Study On Quality Of Life Of Patients With Differentiated Thyroid Cancer Before And After Stopping Levothyroxine Before ¹³¹I Treatment

Objective（s）:To evaluate the quality of life of patients with differentiated thyroid cancer（DTC）before and after withdrawal of levothyroxine（L-T4）before and after¹³¹I treatment,to understand the effect of transient thyroid hormone deficiency on patients’quality of life,and to explore the influencing factors of quality of life of DTC patients before¹³¹I treatment and L-T4 withdrawal before¹³¹I treatment.Methods:The health-related quality of life（HRQOL）and psychological status of255 DTC patients who needed 131I treatment in the Department of Nuclear Medicine of the third affiliated Hospital of Kunming Medical University from March 2021 to October 2022 were evaluated.HRQOL was assessed by European Cancer Research and treatment Organization Core quality of Life scale（EORTCQLQ-C30）and thyroid Cancer quality of Life Module scale（QLQ-THY34）.The psychological status was evaluated by Hospital anxiety and Depression scale（HADS）.According to L-T4 and after withdrawal,the patients were divided into group An and group B for HRQOL and psychological evaluation respectively（group A:one day before drug withdrawal,group B:21 days after drug withdrawal）.All data were statistically analyzed by SPSS25.0 software.The differences between non-withdrawal and post-withdrawal were analyzed by Wilcoxon rank sum test,and the differences between groups were compared by Mann-Whitney and Krukal-Wallis rank sum test.The difference was statistically significant（P<0.05）.Results:1.Comparison between non-withdrawal and post-withdrawal:the physical function,role function and cognitive function of the patients after withdrawal were worse than those without withdrawal,and the voice worry and head and neck discomfort after withdrawal were worse than those after withdrawal.2.Analysis of the factors affecting the quality of life of patients without drug withdrawal:female patients are prone to emotional function,sleep,fear and hair problems,while male patients are prone to diarrhea.Young and middle-aged patients are prone to emotional function and body image problems.Unmarried patients are prone to cognitive function and fatigue.Patients with unhealthy spouses are prone to role function,social function,head and neck discomfort,impact on work or education,joint pain,shoulder function problems.Patients with low academic qualifications are prone to financial difficulties and joint pain.Farmers or migrant workers are prone to physical function,pain and economic difficulties.Patients from low-income families are prone to pain,financial difficulties,nausea and vomiting.Patients with health insurance for urban and rural residents are prone to financial difficulties and worry about important others.There were statistical differences in diarrhea,restlessness,nausea and vomiting,tingling or numbness among patients with different doses of L-T4.There were statistical differences in the scores of emotional function,overall health and dyspnea among patients with different pathological stages.Patients without lymph node metastasis are prone to pain.The patients treated with ¹³¹I for 3 times were prone to cramp.There was no statistical significance in the scores of operation times,distant metastasis and cumulative dose of ¹³¹I.3.Analysis of factors affecting the quality of life of patients after drug withdrawal:female patients were prone to constipation,social support and hair problems,while male patients were prone to diarrhea.There were statistical differences between young and middle-aged patients in emotional function,worry about important others,fear,fatigue,joint pain and loss of appetite.Unmarried patients are prone to nausea and vomiting,loss of appetite,social support,impact on work or education,and body image problems.Patients with unhealthy spouses are prone to insomnia and joint pain.Patients with low academic qualifications are prone to pain,financial difficulties,tingling or numbness.Farmers or migrant workers are prone to financial difficulties.Patients from low-income families are prone to physical function,head and neck discomfort,social function,tingling or numbness,and economic difficulties.Patients with medical insurance for urban and rural residents are prone to role function,social function,nausea and vomiting,economic difficulties,and worry about important others.The patients with one operation were easy to dry mouth.There were statistical differences in the scores of arthralgia,shoulder function,social function and fear among patients with different pathological stages.Patients without lymph node metastasis are prone to hair problems.Patients with distant metastasis are prone to diarrhea.The patients treated with ¹³¹I for 3 times were prone to diarrhea.There was no statistical significance in the cumulative dose score of ¹³¹I.4.Analysis of influencing factors of psychological status after drug withdrawal:there were statistical differences in patients’education,occupation and family monthly income.（after drug withdrawal）there are statistical differences in education,occupation,monthly family income,type of health insurance,pathological stage,lymph node and distant metastasis.Conclusion（s）:1.There was significant difference in the quality of life of DTC patients before and after stopping taking L-T4 before ¹³¹I treatment.The physical function,role function and cognitive function after drug withdrawal were worse than those without drug withdrawal,and sound worry and head and neck discomfort were better than those without drug withdrawal.2.During the period of drug withdrawal,female,young and middle-aged,unmarried,unmarried spouse,poor education,farmers,low income,health insurance for urban and rural residents,no lymph node metastasis and ¹³¹I treatment were related to the decline of quality of life.Education,occupation and income are related to the deterioration of psychological status.3.During the period of drug withdrawal,female,young and middle-aged,unmarried,unmarried spouse,low education,farmers,low income,health insurance for urban and rural residents,no lymph node metastasis,distant metastasis and ¹³¹I treatment were related to the decline of quality of life.The psychological status of patients with drug withdrawal is related to many factors.