# Factors Associated with Sleep Disruption and Fatigue in Thyroid Cancer Survivors

## TL;DR

Young thyroid cancer survivors, especially women diagnosed at a younger age or with certain complications, are more likely to experience fatigue and sleep problems.

## Contribution

Identifies younger age at diagnosis and specific complications as novel risk factors for fatigue and sleep disruption in thyroid cancer survivors.

## Key findings

- Younger age at diagnosis is significantly associated with worse sleep and greater fatigue.
- Vocal cord paralysis and hypoparathyroidism are linked to increased fatigue and sleep problems.
- Fatigue and sleep issues are more common in female survivors and not related to recurrence risk or hormone levels.

## Abstract

Thyroid cancer is one of the most common cancers affecting young women, and although survival rates are very high, many survivors struggle with long-term issues that impact their quality of life. Fatigue and poor sleep are especially common, but the pattern of who experiences these problems has not been well understood. In this study of thyroid cancer survivors, we found that women diagnosed at a younger age were more likely to report worse sleep and greater fatigue. Those who developed vocal cord paralysis or hypoparathyroidism were also more likely to experience fatigue and sleep problems. These findings suggest that the challenges thyroid cancer survivors face are not just related to their cancer treatment or hormone levels. Better understanding of the factors that are impacting these young women could help guide future research and develop strategies to improve daily well-being and long-term health in thyroid cancer survivors.

Thyroid cancer survivors often experience worse quality of life than other cancer survivors, with fatigue and sleep disturbance being common contributors. In this prospective cohort from the ICaRe2 cancer registry, survivors completed the Brief Fatigue Inventory (BFI) and Pittsburgh Sleep Quality Index (PSQI) at enrollment and follow-up, with univariate and multivariable analyses identifying factors associated with fatigue and sleep quality. Among 249 survivors (83% female, median age 42), 205 completed the BFI and 224 the PSQI. Most were low (57%) or intermediate (34%) risk or recurrence at diagnosis, and 74% had no structural recurrence. Poor sleep and greater fatigue were significantly associated with female sex (p = 0.0003 and 0.001), younger age at diagnosis (p = 0.02 and 0.0006), and vocal cord paralysis (p = 0.01 and 0.046). Fatigue was also higher in those with hypoparathyroidism (p = 0.04). No associations were found with recurrence risk, therapy response, thyroid hormone type, or TSH levels. Younger female survivors, particularly those with vocal cord paralysis or hypoparathyroidism, are more prone to fatigue and poor sleep, highlighting potential targets for interventions to improve quality of life.