Abstract
BackgroundThyroid stimulating hormone (TSH) suppression therapy after differentiated thyroid carcinoma surgery causes cognitive impairment. However, data on naming difficulties (anomia)—related specific cognitive impairment are lacking.MethodsA prospective cohort study was conducted, in which, patients with differentiated thyroid carcinoma and benign thyroid nodules were given oral L-T4 therapy after surgery, after meeting the criteria of TSH suppression therapy and thyroxine replacement therapy, respectively, the patients were continually given l-T4 therapy for 6 and 12 months, and then, the neuropsychological test was performed.ResultsOf the 255 subjects, 212 cases (83.13%) completed all the tests, including 33 cases in the normal control group (NC group), 110 cases in the TSH suppression therapy group (TS group), and 69 cases in the thyroxine replacement therapy group (TR group). There was no significant difference in background data among the three groups (P > 0.05). The scores of mini-mental state examination, clock drawing test, digit symbol substitution test, personal history, temporal and spatial orientation, digit order relation, visual object recognition, associative learning, and color naming in the TS and TR groups were not significantly different from those in the NC group after 6 and 12 months of L-T4 therapy (P > 0.05); the scores of picture recall, visual recall, comprehension memory, and digit span forward in the TS and TR groups were notably lower than those in the NC group (P < 0.01); the scores of confrontation naming and listing the names in the TS group were significantly lower than those in the NC and TR groups, and the scores decreased with the prolongation of TSH suppression therapy (P < 0.01).ConclusionTSH suppression therapy after differentiated thyroid carcinoma surgery could lead to short-term memory impairment, attention impairment, word selection anomia, and depression, of which, word selection anomia was aggravated with the prolongation of TSH suppression therapy. Therefore, we suggested that optimal TSH goals for individual patients must balance the potential benefit of TSH suppression therapy with the possible harm from subclinical hyperthyroidism especially in low risk differentiated thyroid carcinoma patients (ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT0266532, Registered on 21 June 2016).
Highlights
Supplementary information The online version of this article contains supplementary material, which is available to authorized users.Normal thyroid function is an important basis for maintaining the best cognitive function
Of the 212 patients, 33 cases were enrolled in the Normal control group (NC group), including 4 males and 29 females, with an average age of 43.76 years; 69 cases were enrolled in the Thyroxine replacement therapy group (TR group), involving 14 males and 55 females, with an average age of 43.52 years, 64 cases underwent thyroid lobectomy, and 5 cases underwent total thyroidectomy, in which the postoperative pathology was thyroid adenoma or nodular goiter; 110 cases were enrolled in the Thyroid stimulating hormone (TSH) suppression therapy group (TS group), including 20 males and 90 females, with an average age of 43.44 years, 59 cases underwent thyroid lobectomy and isthmectomy, and 51 cases underwent total thyroidectomy, in which the type of pathology was papillary thyroid cancer
Bunevicius et al adopted L-T4 therapy alone or combined with L-T4+T3 replacement therapy to treat patients with hypothyroidism after thyroidectomy, in which the results showed that the combination therapy did not significantly improve cognitive function, it could promote the improvement of emotional state [24]
Summary
The above data reflected that TSH suppression therapy after thyroid cancer surgery is associated with impaired cognitive function, while the majority of the research data have small sample size, poor homogeneity, or general measurement tools (scales), rather than a domain-specific assessment, due to lack of specificity. This is a prospective cohort study, aiming to assess the cognitive and emotional state of DTC patients treated with TSH suppression after thyroidectomy, and find out the specific cognitive impairment and affective disorders associated with TSH suppression therapy
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