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      Health-related quality of life following FDG-PET/CT for cytological indeterminate thyroid nodules


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          This study assessed the health-related quality of life (HRQoL) in patients undergoing 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET/CT for an indeterminate (Bethesda III/IV) thyroid nodule. FDG-PET/CT accurately rules out malignancy and prevents 40% of futile diagnostic surgeries in these nodules.


          Secondary analyses of HRQoL data from a randomised controlled multicentre trial (NCT02208544) in 126 patients from 15 hospitals in the Netherlands were done.


          Longitudinal HRQoL assessment was performed using the EuroQol 5-dimension 5-level (EQ-5D-5L), the RAND 36-item Health Survey v2.0 (RAND-36), and the Thyroid Patient-Reported Outcome (ThyPRO) questionnaire on baseline, 3, 6, and 12 months, relative to the date of the FDG-PET/CT scan.


          Patients who were randomised to active surveillance following an FDG-negative nodule instead of diagnostic surgery reported stable HRQoL scores throughout the year. Univariate analysis indicated better HRQoL for patients undergoing surveillance than surgical patients with benign histopathology on multiple physical and psychosocial domains. Univariate within-group analysis suggested both temporary and continued HRQoL deteriorations in patients with benign histopathology over time. Multivariate within-group analysis demonstrated no significant longitudinal HRQoL changes in patients undergoing active surveillance. In contrast, in patients with benign histopathology, worse HRQoL was observed with regard to ThyPRO cognitive impairment ( P = 0.01) and cosmetic complaints ( P = 0.02), whereas goitre symptoms ( P < 0.001) and anxiety ( P = 0.04) improved over time. In patients with malignant histopathology, anxiety also decreased ( P = 0.05).


          The reassurance of a negative FDG-PET/CT resulted in sustained HRQoL throughout the first year of active surveillance. Diagnostic surgery for a nodule with benign histopathology resulted in more cognitive impairment and physical problems including cosmetic complaints, but improved goitre symptoms and anxiety. Anxiety was also reduced in patients with malignant histopathology.

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          Most cited references41

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          2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

          Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.
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            Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

            Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
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              Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.

              A number of studies have computed the minimally important difference (MID) for health-related quality of life instruments. To determine whether there is consistency in the magnitude of MID estimates from different instruments. We conducted a systematic review of the literature to identify studies that computed an MID and contained sufficient information to compute an effect size (ES). Thirty-eight studies fulfilled the criteria, resulting in 62 ESs. For all but 6 studies, the MID estimates were close to one half a SD (mean = 0.495, SD = 0.155). There was no consistent relationship with factors such as disease-specific or generic instrument or the number of response options. Negative changes were not associated with larger ESs. Population-based estimation procedures and brief follow-up were associated with smaller ESs, and acute conditions with larger ESs. An explanation for this consistency is that research in psychology has shown that the limit of people's ability to discriminate over a wide range of tasks is approximately 1 part in 7, which is very close to half a SD. In most circumstances, the threshold of discrimination for changes in health-related quality of life for chronic diseases appears to be approximately half a SD.

                Author and article information

                Endocr Connect
                Endocr Connect
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                22 June 2022
                01 August 2022
                : 11
                : 8
                : e220014
                [1 ]Department of Radiology and Nuclear Medicine , Radboud University Medical Centre, Nijmegen, The Netherlands
                [2 ]Department of Psychosocial Research and Epidemiology , Netherlands Cancer Institute, Amsterdam, The Netherlands
                [3 ]Division of Medical Oncology , Netherlands Cancer Institute, Amsterdam, The Netherlands
                [4 ]Division of Clinical Studies , Institute of Cancer Research, London, UK
                [5 ]Department of Internal Medicine , Division of Endocrinology, location VU University Medical Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands
                [6 ]Department of Internal Medicine , Isala Hospital, Zwolle, The Netherlands
                [7 ]Department of Internal Medicine , Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
                [8 ]Department of Radiology and Nuclear Medicine , Rijnstate Hospital, Arnhem, The Netherlands
                [9 ]Department of Biomedical Sciences and Humanitas Clinical and Research Centre , Department of Nuclear Medicine, Humanitas University, Milan, Italy
                [10 ]Department of Medicine , Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
                [11 ]Department of Radiology , Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
                [12 ]Biomedical Photonic Imaging Group , University of Twente, Enschede, The Netherlands
                Author notes
                Correspondence should be addressed to O Husson: olga.husson@ 123456icr.ac.uk
                Author information
                © The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                : 02 June 2022
                : 22 June 2022

                health-related quality of life,thyroid nodule,indeterminate cytology,bethesda,fdg-pet/ct,diagnostic thyroid surgery


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