Clinical Research Papers:

Thyroid function in the etiology of fatigue in breast cancer

Nagi B. Kumar _, Angelina Fink, Silvina Levis, Ping Xu, Roy Tamura and Jeffrey Krischer

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Oncotarget. 2018; 9:25723-25737. https://doi.org/10.18632/oncotarget.25438

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Nagi B. Kumar1, Angelina Fink1, Silvina Levis3, Ping Xu2, Roy Tamura2 and Jeffrey Krischer2

1H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA

2Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA

3Pediatrics Epidemiology Center at University of South Florida, Health Informatics Institute, Tampa, FL 33612, USA

Correspondence to:

Nagi B. Kumar, email: [email protected]

Keywords: thyroid function; fatigue; hypothyroidism; subclinical hypothyroidism; breast cancer

Received: March 15, 2018     Accepted: April 27, 2018     Published: May 22, 2018


Background: Cancer related fatigue (CRF), reported in about 90% of breast cancer patients receiving chemotherapy, and has a profound impact on physical function, psychological distress and quality of life. Although several etiological factors such as anemia, depression, chronic inflammation, neurological pathology and alterations in metabolism have been proposed, the mechanisms of CRF are largely unknown.

Methods: We conducted a pilot, prospective, case-control study to estimate the magnitude of change in thyroid function in breast cancer patients from baseline to 24 months, compared to cancer-free, age-matched controls. Secondary objectives were to correlate changes in thyroid function and obesity over time with fatigue symptoms scores in this patient population.

Results: The proportion of women with breast cancer who developed subclinical or overt hypothyroidism (TSH >4.0 mIU/L) from baseline to year 1 was significantly greater compared to controls (9.6% vs. 5%; p=0.02). Subjects with breast cancer reported significantly worse fatigue symptoms than age-matched controls, as indicated by higher disruption indices (p<0.001 at baseline, p=0.02 at year 1, p=0.09 at year 2). Additionally, a significant interaction effect on disruption index score (p=0.019), general level of activity over time (p=0.006) and normal work activity (p= 0.002) was observed in the subgroup of women with BMI>30.

Conclusion: Screening breast cancer patients for thyroid function status at baseline and serially post-treatment to evaluate the need for thyroid hormone replacement may provide for a novel strategy for treating chemotherapy-induced fatigue.

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