Background: Cancer-related fatigue is one of the most important issues for patients, but research on this topic is sparse. This study aimed to determine the prevalence of fatigue in postoperative patients with papillary thyroid carcinoma (PTC) and to identify the clinical features associated with fatigue. Methods: We conducted a cross-sectional study on 292 thyroid cancer survivors. Fatigue and quality of life were the study outcomes, measured using the Cancer Fatigue Scale (CFS) and the SF-36 version 2.0. Furthermore, correlations of demographic characteristics and hormonal data with the CFS scores were assessed by univariable and multivariable analyses. Results: The prevalence of fatigue was 41.8% (95% CI: 36.1, 47.5). The CFS score was significantly correlated the free T3 level (Pearson's r = −0.123, 95%CI: −0.234, −0.008). Multiple regression analysis revealed that the free T3 level and having a job were significant predictors of the CFS score, with unstandardized regression coefficients of −2.52 (95% CI: −4.94, −0.09) and 2.85 (95% CI: 0.49, 5.20), respectively. The median Z-scores were negative for General Health (−0.28) and Vitality (−0.15) subscales of the SF-36.The CFS score was a significant predictor of summary scores of the SF-36. The free T3 level was significantly associated with the physical component summary score with an unstandardized coefficient of 3.20 (95%CI: 0.77, 5.63). Conclusions: Fatigue was prevalent and associated with poor quality of life among PTC survivors. Thyroid functional status, particularly the level of free T3, may be worth to be considered in alleviating the burden.
A 70's man visited our outpatient clinic for painless bulging in the left groin and right lateral abdomen. The patient was diagnosed with a left inguinal hernia with an orifice size of 1.5 finger widths and a Spigelian hernia with an orifice size of 1 finger width. As there was no sign of incarceration, the patient was scheduled for elective surgery. Transabdominal preperitoneal (TAPP) repair was selected to treat the two lesions in one stage. A camera port was inserted in the umbilical area. Intraperitoneal observation revealed a left direct inguinal hernia, a right Spigelian hernia, and another left Spigelian hernia that had not been identified preoperatively. The TAPP method was performed for the groin hernia on schedule. Direct closure of the hernia orifices was performed for both Spigelian hernias because the orifices were small. The postoperative course was favorable, and the patient was discharged on postoperative day 4. A Spigelian hernia is a relatively rare abdominal wall hernia. In this case, laparoscopic observation enabled us to identify and treat a hernia that had not been diagnosed preoperatively. This case highlights the significance of intraperitoneal observation during laparoscopic surgery, and we report the case with a literature review.
BACKGROUND Fatigue among thyroid cancer survivors is an important issue that needs to be appreciated and managed appropriately. Although several studies have reported potential factors that might be related to postoperative fatigue, the associations have yet to be inconclusive. The purpose of the present study was to estimate the prevalence of clinical fatigue in patients with papillary thyroid carcinoma and to reveal predictive factors, including their quality of life. METHODS A cross-sectional survey was conducted on patients with papillary thyroid carcinoma. Patients who underwent non-curative surgery, or those with recurrent or metastatic PTC, or those with other malignancies were excluded. The primary outcome was fatigue measured by the Cancer Fatigue Scale (CFS), and the secondary outcome was quality of life (QoL) quantified using the SF-36 v2. The following explanatory variables were collected; gender, age, employment status, marital status, co-morbidities, time since initial surgery, types of surgery, replacement of thyroid hormone, use of radioactive iodine, and the level of thyrotropin. The prevalence of clinical fatigue was estimated with the cut-off value of 18/19 of the CFS score. Correlations between the CFS score and the explanatory variables were examined using uni-variable analyses as well as multi-variable analysis. RESULTS Three hundred twenty-one patients participated in the survey. Of them, 258 respondents (80%) were female. The median age was 58 years, and the median time from initial surgery was 6.4 years. The mean and the standard deviation of the CFS score were 17.9 and 9.3, respectively (range: 0-48). The prevalence of clinical fatigue was 42% [95%CI: 36-47%]. Among the variables explored, having a job and scores of the mental component summary, the physical component summary, and the role/social component summary of the SF-36 were inversely associated with the CFS score in both uni- and multivariable analyses. CONCLUSION Postoperative fatigue was common in thyroid cancer survivors. Patients with a job and better QoL, in particular, those with good mental health, maybe at low-risk of developing the burden.
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