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Xu Q, Jiang H, Li Y, Qi X, Chen L. Construction and verification of rehabilitation nursing program for shoulder and neck discomfort after thyroid cancer surgery: A pilot randomized controlled trial. Medicine (Baltimore) 2024; 103:e39291. [PMID: 39151505 PMCID: PMC11332766 DOI: 10.1097/md.0000000000039291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/12/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND To develop a nursing program for the prevention and rehabilitation of shoulder and neck discomfort after thyroid cancer surgery based on the empowerment theory, and to evaluate the application effect of the program. METHODS The prevention and rehabilitation nursing program for shoulder and neck discomfort after thyroid cancer surgery was established by literature review and the Delphi method. Between July 2022 and January 2023, a total of 62 postoperative thyroid cancer patients were recruited and randomly allocated to either the intervention group (n = 31) or the control group (n = 31) in this randomized controlled trial. Comparisons of shoulder and neck function, self-efficacy, and quality of life between the 2 groups were performed using a 2-sample independent t test, Wilcoxon rank-sum test, and repeated-measures analysis of variance. RESULTS At the end of the study, the control group and intervention group were 30 cases each completed the study. After the intervention, the self-efficacy score of the intervention group was higher than the control group (P < .05), and the score of emotional function, cognitive function, and overall health dimension of the intervention group was higher than the control group (P < .05). The pain dimension score of the intervention group was lower than the control group (P < .05). There were significant differences in the group and time effects of the total shoulder joint scores between the 2 groups (P < .05). CONCLUSION This study demonstrated that the shoulder and neck rehabilitation nursing program can alleviate the symptoms of shoulder and neck discomfort and improve patients' self-efficacy and quality of life.
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Affiliation(s)
- Qiuqin Xu
- Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, China
- Xiamen TCM Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Xiamen, China
| | - Hongzhan Jiang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yuanchan Li
- Zunyi Hospital of Traditional Chinese Medicine, Zunyi, China
| | - Xiushan Qi
- Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, China
| | - Lijuan Chen
- Department of General Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Pagliaro S, Rossi L, Meligeni M, Catani L, Morganti R, Materazzi G, Bakkar S, Montanino A, Pagliaro D, Scateni M, Pagnucci N. Correlation between surgical position and neck pain in patients undergoing thyroidectomy: a prospective observational study. Perioper Med (Lond) 2024; 13:74. [PMID: 39010151 PMCID: PMC11251317 DOI: 10.1186/s13741-024-00428-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Thyroid diseases are one of the most common health problems worldwide. Although they represent a necessary step in order to perform thyroidectomy, hyperextension of the neck can potentially increase postoperative pain. The aim of this study is to determine a correlation between the degree of neck hyperextension on the operative table and the postoperative pain in patients undergoing open thyroidectomy. METHODS Patients were prospectively enrolled from the cohort of patients operated at the Endocrine Surgery Unit of the University Hospital of Pisa, between May and July 2021. Both of patients who underwent total thyroidectomy or hemi-thyroidectomy were recruited. The following data were analysed in order to find a correlation with postoperative pain at 24 h: age, gender, type of surgery, BMI, operative time, and degree of neck extension. RESULTS Overall, 195 patients were enrolled. A direct, statistically significant correlation emerged between the degree of neck hyperextension and the postoperative pain 24 h after surgery, regardless of the pain of the surgical wound (p < 0.001; beta 0.270). CONCLUSIONS A direct correlation emerges between neck tilt angle and postoperative neck pain. Moreover, total thyroidectomy (TT) predisposes more to postoperative neck pain, considering the type of surgery.
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Affiliation(s)
| | - Leonardo Rossi
- Medical, Molecular, and Critical Area Pathology, Department of Surgery, University of Pisa, Pisa, Italy
| | | | | | | | - Gabriele Materazzi
- Medical, Molecular, and Critical Area Pathology, Department of Surgery, University of Pisa, Pisa, Italy
| | | | | | | | | | - Nicola Pagnucci
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
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Zhou J, Jing Y, Qi X, Wu J, Huang J, Chen X, Ding Y, Chen X. A novel minimally invasive endoscopic approach of thyroid surgery-endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach. Gland Surg 2024; 13:942-951. [PMID: 39015696 PMCID: PMC11247576 DOI: 10.21037/gs-24-48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/30/2024] [Indexed: 07/18/2024]
Abstract
Background Since the endoscopic thyroidectomy was firstly reported by Hüscher in 1997, there has been an ongoing debate regarding whether mainstream endoscopic thyroidectomy can be classified as minimally invasive surgery. In this study, we innovatively proposed the endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach (ETSPIA), a novel minimally invasive surgical technique, and compared its efficacy with the well-established transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods We retrospectively analyzed 50 patients who underwent ETSPIA and 50 patients who underwent TOETVA at Beijing Tongren Hospital, comparing their clinical characteristics, operative duration, blood loss, postoperative alterations in parathyroid hormone (PTH) and serum calcium, recovery post-surgery, complications, and follow-up data. Results The ETSPIA group had a shorter operation time compared to the TOETVA group (243.40±58.67 vs. 278.08±78.50 min; P=0.01). The ETSPIA group also had less intraoperative blood loss than the TOETVA group (20.60±10.58 vs. 33.00±11.11 mL; P<0.001). More central lymph nodes were dissected in the ETSPIA group compared to the TOETVA group (5.90±4.72 vs. 3.36±2.80; P=0.002). However, the difference in the number of positive central lymph nodes dissected was not statistically significant (1.38±2.33 for ETSPIA vs. 0.94±1.39 for TOETVA; P=0.26). The ETSPIA group had a shorter length of stay (LOS) compared to the TOETVA group (6.82±2.02 vs. 8.26±2.72 days; P=0.003). The alteration in PTH levels 1 day after surgery was less pronounced in the ETSPIA group compared to the TOETVA group (-26.38%±18.43% vs. -35.75%±22.95%; P=0.04). At the 1-month postoperative mark, the ETSPIA group showed a marginal increase in PTH levels, whereas the TOETVA group exhibited a slight decrease (10.12%±35.43% vs. -11.53%±29.51%; P=0.03). Regarding the average percentage change in serum calcium level 1 day after surgery, the ETSPIA group showed a smaller change, though this difference was not statistically significant (-4.79%±5.47% vs. -5.66%±3.90%; P=0.40). Furthermore, the incidence of hoarseness attributable to transient recurrent laryngeal nerve (RLN) injury in postoperative patients was lower in the ETSPIA group compared to the TOETVA group, but this difference did not reach statistical significance (0% vs. 4%; P=0.15). Conclusions Overall, compared to TOETVA, the ETSPIA is characterized by a shorter operative route, enhanced protection of the parathyroid glands, reduced trauma, and expedited postoperative recovery.
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Affiliation(s)
- Jing Zhou
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yixin Jing
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinmeng Qi
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Wu
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junwei Huang
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiao Chen
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yiming Ding
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chen
- Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Mao Y, Zhou S, Wu P, Li W, Li H, Wang Z, Xia X, Song X, Wang M, Peng X. Postoperative rehabilitation and quality of life evaluation for transoral endoscopic thyroidectomy vestibular approach. Sci Rep 2024; 14:14747. [PMID: 38926508 PMCID: PMC11208515 DOI: 10.1038/s41598-024-65589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein, we develop a new assessment questionnaire and rehabilitation training modality and evaluate its safety and effectiveness. The THYCA-QoL-TOETVA questionnaire was compiled, and reliability and validity analyses were performed. Patients were divided into the new rehabilitation training group (N) or the conventional rehabilitation training group (C), and 1:1 propensity score matching (PSM) was performed after administering questionnaires to patients in both groups. Cervical range of motion (CROM) data were also measured and collected for statistical analysis. The questionnaire used in this study showed good expert authority, coordination, internal consistency, and questionnaire reliability. A total of 476 patients were included after PSM, and the questionnaire results showed that recovery and quality of life were better in the N group than in the C group (124.55 ± 8.171 vs. 122.94 ± 8.366, p = 0.026). Analysis of cervical spine mobility showed that rehabilitation was better in the N group compared to the C group at postoperative one month (flexion: 1.762°, extension: 4.720°, left lateral bending: 3.912°, right lateral bending: 4.061°, left axial rotation: 5.180°, right axial rotation: 5.199°, p value all of these < 0.001), and at postoperative three months (flexion: 2.866°, extension: 2.904°, left lateral bending: 3.927°, right lateral bending: 3.330°, left axial rotation: 4.395°, right axial rotation: 3.992°, p value all of these < 0.001). The THYCA-QoL-TOETVA provides an appropriate and effective tool for measuring the postoperative quality of life of TOETVA patients. This new rehabilitation training can effectively alleviate the problem of limited neck movement and improve the quality of life of patients after TOETVA surgery.Trial registration: ChiCTR2300069097.
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Affiliation(s)
- Yu Mao
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Shiwei Zhou
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Peng Wu
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Wu Li
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Hui Li
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Zhiyuan Wang
- Department of Medical Ultrasound, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, People's Republic of China
| | - Xibin Xia
- Department of Diagnostic Radiology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan, People's Republic of China
| | - Xiaohua Song
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China
| | - Mingming Wang
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Xiaowei Peng
- Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, 410013, Hunan Province, People's Republic of China.
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Kim W, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. The anterior neck scar outcomes of conventional thyroidectomy using a wound protector: a multicenter double-blinded randomized controlled trial. Int J Surg 2024; 110:3425-3432. [PMID: 38498353 PMCID: PMC11175810 DOI: 10.1097/js9.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This study aimed to investigate the effectiveness of a novel wound protector in enhancing the cosmetic outcomes of thyroidectomy. MATERIAL AND METHODS This multicenter, double-blinded randomized controlled trial enrolled 129 patients undergoing open thyroidectomy. The patients were divided into a wound protector group and a control group. Subjective patient assessments were conducted, measuring wound satisfaction, pain, and itchiness. Additionally, blinded observers evaluated scars using the Vancouver Scar Scale. RESULTS The Vancouver Scar Scale revealed significant advantages for the wound protector group, demonstrating improvements in pigmentation ( P =0.002), vascularity ( P =0.014), pliability ( P =0.001), and height ( P =0.001). CONCLUSION The thyroid wound protector offers a potential to improve postoperative cosmetic outcomes. Further research is warranted to explore patient experiences and optimize the application of this innovative wound protector across diverse surgical contexts.
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Affiliation(s)
- Woochul Kim
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University, Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University, College of Medicine, Jongno-gu
| | - Su-jin Kim
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul
- Department of Surgery, Seoul National University, College of Medicine, Jongno-gu
| | - Young Jun Chai
- Department of Surgery, Seoul National University, College of Medicine, Jongno-gu
- Department of Surgery, Seoul National University, Boramae Medical Center, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University, Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do
- Department of Surgery, Seoul National University, College of Medicine, Jongno-gu
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul
- Department of Surgery, Seoul National University, College of Medicine, Jongno-gu
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井 溢, 丁 一, 周 晶, 武 骏, 刘 宏, 黄 俊, 陈 笑, 黄 志, 陈 晓. [The application of transcervical non-inflatable endoscopic posterior inferior sternocleidomastoid approach in thyroid surgery]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:691-694. [PMID: 37640992 PMCID: PMC10722125 DOI: 10.13201/j.issn.2096-7993.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Objective:To investigate the clinical efficacy and safety of transcervical non-inflatable endoscopic thyroidectomy through the posterior inferior sternocleidomastoid approach. Methods:From December 2022 to May 2023, the clinical data of 35 patients with papillary thyroid carcinoma treated by transcervical non-inflatable endoscopic surgery via posterior inferior sternocleidomastoid approach were retrospectively analyzed. There were 14 males and 21 females, with an average age of 44.7 years. The operation time, bleeding volume, postoperative recovery, complications and follow-up were recorded. Results:All 35 patients successfully completed the surgery, with an average operation time of 4 hours and 7 minutes, an average bleeding volume of 14 ml, and an average postoperative hospital stay of 3.5 days. There were no serious complications and no obvious neck discomfort during postoperative follow-up. Conclusion:Transcervical non-inflatable endoscopic thyroidectomy via posterior inferior sternocleidomastoid approach is safe and effective, with fast postoperative recovery,high appearance satisfaction and good neck comfort.
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Affiliation(s)
- 溢鑫 井
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 一鸣 丁
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 晶 周
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 骏 武
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 宏飞 刘
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 俊伟 黄
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 笑 陈
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 志刚 黄
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - 晓红 陈
- 首都医科大学附属北京同仁医院甲状腺头颈外科(北京,100730)Department of Thyroid Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
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Tuzil J, Pilnackova BF, Watt T, Jiskra J, Koudelkova M, Novotna E, Tuzilova K, Dolezal T, Bartakova J. The Impact of Subclinical Hypothyroidism on the Quality of Life During Pregnancy: Mapping 5-Level Version of EQ-5D and ThyPRO-39. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1085-1097. [PMID: 36878311 DOI: 10.1016/j.jval.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To describe how subclinical hypothyroidism (SubHypo) influences the quality of life (QoL) during pregnancy. METHODS In primary data collection (NCT04167423), thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibodies, generic quality of life (QoL; 5-level version of EQ-5D [EQ-5D-5L]), and disease-specific QoL (ThyPRO-39) were measured among pregnant women. SubHypo during each trimester was defined according to the 2014 European Thyroid Association guidelines (TSH > 2.5, 3.0, and 3.5 IU/L, respectively; with normal FT4). Path analysis described relationships and tested mediation. Linear ordinary least squares, beta, tobit, and two-part regressions were used to map ThyPRO-39 and EQ-5D-5L. Alternative SubHypo definition was tested in sensitivity analysis. RESULTS A total of 253 women at 14 sites (31 ± 5 years old, 15 ± 6 weeks pregnant) completed the questionnaires. Sixty-one (26%) had SubHypo and differed from 174 (74%) euthyroid women in smoking history (61% vs 41%), primiparity (62% vs 43%) and TSH level (4.1 ± 1.4 vs 1.5 ± 0.7 mIU/L, P < .001). EQ-5D-5L utility in SubHypo (0.89 ± 0.12) was lower than that in euthyroid (0.92 ± 0.11; P = .028) even after adjustment (difference -0.04, P = .033), whereas ocular (P = .001, ThyPRO-39), cognitive symptoms (P = .043), anxiety (P < .0001), and the composite score were higher. The impact of SubHypo on utility was mediated by anxiety. Results were confirmed by sensitivity analysis. Final mapping equation (ordinary least squares) includes goiter symptoms, anxiety, upset stomach, composite score (ThyPRO-39), FT4 levels, and week of pregnancy (determination coefficient 0.36). CONCLUSION This is the first QoL mapping of SubHypo during pregnancy and the first evidence that SubHypo is associated with a negative impact on QoL. The effect is mediated by anxiety. EQ-5D-5L utilities can be generated based on ThyPRO-39 scores collected in pregnant euthyroid and patients with SubHypo.
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Affiliation(s)
- Jan Tuzil
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic; First Medical Faculty, Charles University, Prague, Czech Republic.
| | | | - Torquil Watt
- Department of Internal Medicine, Endocrinology, Herlev Gentofte Hospital, Copenhagen, Denmark
| | - Jan Jiskra
- Third Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Koudelkova
- Institute of Health Information and Statistics of the Czech Republic, National Screening Centre, Praha, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Novotna
- Outpatient gynecology Femcare s.r.o., Odolena Voda, Czech Republic
| | | | - Tomas Dolezal
- Institute of Health Economics and Technology Assessment, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Bartakova
- Department of Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
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