Effectiveness Not Established

T3 - T4

for Fatigue

T3 and T4 are thyroid hormones that control the body's metabolism and metabolic rate, regulate protein metabolism, have excitatory effects on the central nervous system, and increase the rate of secretion of most other endocrine glands. The administration of T3 and T4 was examined in patients who were treated for thyroid cancer for its effect on fatigue.

Systematic Review/Meta-Analysis

To, J., Goldberg, A.S., Jones, J., Zhang, J., Lowe, J., Ezzat, S., . . . Sawka, A.M. (2014). A systematic review of randomized controlled trials for management of persistent post-treatment fatigue in thyroid cancer survivors. Thyroid, 25, 198–210. 

Purpose

STUDY PURPOSE: To identify and critically appraise published randomized, controlled trials of interventions for the management of persistent post-treatment fatigue in thyroid cancer survivors
 
TYPE OF STUDY: Systematic review

Search Strategy

  • DATABASES USED: Medline (Ovid), MEDLINE In-Process, other nonindexed citations (Ovid), Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and CINAHL (EBSCO) 
  • KEYWORDS: Extensive search terms per database were provided
  • INCLUSION CRITERIA: One randomized, controlled trial of interventions for the management of persistent post-treatment fatigue of adult thyroid cancer survivors  
  • EXCLUSION CRITERIA: Studies primarily focusing on patients with thyroid cancer around the time of thyroid cancer treatment (e.g., first six months around first surgery or radioactive iodine treatment) or those focusing on the preparation procedures for radioactive iodine treatment or scanning were not eligible for inclusion. Pharmacologic (including hormonal) and nonpharmacologic interventions were included.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,086 
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The critical appraisal of studies and data abstraction were independently performed by two reviewers (A.S.G. and A.M.S. using standardized abstraction forms). The Cochrane Risk of Bias Tool was used to appraise the quality of the studies. Each abstracted data set was checked (by the other reviewer), and a final consensus data set was created after detailed discussion.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 4 (one of these was a second report on the same population as in another study)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 75 
  • SAMPLE RANGE ACROSS STUDIES: 15–36 patients
  • KEY SAMPLE CHARACTERISTICS: The target population was thyroid cancer survivors aged greater than 18 years whose disease was of any histologic subtype and who completed primary treatment (surgery with or without other treatment). To be eligible for inclusion, more than half the study population was required to consist of thyroid cancer survivors, or a thyroid cancer subgroup data analysis needed to have been reported. There was no specific requirement relating to disease stage or disease status. All patients were receiving thyrotropin suppressive therapy.

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

Two studies examined use of T3 and T4. In one study comparing the combination of T3 and T4 to T4 alone, the fatigue subscale of the Profile of Mood states showed significant improvement at five weeks. One study using T4 compared to maintenance TSH suppression showed improvement in one subscale of the multidimensional fatigue scale at six months but no change in other fatigue subscales. Two references that reported on one study examined the impact of an exercise program.

Conclusions

There is insufficient evidence to demonstrate the impact of the administration of T3 or T4 on fatigue in patients who had thyroid cancer.

Limitations

There was a small number of studies included, the number participants recruited in the identified studies was small, and some of these studies were of low quality.

Nursing Implications

There is insufficient evidence to evaluate any benefits of the administration of T3 or T4 for the management of fatigue among patients receiving TSH suppressive therapy

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