Evaluation of Quality of Life in Tunisian patients with Differentiated Thyroid Cancer Section Original articles


Sihem Mensi
Abir Ezzine
Teheni Dardouri
Mohamed Ben Rejeb
Maha Ben Fredj
Kaouther Chatti


Introduction: Differentiated thyroid cancer (DTC), despite its good prognosis, affects the quality of life (QOL) of patients by its physical and psychological repercussions and by the toxicity of treatment. A study of the quality of life as well as the potentially associated factors is necessary in order to carry out targeted actions.

Aim: This work was conducted to assess the quality of life of patients treated for thyroid cancer.

Methods: 89 patients treated surgically and by iratherapy for DTC responded from January 2018 to December 2019 to the SF36 questionnaire in its validated version in Tunisian dialect. A descriptive and bivariate analysis between the scores of the different domains and the variables of interest was performed.

Results: The overall mean score (SMG) of the QOL of our patients ranged from 12.8 to 94.25 with a mean of 58±22%. The factors that proved to have a positive impact on the QOL of patients followed for CDT assessed by the SMG and/or the mental summary score (MSS) and/or the physical summary score (PSS) were: male gender (p=0.034), higher educational level (p=0.037), early TNM stage (p=0.041) and low cumulative iodine-131 dose (≤ 5550 MBq) (p=0.031).

Conclusion: QOL is strongly influenced by many sociodemographic and clinical factors. More attention should be paid to patients followed for DTC to improve quality of life.


Quality of life, Differentiated thyroid cancer, SF36



  1. Colonna M, Uhry Z, Guizard AV, Delafosse P, Schvartz C, Belot A, et al. Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France. Cancer Epidemiol 2015;39:511-8. doi: 10.1016/j.canep.2015.04.015.
  2. Guermazi M, Allouch C, Yahia M, Huissa TB, Ghorbel S, Damak J, et al. Translation in Arabic, adaptation and validation of the SF-36 Health Survey for use in Tunisia. Ann Phys Rehabil Med 2012;55:388-403. doi: 10.1016/j.rehab.2012.05.003.
  3. Leplège A, Ecosse E, Verdier A, Perneger TV. The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 1998;51:1013-23. doi: 10.1016/s0895-4356(98)00093-6.
  4. Malterling RR, Andersson RE, Falkmer S, Falkmer U, Niléhn E, Järhult J. Differentiated thyroid cancer in a Swedish county--long-term results and quality of life. Acta Oncol 2010;49:454-9. doi: 10.3109/02841860903544600.
  5. Borget I, Bonastre J, Catargi B, Déandréis D, Zerdoud S, Rusu D, et al. Quality of life and cost-effectiveness assessment of radioiodine ablation strategies in patients with thyroid cancer: results from the randomized phase III ESTIMABL trial. J Clin Oncol 2015;33:2885-92. doi: 10.1200/JCO.2015.61.6722.
  6. Lean ME, Han TS, Seidell JC. Impairment of health and quality of life using new US federal guidelines for the identification of obesity. Arch Intern Med 1999;159:837-43. doi: 10.1001/archinte.159.8.837.
  7. Vega-Vázquez MA, Gonzalez-Rodriguez L, Santiago-Rodríguez EJ, Garcés-Domínguez A, Shum LM, Tírado-Gómez M, et al. Quality of life-in patients with differentiated thyroid cancer at the general endocrinology clinics of the University Hospital of Puerto Rico. Bol Asoc Med P R 2015;107:25-31.
  8. Khader S, Hourani MM, Al-Akour N. Normative data and psychometric properties of short form 36 health survey (SF-36, version 1.0) in the population of north Jordan. East Mediterr Health J 2011;17:368-74.
  9. Sabbah I, Drouby N, Sabbah S, Retel-Rude N, Mercier M. Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Health Qual Life Outcomes 2003;1:30. doi: 10.1186/1477-7525-1-30.
  10. Haraj NE, Bouri H, El Aziz S, Nani S, Habti N, Chadli A. Evaluation of the quality of life in patients followed for differentiated cancer of the thyroid. Ann Endocrinol (Paris) 2019;80:26-31. doi: 10.1016/j.ando.2018.01.003.
  11. Bãrbuş E, Peştean C, Larg MI, Piciu D. Quality of life in thyroid cancer patients: a literature review. Clujul Med 2017;90:147-53. doi: 10.15386/cjmed-703.
  12. Hoftijzer HC, Heemstra KA, Corssmit EP, van der Klaauw AA, Romijn JA, Smit JW. Quality of life in cured patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab 2008;93:200-3. doi: 10.1210/jc.2007-1203.
  13. Tan LG, Nan L, Thumboo J, Sundram F, Tan LK. Health-related quality of life in thyroid cancer survivors. Laryngoscope 2007;117:507-10. doi:10.1097/MLG.0b013e31802 e3739.
  14. Boughattas S, Hassine H, Chatti K, Letaief B, Jomaa R, Essabbah H. [Role of iodine-131 in the management of differentiated thyroid cancers (vesicular origin)]. Tunis Med. 2002 Aug;80(8):434-44.
  15. Husson O, Haak HR, Oranje WA, Mols F, Reemst PH, van de Poll-Franse LV. Health-related quality of life among thyroid cancer survivors: a systematic review. Clin Endocrinol (Oxf) 2011;75:544-54. doi: 10.1111/j.1365-2265.2011.04114.x.
  16. Schultz PN, Stava C, Vassilopoulou-Sellin R. Health profiles and quality of life of 518 survivors of thyroid cancer. Head Neck 2003;25:349-56. doi: 10.1002/hed.10217.
  17. Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA. Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 1997;52:15-23. doi: 10.1111/j.1365-2044.1997.015-az014.x.
  18. Tagay S, Herpertz S, Langkafel M, Erim Y, Bockisch A, Senf W, Görges R. Health-related Quality of Life, depression and anxiety in thyroid cancer patients. Qual Life Res 2006;15:695-703. doi: 10.1007/s11136-005-3689-7.
  19. El Emrani L, Senhaji M, Bendriss A. Measuring health-related quality of life in the population of Tetouan, Morocco, by the SF-36: normative data and the influence of gender and age. East Mediterr Health J 2016;22:133-41.
  20. Almeida JP, Vartanian JG, Kowalski LP. Clinical predictors of quality of life in patients with initial differentiated thyroid cancers. Arch Otolaryngol Head Neck Surg 2009;135:342-6. doi: 10.1001/archoto.2009.16.
  21. Taïeb D, Baumstarck-Barrau K, Sebag F, Fortanier C, De Micco C, Loundou A, et al. Heath-related quality of life in thyroid cancer patients following radioiodine ablation. Health Qual Life Outcomes 2011;9:33. doi: 10.1186/1477-7525-9-33.
  22. Gamper EM, Wintner LM, Rodrigues M, Buxbaum S, Nilica B, Singer S, et al. Persistent quality of life impairments in differentiated thyroid cancer patients: results from a monitoring programme. Eur J Nucl Med Mol Imaging 2015;42:1179-88. doi: 10.1007/s00259-015-3022-9.
  23. Metallo M, Groza L, Brunaud L, Klein M, Weryha G, Feigerlova E. Long-term quality of life and pregnancy outcomes of differentiated thyroid cancer survivors treated by total thyroidectomy and I(131) during adolescence and young adulthood. Int J Endocrinol 2016;2016:7586482. doi: 10.1155/2016/7586482.