Effect of Thyroid-Related Symptoms on Long-Term Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Population-Based Study in Sweden

Thyroid. 2017 Aug;27(8):1034-1042. doi: 10.1089/thy.2016.0604. Epub 2017 Jun 5.


Background: Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence, and life-long follow-up as well as medication with levothyroxine may be necessary. The aim of this study was to clarify how thyroid-related symptoms affect health-related quality of life (HRQoL) 14-17 years after diagnosis in Swedish DTC patients.

Methods: From the all-encompassing population-based Swedish Cancer Registry, 353 patients diagnosed with DTC during 1995-1998 were identified and invited to answer a study-specific questionnaire and the HRQoL questionnaire SF-36 14-17 years after their diagnosis. Subgroups were studied according to thyroid-related symptoms, both symptoms correlated to thyroid disease or levothyroxine treatment and side effects from surgery and radioiodine treatment.

Results: Of the patients with DTC, 279 (79%) answered the questionnaires. In all, only 19 (7%) reported a recurrence. Patients with one single symptom (e.g., fatigue, sleeping disorders, irritability, lower stress resistance, muscle weakness, bodily restlessness, sweating, palpitations, or flushes) had significantly lower HRQoL measured with the SF-36 compared to those without that specific symptom (p < 0.001). Furthermore, those 238 patients with at least one symptom, regardless of which one, had significantly lower HRQoL in all eight SF-36 domains compared to patients that no thyroid symptom (n = 34; p < 0.001). In seven patients, the questionnaires were not complete in terms of the thyroid-related questions. The association between thyroid symptoms and lower HRQoL remained after adjusting for age, sex, comorbidities, education, and menopause.

Conclusions: DTC patients reporting thyroid symptoms scored lower in HRQoL compared to those with no symptoms >14 years after diagnosis.

Keywords: DTC; comorbidities; population based; quality of life; thyroid symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Carcinoma / pathology
  • Carcinoma / physiopathology*
  • Carcinoma / prevention & control
  • Carcinoma / therapy
  • Cell Differentiation
  • Cohort Studies
  • Combined Modality Therapy / adverse effects
  • Cost of Illness*
  • Cross-Sectional Studies
  • Fatigue / epidemiology
  • Fatigue / etiology*
  • Fatigue / prevention & control
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / prevention & control
  • Quality of Life*
  • Registries
  • Risk
  • Self Report
  • Sleep Wake Disorders / epidemiology
  • Sleep Wake Disorders / etiology*
  • Sleep Wake Disorders / prevention & control
  • Stress, Psychological / epidemiology
  • Stress, Psychological / etiology*
  • Stress, Psychological / prevention & control
  • Sweden / epidemiology
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / physiopathology*
  • Thyroid Neoplasms / prevention & control
  • Thyroid Neoplasms / therapy