个领域分别显著低于充血性心力衰竭、抑郁症和偏头痛的正常水平。
停用L-T4后的短期甲状腺功能减退与生活质量显著下降相关，而使用rhTSH可消除这种下降。
