recreation, speech, and saliva domains. The greatest effect
on QOL with specific domains was the dose of RIT. Pa-
tients submitted to doses higher than 150 mCi had many
domains affected, such as pain, swallowing, chewing,
speech, taste, anxiety, and composite score. Morbidities
of the surgery are detected in chewing and shoulder func-
tions. Time since treatment and sex were not associated
with alterations in QOL.
These results reveal that despite patients with thy-
roid cancer having a good general QOL, there is a sub-
set of patients who live with some comorbidities of the
cancer treatment. The dose of RIT can affect specific ac-
tivities in the daily lives of these patients. The effects of
RIT on specific functions had not been assessed and re-
ported in the literature until now, and more studies are
needed to confirm these findings. Certainly, this study
has some limitations because it is a cross-sectional study,
and there is neither a baseline QOL score before treat-
ment nor follow-up across time. Evaluation of QOL at
different points in time after treatment could be another
limitation, but at the time of the analysis it seems not to
have affected the results. Prospective studies using vid-
eofluoroscopy to evaluate the different phases of swal-
lowing and salivary gland function in patients receiving
more than 150 mCi of RIT can contribute to the clarifi-
cation of these findings.
Submitted for Publication: April 15, 2008; final revi-
sion received December 5, 2008; accepted December 8,
2008.
Correspondence: Luiz Paulo Kowalski, MD, PhD, De-
partment of Head and Neck Surgery and Otorhinolaryn-
gology, Hospital A. C. Camargo, Rua Professor Antoˆnio
Prudente, 211, 01509-900 Sa˜o Paulo, Brazil (lp_kowalski
@uol.com.br).
Author Contributions: All authors had full access to all
the data in the study and take responsibility for the in-
tegrity of the data and the accuracy of the data analysis.
Study concept and design: Almeida, Vartanian, and
Kowalski. Acquisition of data: Almeida. Analysis and in-
terpretation of data: Almeida and Vartanian. Drafting of
the manuscript: Almeida. Critical revision of the manu-
script for important intellectual content: Vartanian and
Kowalski. Statistical analysis: Vartanian. Obtained fund-
ing: Almeida and Kowalski. Administrative, technical, and
material support: Kowalski. Study supervision: Vartanian
and Kowalski.
Financial Disclosure: None reported.
Funding/Support: This study was funded by grants
05/60474-0 and 06/50061-2 from the Fundac¸a˜o de Am-
paro à Pesquisa do Estado de Sa˜o Paulo.
Previous Presentation: This study was presented at the
Seventh International Conference on Head and Neck Can-
cer of the American Head and Neck Society; July 21-23,
2008; San Francisco, California.
REFERENCES
1. Tan LGL, Nan L, Thumboo J, Sundram F, Tan LKS. Health-related quality of life
in thyroid cancer survivors. Laryngoscope. 2007;117(3):507-510.
2. Huang SM, Lee CH, Chien LY, Liu HE, Tai CJ. Postoperative quality of life among
patients with thyroid cancer. J Adv Nurs. 2004;47(5):492-499.
3. Mazzaferri EL. An overview of the management of papillary and follicular thyroid
carcinoma. Thyroid. 1999;9(5):421-427.
4. Bilimoria KY, Bentrem DJ, Linn JG, et al. Utilization of total thyroidectomy for
papillary thyroid cancer in the United States. Surgery. 2007;142(6):906-913.
5. Mandel SJ, Mandel L. Radioactive iodine and the salivary glands. Thyroid. 2003;
13(3):265-271.
6. de Pedro Netto I, Fae A, Vartanian JG, et al. Voice and vocal self-assessment
after thyroidectomy. Head Neck. 2006;28(12):1106-1114.
7. Lombardi CP, Raffaelli M, D’Alatri L, et al. Voice and swallowing changes after
thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;
140(6):1026-1032.
8. Vartanian JG, Carvalho AL, Yueh B, et al. Long-term quality-of-life evaluation af-
ter head and neck cancer treatment in a developing country. Arch Otolaryngol
Head Neck Surg. 2004;130(10):1209-1213.
9. World Health Organization Quality of Life (WHOQOL) Group. Study protocol for
the World Health Organization project to develop a Quality of Life assessment
instrument (WHOQOL). Qual Life Res. 1993;2(153):9.
10. Crevenna R, Zettinig G, Keilani M, et al. Quality of life in patients with non-
metastatic differentiated thyroid cancer under thyroxine supplementation therapy.
Support Care Cancer. 2003;11(9):597-603.
11. Dagan T, Bedrin L, Horowitz Z, et al. Quality of life of well-differentiated thyroid
carcinoma patients. J Laryngol Otol. 2004;118(7):537-542.
12. Alexander C, Bader JB, Schaefer A, Finke C, Kirsch CM. Intermediate and long-
term side effects of high-dose radioiodine therapy for thyroid carcinoma. J Nucl
Med. 1998;39(9):1551-1554.
13. Malpani BL, Samuel AL, Ray S. Qualification of salivary gland function in thyroid
cancer patients treated with radioiodine. Int J Radiation Oncol Biol Phys. 1996;
35:535-540.
14. Newkirk KA, Ringel MD, Wartofsky L, Burman KD. The role of radioactive iodine
in salivary gland dysfunction. Ear Nose Throat J. 2000;79(6):460-468.
15. ASA Physical Status Classification. http://www.asahq.org/clinical/physicalstatus
.htm. Accessed July 10, 2008.
16. Vartanian JG, Carvalho AL, Yueh B, et al. Brazilian-Portuguese validation of the
University of Washington Quality of Life Questionnaire for patients with head and
neck cancer. Head Neck. 2006;28(12):1115-1121.
17. Gonc¸alves Filho J, Kowalski LP. Surgical complications after thyroid surgery per-
formed in a cancer hospital. Otolaryngol Head Neck Surg. 2005;132(3):490-
494.
18. Bushnell DL, Boles MA, Kaufman GE, Wadas MA, Barnes E. Complications, se-
quela and dosimetry of iodine-131 therapy for thyroid carcinoma. J Nucl Med.
1992;33(12):2214-2221.
19. Maier H, Bihl H. Effect of radioactive iodine therapy on parotid gland function.
Acta Otolaryngol. 1987;103(3-4):318-324.
20. Botella-Carretero JI, Gala´n JM, Sancho J, Escabar-Marreale HF. Quality of life
and psychometric functionality in patients with differentiated thyroid carcinoma.
Endocr Relat Cancer. 2003;10(4):601-610.
21. Chow SM, Au KH, Choy TS, et al. Health-related quality-of-life study in patients
with carcinoma of the thyroid after thyroxine withdraw for whole body scanning.
Laryngoscope. 2006;116(11):2060-2066.
22. Kung S, Rummans TA, Colligan RC, et al. Association of optimism-pessimism
with quality of life in patients with head and neck and thyroid cancers. Mayo Clin
Proc. 2006;81(12):1545-1552.
23. Tagay S, Herpertz S, Langkafel M, et al. Health-related quality of life, depression
and anxiety in thyroid cancer patients. Qual Life Res. 2006;15(4):695-703.
(REPRINTED) ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 135 (NO. 4), APR 2009 WWW.ARCHOTO.COM
346
©2009 American Medical Association. All rights reserved.
at Capes Consortia, on May 18, 2009 www.archoto.comDownloaded from