Kuijpens, J.L.P.

Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: A study from the population-based PROFILES registry (Article)

2013-02-01T00:00:00Z

Background. Given the longevity of thyroid cancer patients, any impairment in health-related quality of life (HRQoL) during the follow-up period is of considerable concern. Therefore, the first aim of this study was to assess (thyroid cancer specific) HRQoL among long-term thyroid cancer survivors and to compare this with the HRQoL of an age-and sex-matched normative population. Secondly, our aim was to investigate which clinical and socio-demographic characteristics and thyroid cancer specific problems were associated with HRQoL. Material and methods. All patients diagnosed with thyroid cancer between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received a survey on HRQoL (EORTC QLQ-C30) and disease-specific symptoms (THYCA-QoL). The scores were compared with age-and sex-matched cancer free controls (n = 800). A series of multiple linear regression analyses were conducted to investigate the independent associations between clinical, socio-demographic and thyroid cancer specific factors with HRQoL. Results. A total of 306 patients (86%) responded to the invitation. Thyroid cancer survivors had significantly lower scores on physical, role, emotional, cognitive and social functioning (p < 0.001) compared to the normative population after adjusting for comorbidities. Sympathetic problems [feeling chilly (52%), hot flushes (40%)], neuromuscular problems [cramp legs (43%) and pain joints/muscles (64%)] and abrupt attacks of fatigue (50%) were the most often reported thyroid cancer specific complaints. Thyroid cancer specific neuromuscular, concentration, sympathetic and psychological problems explained 41-58% of the variance in HRQoL. Clinical and socio-demographic factors explained a small part of the variance in (thyroid cancer specific) HRQoL (1-27%). Conclusion. Long-term thyroid cancer survivors experience more symptoms and deteriorated HRQoL compared to the normative population. Thyroid cancer specific neuromuscular, sympathetic, concentration and psychological symptoms are stronger associated with HRQoL than clinical and socio-demographic factors alone. Awareness of these specific determinants of HRQoL could help health care practitioners to provide better supportive care.

Prevalence of autoimmune thyroid dysfunction in postpartum psychosis (Article)

2011-02-01T00:00:00Z

Abstract. BACKGROUND: Postpartum psychosis is a life-threatening psychiatric emergency, which often occurs without significant premorbid symptoms. Although many studies have postulated an involvement of the immune and endocrine systems in the onset of postpartum psychosis, the specific aetiological factors have remained unknown. AIMS: To examine the hypothesis that autoimmune thyroid dysfunction may be associated with the onset of postpartum psychosis. METHOD: Thirty-one consecutive primiparous women with no prior psychiatric history were referred to our in-patient unit for postpartum psychosis. The control group (n = 117) comprised primiparous women with consecutive deliveries at a community practice. Blood samples were obtained from all participants at 4 weeks and 9 months postpartum. Thyroperoxidase antibody levels were quantified as immunological measures of autoimmune thyroid disease (AITD). Thyroid-stimulating hormone and free thyroxine levels were measured to assess clinical thyroid dysfunction. RESULTS: At 4 weeks postpartum and prior to the initiation of mood stabiliser therapy, 19% of women with postpartum psychosis had AITD compared with only 5% in the control group. Women with both postpartum psychosis and AITD had a dramatically higher risk of progression to clinical thyroid dysfunction (67%) than control participants with AITD (20%). CONCLUSIONS: Women with postpartum psychosis are at higher risk not only of AITD but also of clinical thyroid failure. These data implicate thyroid function as an important clinical outcome in patients with postpartum psychosis. Further, AITD represents a potentially strong aetiological factor for the development of postpartum psychosis. Therefore, screening for thyroperoxidase antibodies is warranted in patients with postpartum psychosis.

Epidemiological studies on postpartum thyroid dysfunction and thyroid cancer in Southeastern Netherlands (Doctoral Thesis)

1998-10-21T00:00:00Z

The studies described in this thesis concentrate OIl epidemiological and pathogenetic aspects of postpartum thyroid dysfunction (PPTD) and related topics, and on epidemiological and treatment aspects of thyroid cancer. The studies were petfonned in the southeastern part of the Netherlands and included prospective studies in a representative cohort of women followed dming pregnancy and in the first postpartum year, and retrospective studies on thyroid cancer based on data derived from the population-based Eindhoven Cancer Registry. In the first chapter a general introduction is given 011 the epidemiology of thyroid diseases in the Netherlands (Chapter 1.1), followed by a discussion on clinical aspects of PPTD and thyroid cancer (Chapters 1.2 and 1,3), Thereafter the specific aims of the present studies are formulated (Chapter 1.4). Infonnation about the epidemiology of thyroid diseases in the Netherlands is scarce and fragmented. Data have been obtained from different sources, such as from reports of screening programmes, general practice registration projects. hospital based registries or popUlation based registries (e.g. the Dutch Cancer Registry). To be able to put our data in perspective, an introduction to some epidemiological data concerning the most relevant thyroid disorders is presented in short.