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@ARTICLE{Schmidt:136802,
      author       = {M. Schmidt$^*$ and J. Wiskemann and T. S. Johnson$^*$ and
                      N. Habermann and A. Schneeweiss and K. Steindorf$^*$},
      title        = {{L}-{T}hyroxine intake as a potential risk factor for the
                      development of fatigue in breast cancer patients undergoing
                      chemotherapy.},
      journal      = {Supportive care in cancer},
      volume       = {26},
      number       = {8},
      issn         = {1433-7339},
      address      = {Berlin},
      publisher    = {Springer},
      reportid     = {DKFZ-2018-01240},
      pages        = {2561 - 2569},
      year         = {2018},
      abstract     = {L-Thyroxine is one of the most commonly prescribed drugs
                      and accordingly used by many breast cancer patients with
                      thyroid disorders. Hence, potential interactions of
                      chemotherapy with L-thyroxine, possibly contributing to
                      fatigue, would be of high clinical relevance. Therefore, we
                      investigated fatigue and underlying pathways in
                      L-thyroxine-using breast cancer patients during
                      chemotherapy.Thyroid-stimulating hormone (TSH),
                      L-triiodothyronine (T3), and diurnal salivary cortisol
                      patterns were analyzed in breast cancer patients in the
                      beginning and at the end of adjuvant chemotherapy within the
                      control group (n = 41) of a randomized exercise
                      intervention trial. Additionally, relationships in the
                      exercising group (n = 45) as well as in healthy women
                      (n = 25) were explored. Regression and mediation
                      analyses were performed.L-Thyroxine use was significantly
                      associated with lower TSH (median = 0.33 mU/l,
                      interquartile range = (0.15-0.48)), whereas patients not
                      using L-thyroxine had TSH comparable to healthy women
                      (0.51 mU/l (0.37-0.74)). T3 significantly declined during
                      chemotherapy in L-thyroxine users but not in non-users.
                      However, the group difference failed statistical
                      significance. L-Thyroxine treatment was significantly
                      associated with increased physical fatigue during
                      chemotherapy (p = 0.004) in the non-exercising group.
                      This association appeared to be partly mediated by TSH.
                      Further, TSH appeared to affect fatigue partly via increased
                      cortisol levels. In the exercise group, there was no
                      significant association between L-thyroxine and
                      fatigue.L-Thyroxine treatment during chemotherapy might
                      result in hormonal dysregulations that can contribute to
                      increased physical fatigue. Therefore, breast cancer
                      patients on L-thyroxine treatment may need special
                      monitoring of their thyroid levels and of fatigue during
                      chemotherapy and should be encouraged to
                      exercise.ClinicalTrials.gov NCT01106820.},
      cin          = {G210 / C020},
      ddc          = {610},
      cid          = {I:(DE-He78)G210-20160331 / I:(DE-He78)C020-20160331},
      pnm          = {317 - Translational cancer research (POF3-317)},
      pid          = {G:(DE-HGF)POF3-317},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29445858},
      doi          = {10.1007/s00520-018-4095-3},
      url          = {https://inrepo02.dkfz.de/record/136802},
}