The effect of TSH suppression achieved with levothyroxine therapy on quality of life, anxiety, depression, and hypomania development in patients with differentiated thyroid cancer

Objective:To evaluate the impact of TSH (Thyroid-Stimulating Hormone) suppression therapy, which is used to reduce recurrence and relapse rates in patients with differentiated thyroid cancer (DTC), on the development of anxiety, depression, and hypomania, and to investigate whether unnecessary high-dose levothyroxine therapy should be avoided based on these outcomes. Materials and Methods: This study included patients diagnosed with differentiated thyroid carcinoma who had undergone total thyroidectomy and provided informed consent to participate. Patients were divided into three groups based on their TSH levels: TSH < 0.1, TSH 0.1-0.5, and TSH > 0.5. The Short Form-36 (SF-36), Hypomania Checklist (HCL-32), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to evaluate the effects of TSH suppression on depression, anxiety, hypomania development, and quality of life. Results: No significant differences were found among the three groups of DTC patients in terms of anxiety, depression, hypomania, and SF-36 scores. However, a statistically significant positive correlation was identified between TSH levels and anxiety. Conclusion: Diagnosis and treatment processes of thyroid cancer can impose significant physical and psychological burdens on patients. In our study, TSH levels and levothyroxine dosage were found to play a crucial role in the assessment of mental health disorders. Notably, the increase in levothyroxine dosage was associated with higher anxiety and depression scores, highlighting this as a critical factor to consider in treatment planning. Although differences in mean TSH, T3, and T4 levels were observed between groups, these differences were not found to have a significant impact on hypomania vii scores. These findings indicate the need for further research involving larger sample sizes and long-term follow-up studies to explore the potential relationship between thyroid hormone levels and the development of hypomania. Additionally, it is essential to individualize thyroid hormone dosages while considering potential side effects, such as the risk of hypomania. Routine mental health assessments should be integrated into the standard care of patients undergoing TSH suppression therapy. Keywords: Differentiated Thyroid Cancer (DTC), TSH suppression, Anxiety, Depression, Hypomania, Quality of Life, Thyroid Dysfunction