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Larisch R, Midgley JEM, Dietrich JW, Hoermann R. Effect of Radioiodine Treatment on Quality of Life in Patients with Subclinical Hyperthyroidism: A Prospective Controlled Study. Nuklearmedizin 2024; 63:176-187. [PMID: 38262472 DOI: 10.1055/a-2240-8087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Radioiodine treatment (RIT) has a high success rate in both the treatment of hyperthyroidism and improving the quality of life (QoL) of symptomatic patients. In asymptomatic patients with subclinical hyperthyroidism thyroid related QoL outcomes are less well known. METHODS Study aim was to evaluate thyroid-related QoL in patients with subclinical hyperthyroidism mostly due to toxic nodular goitre undergoing RIT, compared to a control group of euthyroid subjects. Study design was monocentric, prospective, controlled. Fifty control subjects were enrolled and 51 RIT patients. Most subjects were examined at least twice at an interval of 6 months, with visits immediately before and 6 months after treatment in the RIT group. QoL was estimated with the ThyPRO questionnaire, using its composite scale as primary outcome. Treatment effect was the mean adjusted difference (MAD) between groups over time, using repeated? measures mixed? effects models. RESULTS TSH concentrations were lower in the RIT group prior to treatment and recovered thereafter slightly above the level of the control group. Correspondingly, QoL improved significantly after 6 months from a worse level in the RIT group, compared to controls (MAD -10.3 [95% CI -14.9, -5.7], p<0.001). QoL improvements were strong for general items, but less pronounced for the hyperthyroid domain. Compared to controls, thyroid volume, thyroid functional capacity (SPINA-GT) and deiodinase activity (SPINA-GD) were significantly reduced in the RIT group. CONCLUSION Patients with subclinical hyperthyroidism improve both biochemically and in their QoL after RIT, compared to controls. QoL assessment should have a wider role in clinical practice to complement biochemical tests and help with treatment decisions.
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Affiliation(s)
- Rolf Larisch
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - John E M Midgley
- North Lakes Clinical, Ilkley LS29 8PT, United Kingdom of Great Britain and Northern Ireland
| | - Johannes W Dietrich
- Medical Hospital I, Endocrinology and Diabetes Department, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Bochum, Germany
| | - Rudolf Hoermann
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
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Durante C, Hegedüs L, Czarniecka A, Paschke R, Russ G, Schmitt F, Soares P, Solymosi T, Papini E. 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management. Eur Thyroid J 2023; 12:e230067. [PMID: 37358008 PMCID: PMC10448590 DOI: 10.1530/etj-23-0067] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/23/2023] [Indexed: 06/27/2023] Open
Abstract
With the widespread use of sensitive imaging techniques, which include neck visualization, a conspicuous number of thyroid nodules emerge and demand attention. Most lesions are benign, asymptomatic, and do not warrant treatment. In the case of cancer diagnosis, most are small, intrathyroidal and indolent neoplasms that can safely be managed conservatively. There is a pronounced need for more cost-effective, risk-adapted approaches to the management of this highly prevalent condition, taking the wishes of the patient into consideration. Thus, the present guidelines aim at providing a clinical practice guide for the initial workup and the subsequent management of adult individuals harboring thyroid nodules. Importantly, these guidelines are not intended to cover the management of thyroid malignancy. The manuscript and the specific recommendations were developed by reconciling the best available research evidence with the knowledge and clinical experience of the panelists and updating aspects of a number of previous European Thyroid Association guidelines.
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Affiliation(s)
- Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Agnieszka Czarniecka
- M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Ralf Paschke
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gilles Russ
- Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital, Sorbonne University GRC N°16, Paris, France
| | - Fernando Schmitt
- Faculty of Medicine of University of Porto, CINTESIS@RISE and Institute of Molecular Pathology and Immunology, University of Porto (Ipatimup), Porto, Portugal
| | - Paula Soares
- Institute of Investigation and Innovation in Health (I3S), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Tamas Solymosi
- Endocrinology and Metabolism Clinic, Bugat Hospital, Gyöngyös, Hungary
| | - Enrico Papini
- Department of Endocrine and Metabolic Diseases, Regina Apostolorum Hospital, Albano, Rome, Italy
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Jonklaas J. Is euthyroidism within reach for all? Expert Rev Endocrinol Metab 2023; 18:455-458. [PMID: 37811647 DOI: 10.1080/17446651.2023.2267120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University, Washington, DC, United States
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Lindo A, Breikert A, Lakwijk P, Lundberg C, Lunner K, Johansson B, Filipsson Nyström H. Patient needs and care: moves toward person-centered care for Graves' disease in Sweden. Eur Thyroid J 2023; 12:e230010. [PMID: 36912797 PMCID: PMC10160562 DOI: 10.1530/etj-23-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 03/14/2023] Open
Abstract
Patients with Graves' disease (GD) not only need appropriate medical care, but they also need to be cared for. The aim of this review is to examine the literature on GD patient needs, expectations, perceptions, and quality of life. We will also present methods for patient care, define gaps in knowledge, and suggest factors that can be introduced into the regular care of GD patients. Patient information, teamwork with thyroid/contact nurses, education of personnel and patients, quality of life measurements, and the formation of a rehabilitation program have enough evidence to be implemented into regular care. However, visualizing patient needs through person-centered care requires further evaluation in GD patients before being implemented in routine care. We conclude that considerable improvement in nursing can be achieved in relation to GD.
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Affiliation(s)
- Agneta Lindo
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
| | - Anne Breikert
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
- Department of Endocrinology and Diabetes, Örebro University Hospital, Örebro, Sweden
| | - Peter Lakwijk
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
- Thyroid Federation International, Kungsbacka, Sweden
| | - Christin Lundberg
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
- Swedish Thyroid Association, Stockholm, Sweden
| | - Katarina Lunner
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
- Swedish Thyroid Association, Stockholm, Sweden
| | - Birgitta Johansson
- Institute of Neuroscience and Physiology Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Helena Filipsson Nyström
- Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- The National Task Force in Hyperthyroidism, Swedish National System for Knowledge-Driven Management, Umeå, Sweden
- Sweden and Wallenberg Center for Molecular and Translational Medicine, Västra Götaland Region, Göteborg, Sweden
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Jansen HI, Boelen A, Heijboer AC, Bruinstroop E, Fliers E. Hypothyroidism: The difficulty in attributing symptoms to their underlying cause. Front Endocrinol (Lausanne) 2023; 14:1130661. [PMID: 36814580 PMCID: PMC9939761 DOI: 10.3389/fendo.2023.1130661] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
Common symptoms of overt hypothyroidism are non-specific and include fatigue, lethargy, and dry skin. Although the diagnosis is considered to be straightforward, no single symptom can be used to identify patients with overt hypothyroidism, while many patients with subclinical hypothyroidism are asymptomatic. A large population-based study on the spectrum of symptoms in subclinical hypothyroidism showed similar rates of thyroid disease-related symptoms compared with euthyroid subjects, while the TSH concentration had no impact on symptom score. Together, these findings make it challenging to attribute symptoms to their underlying cause. This is also true in the case of unexplained persistent symptoms in levothyroxine-treated patients. Although generally considered a life-long replacement therapy, successful thyroid hormone discontinuation resulting in euthyroidism has been reported in approximately one third of patients. Thus, we overtreat patients with (subclinical) hypothyroidism, highlighting the importance of reliable diagnostic criteria. The diagnostic process, including the implementation of robust TSH and FT4 reference intervals, is especially challenging in specific situations including aging, pregnancy, non-thyroidal illness, and central hypothyroidism. There is a clear need for improved adherence to current guidelines from scientific societies and for willingness to manage symptoms without a clear pathological correlate, especially in the case of mild TSH elevations. This review will highlight recent literature on this topic and offers some practice points.
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Affiliation(s)
- Heleen I. Jansen
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical Centers (UMC) Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical (UMC) Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Heleen I. Jansen,
| | - Anita Boelen
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical (UMC) Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
| | - Annemieke C. Heijboer
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical Centers (UMC) Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
- Department of Clinical Chemistry, Endocrine Laboratory, Amsterdam University Medical (UMC) Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
| | - Eveline Bruinstroop
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
- Department of Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Eric Fliers
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), Amsterdam, Netherlands
- Department of Endocrinology & Metabolism, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, Netherlands
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