Effect of thyroid-stimulating hormone suppression on quality of life in thyroid lobectomy patients: interim analysis of a multicenter, randomized controlled trial in low- to intermediate-risk thyroid cancer patients (MASTER study)

Abstract

Purpose: Current clinical practices favor less or no thyroid-stimulating hormone (TSH) suppression for low- to intermediate-risk thyroid cancer patients who receive thyroid lobectomy. The association of TSH suppression on health-related quality of life (HR-QoL) in patients after thyroid lobectomy is not well studied. This study aimed to evaluate the effect of TSH suppression on patient HR-QoL after thyroid lobectomy.

Methods: This study included patients enrolled in an ongoing, multicenter, randomized controlled study investigating the effects of TSH suppression. Patients were randomized to either the low-TSH group (TSH target range, 0.3-1.99 µIU/mL) or the high-TSH group (TSH target range, 2.0-7.99 µIU/mL). The HR-QoL, hyperthyroidism symptom, and depression symptom questionnaires performed preoperatively and 2 weeks and 3 months postoperatively were evaluated.

Results: Total of 669 patients (low-TSH group, 340; high-TSH group, 329) were included. Although total HR-QoL score changes were not different between the 2 groups, the high-TSH group had a significantly higher score in the physical domain at postoperative 3 months (P = 0.046). The 2 groups did not have significant differences in hyperthyroidism and depression scores.

Conclusion: In the short-term postoperative period, the physical HR-QoL scores in thyroid lobectomy patients were better when they did not receive TSH suppression. This study suggests the importance of considering HR-QoL when setting TSH suppression targets in thyroid lobectomy patients.

Keywords: Health-related quality of life; Thyroid neoplasms; Thyroidectomy; Thyrotropin.

Fig. 1. Flow chart of the study population. MASTER, Multicenter, Randomized Controlled study for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid Lobectomy in Low to Intermediate Risk Thyroid Cancer Patients; HR-QoL, health-related quality of life; TSH, thyroid-stimulating hormone; KT-QoL, Korean version of the self-reported thyroid-specific quality-of-life questionnaire; HSS, hyperthyroidism symptom scale questionnaire; PHQ-9, Patient Health Questionnaire-9 (depression scores).

Fig. 2. Observed values of health-related quality of life by thyroid-stimulating hormone (TSH) groups. Mean scores from the Korean version of the self-reported thyroid-specific quality-of-life questionnaire in each follow-up. (A) Total scores. (B) Physical domain. (C) Psychological domain. (D) Social domain. (E) Spiritual domain. Pre, preoperative; PO2W, postoperative 2 weeks; PO3M, postoperative 3 months.

^*Significant increase compared to preoperative scores in all patients (P < 0.05).

Fig. 3. Observed mean scores of the hyperthyroidism symptom scale (A) and Patient Health Questionnaire-9 (depression scores) (B). TSH, thyroid-stimulating hormone; Pre, preoperative; PO2W, postoperative 2 weeks; PO3M, postoperative 3 months.