{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T02:22:17Z","timestamp":1793758937704,"version":"4.6.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>The incidence of differentiated thyroid cancer (DTC) has risen dramatically worldwide. Despite an excellent prognosis, the growing DTC survivors\u2019 community often features poor health-related quality of life (HRQoL), which challenges long-term DTC care, particularly in developing Southern Mediterranean and African countries. We aimed to assess the HRQoL and to investigate its determinants in disease-free Tunisian DTC survivors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a three-month cross-sectional study that included 266 patients diagnosed with DTC. We assessed the HRQoL in eligible participants using the short form\u201336 health survey, in comparison with 76 healthy controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 86 eligible DTC survivors were predominantly female (89.5%) with an average age of 44.3 \u00b1 12.5 years. Physical-functioning (PF), role-physical (RP), and pain domains were substantially altered compared to the reference population. Age was negatively associated with PF, RP, role-emotional (RE), and social functioning (SF). Tumor size and lymph node metastases affected general health and PF, respectively. The cancer-free survival duration was positively correlated with mental health (MH). Poor neck scar healing and persistent post-operative hypoparathyroidism significantly deteriorate MH. Pain perception was positively correlated with the radioactive iodine cumulative dose. Subclinical hyperthyroidism significantly reduced PF and RP scores. TSH suppression was negatively and strongly correlated with MH and SF scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HRQoL is substantially reduced in DTC survivors compared to the normative Tunisian population. These results could be extrapolated to similar individuals in other South Mediterranean and African countries. The development of coordinated multidisciplinary aftercare interventions in this region is warranted to preserve HRQoL in DTC survivors.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2022.999331","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T06:47:59Z","timestamp":1661323679000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Health-related quality of life in long-term differentiated thyroid cancer survivors: A cross-sectional Tunisian-based study"],"prefix":"10.3389","volume":"13","author":[{"given":"Abdel Mouhaymen","family":"Missaoui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Hamza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Maaloul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"Charfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiem","family":"Ghrissi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadhel","family":"Guermazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2013\/965212","article-title":"Worldwide increasing incidence of thyroid cancer: Update on epidemiology and risk factors","volume":"2013","author":"Pellegriti","year":"2013","journal-title":"J Cancer Epidemiol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2020.00551","article-title":"Predictive factors of lymph node metastasis in patients with papillary microcarcinoma of the thyroid: Retrospective analysis on 293 cases","volume":"11","author":"Medas","year":"2020","journal-title":"Front Endocrinol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2016.110","article-title":"The changing incidence of thyroid cancer","volume":"12","author":"Kitahara","year":"2016","journal-title":"Nat Rev Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41574-019-0263-x","article-title":"Geographic influences in the global rise of thyroid cancer","volume":"16","author":"Kim","year":"2020","journal-title":"Nat Rev Endocrinol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2010.03.009","article-title":"Management of thyroid nodules and surgery for differentiated thyroid cancer","volume":"22","author":"Iyer","year":"2010","journal-title":"Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-2512","article-title":"Impact on overall survival of radioactive iodine in low-risk differentiated thyroid cancer patients","volume":"97","author":"Schvartz","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2015.00176","article-title":"Molecular targeted therapies of aggressive thyroid cancer","volume":"6","author":"Ferrari","year":"2015","journal-title":"Front Endocrinol"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.5772\/64597","article-title":"\u201cAurora kinases: New molecular targets for the therapy of aggressive thyroid cancers.,\u201d","volume-title":"Anti-cancer drugs - 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