Thyroid hormone withdrawal effects
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Quality of Life and Psychological Effects of Thyroid Hormone Withdrawal
Thyroid hormone withdrawal (THW), commonly used to prepare patients for radioactive iodine therapy or diagnostic scans after thyroid cancer treatment, has significant effects on quality of life and psychological well-being. Multiple studies show that THW leads to a marked worsening in physical functioning, energy levels, emotional well-being, and social functioning. Patients often experience increased anxiety, psychosis, and general psychological distress during the hypothyroid state induced by THW Kupik2021Kupik2021Dow1997+1 MORE. Fatigue, intolerance to temperature changes, sleep disturbances, and weight gain are among the most common physical symptoms reported, with women experiencing more difficulties than men . The psychological impact is also notable, with stress related to cancer diagnosis and treatment, fear of recurrence, and insufficient support from others being frequently reported .
Metabolic and Biochemical Changes During Thyroid Hormone Withdrawal
THW induces a rapid and significant shift in metabolic parameters. Patients often develop insulin resistance, as the lack of thyroid hormones impairs glucose disposal in skeletal muscle and adipose tissue, increasing cardiovascular risk . Additionally, THW can cause significant changes in blood lipid levels, particularly worsening dyslipidemia, especially in those with pre-existing lipid abnormalities. These changes are more pronounced in women, with notable increases in total cholesterol, triglycerides, and alterations in HDL cholesterol .
THW also affects serum levels of adipokines, with increases in leptin and resistin, while adiponectin remains unchanged. These changes reflect the role of thyroid hormones in regulating energy balance and metabolism . Furthermore, THW impacts cardiac biomarkers, such as natriuretic peptides, with NT-proANP levels more closely reflecting thyroid hormone effects than NT-proBNP, and these changes are associated with alterations in heart rate and blood pressure .
Comparison with Recombinant Human Thyrotropin (rhTSH)
An alternative to THW is the use of recombinant human thyrotropin (rhTSH), which allows patients to avoid hypothyroid symptoms. Studies comparing THW and rhTSH show that patients undergoing THW have significantly higher clinical symptoms and signs of hypothyroidism, as measured by standardized scores. However, overall quality of life scores may not differ significantly between the two groups, though physical symptoms are more pronounced with THW . The use of rhTSH can reduce the side effects of hypothyroidism, but it may be costly and less accessible in some regions Kupik2021Tang2020.
Long-Term and Recovery Effects
While most symptoms and metabolic changes resolve after resuming thyroid hormone therapy, some effects may persist. There is evidence of incomplete recovery of certain hepatic gene expressions even after normalization of thyroid hormone levels, which may explain why some patients continue to experience symptoms despite biochemical recovery .
Conclusion
Thyroid hormone withdrawal has a broad impact on patients, affecting physical, psychological, and metabolic health. The most common and distressing effects include fatigue, mood changes, metabolic disturbances, and reduced quality of life. Alternatives like rhTSH can mitigate some of these effects but may not be universally available. Careful patient selection and support are essential to minimize the negative impact of THW, especially in those at higher risk for psychological or metabolic complications.
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The Effect of Thyroid Hormone Withdrawal, Performed to Evaluate the Success of I-131 Ablation, On Quality of Life in Female Patients With Low-Risk Differentiated Thyroid Cancer
Thyroid hormone withdrawal worsens psychological symptoms and quality of life in female patients with low-risk differentiated thyroid cancer, potentially outweighing the benefits of stimulating Tg and performing a dWBS.
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