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Thyroid hormone withdrawal in differentiated thyroid carcinoma: substantial societal costs?
Hypothyroidism following thyroid hormone withdrawal for diagnostic follow-up caused frequent morbidity, productivity impairment.
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In patients with differentiated thyroid carcinoma, thyroid hormone withdrawal for diagnostic follow-up testing often causes multiple symptoms, substantial missed worktime, and a need for medical attention, according to a study by researchers in Germany.
The researchers, led by Markus Luster, MD, from the department of nuclear medicine at the University of Würzburg, found that symptomatic hypothyroidism was common during withdrawal from thyroid hormone after treatment for differentiated thyroid carcinoma.
Patients who experienced hypothyroidism during this time were also more likely to experience adverse events, including morbidity, safety risks and productivity impairment.
Luster and his colleagues said that use of recombinant human thyroid-stimulating hormone (rhTSH) instead of thyroid hormone withdrawal reduces the risk of such adverse events in this patient population. They added that treatment with rhTSH was associated with “roughly equivalent societal cost to that of withdrawal.”
Their research was published in Thyroid.
Effects of hypothyroidism
The study was designed to examine the clinical, quality-of-life and pharmacoeconomic effects of hypothyroidism secondary to thyroid hormone withdrawal for diagnostic follow-up testing in patients who had been treated for differentiated thyroid cancer. The study also examined societal costs of withdrawal and rhTSH use in this patient population.
Luster and his colleagues mailed a survey to 236 patients who had undergone thyroid hormone withdrawal.
The survey included questions about hypothyroid symptoms after withdrawal, including fatigue, difficulty concentrating and sleep disturbances. One hundred and thirty patients responded.
Luster told Endocrine Today that 82% of the patients reported experiencing fatigue. Fifty-two percent said they had trouble concentrating, 51% said they became intolerant of cold, 45% reported some weight gain and 40% said they had experienced sleep disturbances.
The researchers determined that 92% had symptomatic hypothyroidism; 85% had multisymptomatic hypothyroidism.
About half of the patients sought medical attention for their hypothyroid complaints. In addition, hypothyroid symptoms caused 62% of patients employed outside the home to miss four or more workdays. The median time missed from work per thyroid hormone withdrawal was 11 days. Luster said he was somewhat surprised by the amount of time patients were forced to miss work. “It further demonstrates that clinical hypothyroidism does result in major impairments and subsequently in significant costs for society,” he said.
Luster said he was also surprised that despite the high incidence of fatigue and trouble concentrating, and despite medical advice to the contrary, almost one third of survey respondents drove motor vehicles while hypothyroid.
The study results also demonstrated that patients who were treated with rhTSH did not experience the same symptoms of hypothyroidism during withdrawal.
Costs to society
Using survey results and actual and estimated cost data, the researchers retrospectively constructed a societal cost model comparing thyroid hormone withdrawal vs. rhTSH use in this patient population.
Luster said this model demonstrated that societal costs were about 25% greater for withdrawal than for treatment with rhTSH.
“Patients who experienced serious adverse events under hypothyroid conditions should have their follow-up testing under exogenous TSH stimulation,” Luster said. “The same holds true for patients in certain social situations, such as young mothers, people who cannot afford to miss substantial time from work, and elderly or frail patients.” – by Jay Lewis
For more information:
- Luster M, Felbinger R, Dietlein M, et al. Thyroid hormone withdrawal in patients with differentiated thyroid carcinoma: A one hundred thirty-patient pilot survey on consequences of hypothyroidism and pharmacoeconomic comparison to recombinant thyrotropin administration. Thyroid. 2005;10:1147-1155.