In the Journals

More studies urged in managing posttreatment fatigue in thyroid cancer

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December 17, 2014

A paucity of reliable trials exists to guide evidence-based management of posttreatment fatigue in thyroid cancer survivors, according to a systematic review published in Thyroid.

“Prospective observational and long-term outcome randomized controlled trials in the management of persistent posttreatment fatigue of thyroid cancer survivors are needed,” researchers from Canada wrote.

Joshua To, a BSc candidate at the University of Waterloo, Ontario, with Anna M. Sawka, MD, PhD, of the division of endocrinology, and colleagues searched 1,086 unique citations and 25 full-text studies through electronic and hand searches; studies on short-term interventions used in preparation for radioactive iodine diagnostic scans or treatment were excluded.

The investigators selected four studies summarizing the results of three randomized controlled trials, with durations ranging from 10 weeks to 6 months.

The interventions included combination triiodothyronine with levothyroxine therapy vs. levothyroxine alone; reduction in degree of thyroid-stimulating hormone suppression using levothyroxine vs. maintenance of TSH suppression; and supervised exercise vs. inactivity.

All trials contained limitations. The number of thyroid cancer survivors participating in the randomized controlled trials ranged from 15 to 36. In trials involving hormonal treatment, mixed fatigue outcome results were observed. However, multiple measures suggested improvement in fatigue after the exercise intervention.

“There is currently insufficient evidence to routinely recommend the use of combination [triiodothyronine with levothyroxine] therapy or other nonstandard thyroid hormone treatments in this situation with the promise of significantly improving fatigue, but it is the hope of the authors that further high quality, long-term outcome research may better inform future clinical practice in that regard,” they wrote.

Disclosure: This work was funded in part by a University of Toronto Department of Medicine Strategic Innovation Fund Grant. One researcher had a summer co-op research internship funded by the University Health Network Cancer Survivorship Program, and another holds a Chair in Health Services Research from Cancer Care Ontario, funded by the Ontario Ministry of Health and Long-term Care.

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