Endocrine Abstracts (2008) 16 P302

Impact of the use of recombinant TSH stimulated thyroglobulin measurement on health related quality of life in patients in follow-up for differentiated thyroid carcinoma (DTC)

ACM Persoon1, WJ Sluiter1, PL Jager2, AV Ranchor3, BHR Wolffenbuttel1 & TP Links1


1Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands; 2Department of Nuclear Medicine, McMaster University Medical Center Site, Hamilton, Canada; 3Northern Centre for Healthcare Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.


Introduction: Thyroglobulin (Tg) measurement is the cornerstone in the follow-up of DTC. Sensitivity can be optimised by measuring recombinant TSH stimulated Tg (rhTSH-Tg). Higher sensitivity results in more Tg positive patients who need imaging and considerable patient burden. We assessed the impact of rhTSH-Tg measurement on health related quality of life (HRQOL).

Methods: In 121 patients in follow-up for DTC, Tg during thyroid hormone suppression therapy (Tg-on) and rhTSH-Tg were measured with a sensitive Tg assay. Patients with rhTSH -Tg≥1.0 ng/ml (Tg+ patients) underwent imaging. Anxiety items of the Hospital Anxiety and Depression scale, the General Health Questionnaire (psychological distress) and cancer worries (CW) were completed at baseline and after being informed about rhTSH-Tg result. Additionally, Tg+ patients completed these questionnaires after being informed about imaging results and disease status. Non-parametric statistic tests were used.

Results: RhTSH-Tg measurement resulted in 101 Tg− and 20 Tg+ patients. Imaging showed recurrence in 3/19 Tg+ patients. Two of these three patients could have been identified solely by Tg-on. In 16/19, Tg+ patients imaging was negative. For Tg+ patients, anxiety, psychological distress and CW significantly increased after being informed about Tg result. Only CW remained increased after being informed about disease status. For Tg− patients, anxiety decreased after being informed about rhTSH-Tg result, no other changes were found.

Conclusion: Notification of positive rhTSH-Tg has a negative effect on HRQOL and increment of CW persists despite of negative imaging. The limited clinical benefit and adverse effects on HRQOL of rhTSH-Tg measurement questions the use of this test in the follow-up of DTC. Tg-on measurement with a sensitive Tg assay may represent a useful diagnostic tool, preventing needless patient burden.

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