Quality of life improvement in patients with Hashimoto thyroiditis and other goiters after surgery: A prospective cohort study

Outcomes of thyroidectomy in symptomatic, euthyroid Hashimoto's patients: a case control study

BACKGROUND

Hashimoto's thyroiditis (HT) is managed with thyroid hormone replacement to maintain a euthyroid state. A subset of patients have refractory symptoms, which improve with thyroidectomy (TT). There remains a reluctance to proceed with surgery due to perceptions of complications, and limited data availability regarding improvements in quality of life (QoL). This retrospective case control study aims to analyse the outcomes and QoL scores for symptomatic euthyroid HT patients who underwent TT.

METHODS

Thirty euthyroid patients who underwent TT for the management of HT between 2017 and 2022 were identified. An age-matched control group of patients who underwent TT for symptomatic multinodular goitre (MNG) were randomly selected. Demographics, biochemistry, histology, outcomes, and pre- and post-operative SF-36 and ThyPRO-39 scores were compared between groups.

RESULTS

There were no surgical complications in the HT group, whilst two MNG patients had complications. There was a similar rate of parathyroid auto-transplantation in both groups, more glands were transplanted in the HT group. There was a significant difference in pre- and post-operative QoL scores for both groups. Comparison revealed a significant improvement in hyperthyroid symptoms, social life and daily life scores in the HT group. There was a significant difference in pre- and post-operative anti-TPO, anti-TG and TSH levels in the HT group.

CONCLUSION

Patients with symptomatic Hashimoto's thyroiditis, despite being euthyroid, may benefit from total thyroidectomy however this remains under-utilized. This study demonstrated that thyroidectomy was associated with an improvement in validated post-operative quality of life scores and was not associated with increased complication rates for appropriately selected patients.

The Impact of Thyroidectomy and Lobectomy on Patients' Health-Related Quality of Life, Eastern Region, Saudi Arabia

INTRODUCTION

The thyroid gland is a crucial endocrine organ that can be susceptible to various pathological conditions, often necessitating total thyroidectomy or lobectomy. It is a common surgical procedure in Saudi Arabia. Thus, it is essential to recognize the impact of thyroid surgery on patients' health-related quality of life (HRQoL).

AIM

The aim of this study was to evaluate HRQoL among patients with benign and malignant thyroid diseases who underwent thyroidectomy in the eastern region of Saudi Arabia.

METHODS

This cross-sectional study was conducted at King Fahad Hospital of University in Khobar, Kingdom of Saudi Arabia from January 2018 to May 2018. The data collection method used was divided into two parts. Part I included the patients' socio-demographic characteristics and the clinical characteristics of their thyroid surgery. Part II was a HRQoL questionnaire (SF-36, version 1.0).

RESULTS

The sample included 100 thyroidectomy patients ≥18 years. The study findings revealed that the overall scores for post-thyroidectomy patients showed a significant improvement in HRQoL, and HRQoL was not significantly associated with benign or malignant thyroid diseases.

CONCLUSION

Especially when the surgery is performed by a high-volume endocrine surgeon, thyroidectomy may lead to significant improvements in HRQoL among patients, including the elderly and younger adults, with benign and malignant thyroid disorders. There was no difference in HRQoL between patients who underwent total thyroidectomy or thyroid lobectomy. Also, HRQol among thyroidectomy patients is associated with their educational and occupational statuses.

Surgical Decision-Making in Thyroiditis: A Review Article

Thyroiditis is a common thyroid disorder worldwide. Its commonest variant is Hashimoto's thyroiditis (HT). The usual presenting symptom is hypothyroidism at the time of diagnosis. Most patients are asymptomatic. A few cases may experience more obvious symptoms. The standard treatment is medical, and surgery is rarely indicated. This review aims to shed light on the most relevant articles discussing surgery in thyroiditis and compare them. The author included 16 relevant articles focused on the surgical management of thyroiditis. Of the studies, 10 were designed as retrospective reviews, four as prospective studies, and two as systematic reviews. The included studies aimed to focus on certain objectives. Three of them discussed indications of surgical intervention in cases of thyroiditis. Five covered postoperative complications. Six looked at the thyroid cancer association with thyroiditis. Two explored the impact of thyroiditis on surgery. Five discussed the postoperative improvement of symptoms and the effect on the quality of life. All the studies listed in this review engaged cases of HT except two. This review concentrates on conceptualizing and organizing the parameters in the minds of surgeons who manage cases of thyroiditis to enable them to decide whether to operate or not. These factors are indications of surgery, improvement of local compressor symptoms post thyroidectomy like dysphasia and shortness of breath, risk of thyroid cancer, intraoperative difficulty, and postoperative complications. Different variants of thyroiditis cases are treated medically, and surgery is rarely indicated. The surgeons should consider the mentioned factors affecting their decision to operate on this special entity. Thus, each case should be individualized in deciding whether to operate or not by assessing the benefit-risk ratio.

The Effect of Laser Thermal Ablation on Quality of Life: Improvements in Patients with Solid-Cystic Thyroid Nodules

Background: Evidence of the efficacy of laser thermal ablation (LTA) in benign thyroid nodules is abundant. However, little is known about the effect on quality of life (QoL) of this treatment. Methods: Prospective cohort study investigating the effect of LTA before, three, and six months after LTA on QoL using the thyroid-specific patient-reported outcome (ThyPRO) measure. Patients receiving LTA (laser group [LG]) was compared with a well-characterized control group (CG) from the Danish civil registry. Results: The LG comprised 54 patients, with no age or sex differences compared with the CG (n = 739). Sixty-nine percent of the patients had a recurrent cystic thyroid nodule, 6% had a solid nodule, while the remaining 25% were of mixed character. The median nodule volume was 6.8 mL (interquartile range [IQR]: 4.0-11.1) before LTA, and 1.8 mL (IQR: 0.6-4.1) at 6 months post-LTA (p < 0.001), corresponding to a median reduction of 78%. All cystic fluid (median: 6 mL; IQR: 2.0-9.0) was aspirated before LTA. Median treatment time was 400 seconds (IQR: 300-600), applying a median energy of 823 J (IQR: 600-1200). At baseline and according to the ThyPRO scales, the LG differed significantly from the CG by having more goiter symptoms, hyperthyroid symptoms, tiredness, and cognitive complaints (p < 0.05 for all variables), but only the difference in the goiter symptom scale was of a clinically important magnitude. At three months, the LG experienced a large improvement in goiter symptoms (effect size [ES] = 1.05), a moderate improvement in cosmetic complaints (ES = 0.50), and a moderate improvement in the overall QoL (ES = 0.64). Only the improvements in the goiter symptom and the cosmetic complaint scales were clinically important. Six months after LTA, the anxiety scale showed further improvement of moderate size (ES = 0.52). At 6 months, the results above were maintained, and 79% of patients experienced a large and clinically important improvement in the goiter symptom scale and no clinically important differences were found between the LG and the CG. Conclusions: In this unblinded, prospective observational study, measures of disease-specific QoL were significantly improved compared with preprocedure levels, in patients with solid-cystic nodules.

The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial

Background

Methods

Results

Conclusions

Quality of Life in Patients with Benign Non-Toxic Goiter After Surgical Intervention: A Systematic Review and Meta-Analysis

BACKGROUND

Prior studies evaluating health-related quality of life (HR-QoL) outcomes in patients undergoing surgery for benign non-toxic goiter have used different instruments and time points, leading to conflicting results. We sought to systematically review the differences in HR-QoL among patients with BNTG at baseline and 6 months after surgery, using exclusively the ThyPRO questionnaire.

METHODS

A systematic search was performed using PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO for papers reporting the assessment of HR-QoL utilizing ThyPRO. Data were meta-analyzed using a random-effects model, and pooled estimates were calculated using weighted mean differences (WMD) between baseline and 6 months after surgery. We assessed the quality and risk of bias of the studies using the Robins-I tool and previously published minimally important change (MIC) values to assess clinical significance.

RESULTS

Six papers met the predefined inclusion criteria, describing a total of 496 patients. Meta-analysis demonstrated improved QoL in all thirteen domains of ThyPRO six months post-surgical intervention compared to baseline. Specifically, the largest improvement in QoL was seen in the domains of overall QoL, WMD -25.84 (95% CI -29.70, -21.98, p < 0.001, I² = 23%), goiter symptoms, 23.96 (95% CI -30.29, -17.64, p < 0.001, I² = 91%), and tiredness, -16.20 (95% CI -19.23, -13.16, p < 0.001, I² = 3%). The differences in scores 9 of 13 domains were clinically significant based on MIC.

CONCLUSIONS

Disease-specific HR-QoL improved in all ThyPRO domains after surgery in patients with BNTG. Future studies of QoL in thyroid surgery patients will benefit from a standard questionnaire and improved reporting of covariates including complications to ensure comparability across studies.

Impact of thyroidectomy on quality of life in benign goitres: results from a prospective cohort study

PURPOSE

Benign thyroid diseases encompass a large spectrum of conditions that are chronic and subtle in nature. A majority of patients choose non-surgical management and continue living their daily lives with subconscious impairment of optimal functioning. We studied the effect of thyroidectomy on the quality of life (QoL) in patients with benign goitres.

METHODS

A prospective study was conducted on 50 patients between January 2017 and August 2018 using the ThyPRO 39 questionnaire. This is a disease-specific health-related questionnaire administered the day before surgery and 6 months following surgery. Data analysis was performed using EpiData Manager and EpiData Entry Client (v 3.1).

RESULTS

The mean age of the cohort was 43.30 years ± 11.61, with a female preponderance (34:16). The most common indications for surgery were suspicion of malignancy and compressive symptoms in 34% and 30%, respectively. The most common histopathology reported was nodular/adenomatous hyperplasia (56%). Prior to surgery, the most common domains affected were emotional susceptibility and tiredness. Following surgery, a significant improvement in all domains of the ThyPRO 39 questionnaire were seen except for psychological well-being (p=0.126). In addition, the composite scores significantly improved (p<0.001). Younger age, female gender, and longer duration of goitre were the factors that significantly affected the outcomes in various domains.

CONCLUSION

Patients with benign goitres have subtle impairment of QoL which showed significant improvement following thyroidectomy.

Local symptoms of Hashimoto's thyroiditis: A systematic review

OBJECTIVE

Hashimoto's thyroiditis (HT) is the most common type of thyroid disease and can cause many different manifestations. The local symptoms of HT are an under-studied area of research. Therefore, the purpose of this study was to investigate the local symptoms of HT and their prevalence.

METHODS

A systematic review was performed to find articles in PubMed that discuss the local symptoms of HT. Relevant vocabulary terms and key terms included: autoimmune thyroid disease (AITD), hyperthyroidism, hypothyroidism, neck, throat, pharynx, airway, esophagus, breathe, swallow, globus, sleep apnea, symptoms, and quality of life. Two investigators independently screened the eligible studies.

RESULTS

A total of 54 articles fulfilled the inclusion criteria. Of these, 25 were clinical studies, 24 were case reports, and five were reviews. These clinical studies and case reports included a total of 2660 HT patients. There were eight local symptoms related to HT: neck pain (0.02%~16%), voice changes (7%~30%), throat discomfort (20%~43.7%), shortness of breath (28%~50%), dysphagia (29%), goiter-related symptoms (69.44%), sleep apnea, and generally defined compressive symptoms. Due to the use of different outcome measures among all the studies, a meta-analysis of the data could not be performed.

CONCLUSION

Goiter symptoms, which are an item on the ThyPRO scales, are the most frequent local symptoms in HT patients, and include neck pain, voice changes, throat discomfort, and dysphagia. These local symptoms should be identified in the clinic and included in the early diagnosis and management of HT, as well as evaluated further to understand their relevance in the pathogenesis of HT.

Eye symptoms in patients with benign thyroid diseases

Thyroid diseases may cause a variety of functional and structural body changes, including eye and vision abnormalities, which can have a negative impact on a patient’s well-being. However, only a few studies on the impact of other benign thyroid diseases on the visual process are available in the literature. In this study, using the Polish version of the thyroid-specific quality of life (ThyPROpl) questionnaire, we aimed to determine the self-reported influence of benign thyroid diseases (e.g., nodular goiter, toxic nodular goiter, Graves’ disease, thyroid orbitopathy, Hashimoto’s thyroiditis, and surgical hypothyroidism) on patients’ eyes and vision. This was a prospective study. In total, 374 randomly selected euthyroid patients and 255 control subjects responded to the ThyPROpl questionnaire and the results were evaluated. Nearly 69% of the respondents reported that the most frequent condition was “reduced sight.” Men most often reported wet/tearing eyes (66%). The occurrence of eyelid sacks or swollen eyelids (64%), ophthalmalgia (62%), and eye dryness (61%) was marked almost as often. In total, 29% of the patients reported diplopia, and it was found to be most prevalent among those with thyroid orbitopathy. Other complaints were similarly prevalent among all the subgroups. A positive correlation was also observed between the scores of the “eye symptoms” and other ailments. Except for swelling around the lower eyelids, patients with thyroid diseases more frequently experienced all of the ocular complaints analyzed in this study compared with controls. This study showed that eye complaints are common in patients with benign thyroid diseases and ocular disturbances have a negative impact on the overall quality of life of patients.

Association between anti-thyroid antibodies and quality of life in patients with Hashimoto thyroiditis: a systematic review and meta-analysis

OBJECTIVE

The aim of this review was to evaluate the association between anti-thyroid antibodies and quality of life in people with euthyroid Hashimoto thyroiditis.

INTRODUCTION

Patients with Hashimoto thyroiditis report symptom distress more often than those with non-autoimmune thyroid disorders. Therefore, anti-thyroid antibodies may be related to decreased quality of life in persons with Hashimoto thyroiditis. The etiology of lingering symptoms, even in euthyroidism, remains unknown. The relationship between anti-thyroid antibodies and quality of life for people with Hashimoto thyroiditis has not been evaluated in a systematic review.

INCLUSION CRITERIA

The participants were males and females at least 12 years of age, in any country, with Hashimoto thyroiditis. Participants not in a euthyroid state were excluded from this review. In this review, the exposure was the presence of anti-thyroid antibodies and the primary outcome was quality of life as measured by a validated scale.

METHODS

A three-step search strategy was implemented with an initial search of PubMed and CINAHL. A comprehensive database search using all identified keywords and index terms was undertaken in March 2019 for relevant published literature, gray literature, and clinical trial registries. The final updates to the search strategies were conducted in December 2019. The search was limited to studies published in English after 1956. Two independent reviewers completed screening for inclusion and utilized the recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis. The findings are presented in a meta-analysis and in a narrative synthesis, which includes tables and figures.

RESULTS

All 13 studies had high methodological quality. Four studies found a significant correlation (P < 0.05) between the presence of anti-thyroid antibodies and quality of life. A fifth study found a significant correlation (P < 0.001) between higher antibody levels and quality of life. A meta-analysis was conducted using two cross-sectional studies, which revealed that the summative small effect size was statistically significant and suggested a lower quality of life in antibody-positive patients. Due to the heterogeneity of the studies, a narrative synthesis was conducted for the three secondary outcomes: symptom distress, executive function, and mental health. Three studies found a statistically significant (P < 0.05) correlation between symptom distress and antibodies, two studies found a statistically significant (P < 0.05) association between executive function and antibodies, and all but one study found a statistically significant (P < 0.05) relationship between mental health and antibodies.

CONCLUSIONS

The findings in this review did not reveal a definitive relationship between antibodies and quality of life. However, our meta-analysis suggested a link between anti-thyroid antibodies and decreased quality of life in euthyroid children and adults. Though not conclusive, poor mental health and symptom distress may be associated with anti-thyroid antibodies. Therefore, it may be beneficial to periodically evaluate the quality of life and mental health in euthyroid patients with positive antibodies. It is unlikely that antibodies and executive functions are related. The studies and our review's limitations require replication of findings to confirm a connection between antibodies, quality of life, and the secondary outcomes. Future research should continue to evaluate the relationship between anti-thyroid antibodies and the quality of life in individuals with euthyroid Hashimoto thyroiditis.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018084663.

Persisting symptoms in patients with Hashimoto's disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review

OBJECTIVE

Patients with hypothyroidism due to Hashimoto's disease (HD) may experience persisting symptoms despite normal serum thyroid hormone (TH) levels. Several hypotheses have been postulated to explain these persisting symptoms. We hypothesized that thyroid autoimmunity may play a role.

DESIGN

A systematic literature review.

METHODS

A PubMed search was performed to find studies investigating the relation between the presence of thyroid autoimmunity and (persisting) symptoms. Included studies were critically appraised by the Newcastle - Ottawa Scale (NOS) and then subdivided into (A) disease-based studies, comparing biochemically euthyroid patients with HD, and euthyroid patients with non-autoimmune hypothyroidism or euthyroid benign goitre, and (B) (general) population-based studies. Due to different outcome measures among all studies, meta-analysis of data could not be performed.

RESULTS

Thirty out of 1259 articles found in the PubMed search were included in this systematic review. Five out of seven disease-based studies found an association between thyroid autoimmunity and symptoms or lower quality of life (QoL). Sixteen of 23 population-based studies found a comparable positive association. In total, the majority of included studies reported an association between thyroid autoimmunity and persisting symptoms or lower QoL in biochemically euthyroid patients.

CONCLUSION

(Thyroid) autoimmunity seems to be associated with persisting symptoms or lower QoL in biochemically euthyroid HD patients. As outcome measures differed among the included studies, we propose the use of similar outcome measures in future studies. To prove causality, a necessary next step is to design and conduct intervention studies, for example immunomodulation vs. placebo preferably in the form of a randomized controlled trial, with symptoms and QoL as main outcomes.

Quality of life among patients on levothyroxine: A cross-sectional study

Background

Thyroid disorders affect the life quality of patients in various aspects. The present work aims at investigating the effect of thyroid hormonal status on the quality of life (QoL) among patients receiving Levothyroxine at the level of primary healthcare.

Methods

All patients receiving Levothyroxine at an academic primary healthcare center were included in a cross-sectional evaluation. QoL was measured by the Thyroid-Related Patient-Reported Outcome questionnaire (ThyPRO). The conducted analysis was based on the last thyroid hormones level during the last year and questionnaire scores where higher scores indicated lower QoL.

Results

We included 127 patients; all domains of their QoL questionnaire were affected. The highest scored domain of the ThyPRO was tiredness, while the least was goiter symptoms. An association between the affected QoL and thyroid hormones could not be built. Certain domains of the ThyPRO were influenced by the existence of comorbid diseases.

Conclusions

QoL was impacted in patients receiving Levothyroxine, regardless of hormonal status. Management of comorbid diseases and patients' concerns are advised to be taken into consideration to achieve a satisfying treatment. We highly recommend the integration of health life quality assessments in primary health care systems.

Quality of Life After Thyroidectomy for Hashimoto Disease in Patients With Persistent Symptoms

OBJECTIVES

To determine whether thyroidectomy improves quality of life in patients with Hashimoto thyroiditis with persistent symptoms despite biochemical euthyroidism.

METHODS

A retrospective cohort study was conducted of patients undergoing thyroidectomy for Hashimoto thyroiditis at our institution between 2014 and 2018. The following variables were collected: age, race, body mass index, preoperative symptoms, preoperative thyroid peroxidase antibody titer, thyroglobulin antibody titer, thyroid-stimulating hormone, free thyroxine, specimen weight, and histologic presence of thyroiditis. Outcomes included general health score on the Short Form 36 (SF-36) Health and responses to a questionnaire addressing postoperative disease management.

RESULTS

A total of 19 patients were included in the study, 18 of whom were female with a mean age of 48 years. The majority of patients were Caucasian. There were no significant differences between the postoperative general health scores of the patients with Hashimoto thyroiditis and scores from a healthy control population (66.9 vs 74.1; 95% CI: -16.9 to +2.5, P = .16). There were also no differences between groups within the 7 SF-36 subscores. Elevation in preoperative thyroperoxidase antibody correlated with lower reported postoperative energy levels (r = -0.63, P = .016) and emotional well-being (r = -.55, P = .041); 87.5% of respondents reported being moderately or extremely happy with their decision to proceed with surgery.

CONCLUSIONS

Quality of life in patients with Hashimoto thyroiditis who undergo thyroidectomy is equivalent to the general population, and the majority are satisfied with surgery. Thyroidectomy is a consideration for patients with persistent symptoms despite optimization on medical therapy.

How does thyroidectomy for benign thyroid disease impact upon quality of life? A prospective study

BACKGROUND

Choosing which patients to recommend surgery for benign thyroid conditions can be difficult due to the subjective nature of compressive thyroid and hormonal symptoms. The aim of this prospective study was to analyse changes in quality of life (QOL) following thyroid surgery using a validated disease-specific assessment tool, the thyroid-related patient-reported outcome (ThyPRO) questionnaire.

METHODS

Participants undergoing elective thyroid surgery for benign conditions were recruited. Patient demographics and clinical data were collected. ThyPRO consists of 85 questions grouped into 13 physical, mental and social symptom domains. Patients completed a ThyPRO questionnaire pre-operatively and at 6 weeks and 6 months post-operatively. ThyPRO items were scored according to protocol to produce 13 subscales. Repeated measures linear models with no random effects were performed using data for each outcome.

RESULTS

Results were available for a total of 72 patients. The sample was predominately female (n = 63, 88%) with average age 49.8 years. The majority of patients underwent surgery for multi-nodular goitre. At 6 weeks post-operatively, significant improvement was demonstrated in the goitre, hypothyroid, hyperthyroid and anxiety symptom domains. At 6 months post-operatively, significant improvement was demonstrated in all but four domains. No domains demonstrated significant increase in impairment post-operatively.

CONCLUSION

Patients had significant improvement in nine of 13 symptom domains following surgery. Patients did not experience a negative impact on QOL following surgery. Further studies with larger patient cohorts may be able to identify potential pre-operative predictive factors for a post-operative improvement in QOL for benign thyroid disease.

Thyroidectomy for euthyroid patients with Hashimoto thyroiditis and persisting symptoms: A cost-effectiveness analysis

BACKGROUND

Despite thyroid hormone replacement, some euthyroid patients with Hashimoto thyroiditis will continue to experience persistent symptoms that reduce their quality of life. Recent studies indicate that total thyroidectomy is superior to medical therapy alone in improving these symptoms. However, there is a high complication rate after total thyroidectomy in patients with Hashimoto thyroiditis. This study evaluates the cost-effectiveness of total thyroidectomy for euthyroid patients who have Hashimoto thyroiditis with persistent symptoms.

METHODS

We utilized a Markov model to compare total thyroidectomy and medical therapy alone over the lifetime of the cohort. Costs, probabilities, and utility parameters were derived from literature and Medicare cost data. A willingness-to-pay threshold of $100,000/quality-adjusted life years was used. We performed sensitivity analyses to ascertain model uncertainty.

RESULTS

On average, medical therapy alone costs $12,845, produced 16.9 quality-adjusted life years, and was dominated. Total thyroidectomy costs $1,490 less and produced 1.4 more quality-adjusted life years. Probabilistic sensitivity analysis confirmed total thyroidectomy as the optimal strategy in 89% of cases. Medical therapy alone will become cost-effective if the cost of uncomplicated thyroidectomy increases by 25%, if the probability of permanent complication after total thyroidectomy increases 12-fold, or if there is no gain in quality of life after thyroidectomy.

CONCLUSION

Total thyroidectomy is more cost-effective than medical therapy alone for the management of euthyroid patients who have Hashimoto thyroiditis with persistent symptoms.

A Cross-Sectional Study of Oral Lichen Planus Associated With Thyroid Diseases in East China

Objective: To investigate the prevalence of thyroid diseases in patients with oral lichen planus (OLP) and to explore the correlation between the two diseases. Methods: A cross-sectional study was conducted to investigate the history of thyroid disease in 585 patients with oral lichen planus diagnosed in the Department of Oral Mucosal Diseases of the Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine from June 2017 to April 2018 and in 10,441 normal people in an epidemiological survey conducted by endocrinology department of Ninth People's Hospitalin eastern China from 2014 to 2015. Personal medical history of thyroid disease was obtained through questionnaire and thyroid function was also tested. Results: Of the 585 patients with OLP, 190 (32.48%) had thyroid disease (excluding coexistence of multiple thyroid diseases), 62 (32.6%) had thyroid nodules, and 71 (37.4%) had Hashimoto's thyroiditis. Hyperthyroidism was diagnosed in six patients (3.2%), hypothyroidism in seven patients (3.7%), and thyroid cancer in 11 patients (5.8%). The prevalence of Hashimoto's thyroiditis was significantly higher in patients with oral lichen planus than in the general population. The probability of thyroid disease was significantly higher in women with OLP than in men with OLP (P < 0.001). Conclusion: OLP is associated with a high probability of developing thyroid disease, especially Hashimoto's thyroiditis. In the management of OLP patients, especially in female patients, thyroid disease must be screened.

The Impact of Post-thyroidectomy Paresis on Quality of Life in Patients with Nodular Thyroid Disease

Objective

To investigate the impact of postoperative paresis on disease-specific quality of life (DSQoL) after thyroidectomy in patients with benign nodular thyroid disease.

Study Design

Observational study.

Setting

University hospital.

Subjects and Methods

Patients were evaluated before and 3 weeks and 6 months after surgery in an individual prospective cohort study using videolaryngostroboscopy (VLS), voice range profile, voice handicap index (VHI), multidimensional voice program, maximum phonation time (MPT), and auditory perceptual evaluation. Changes in DSQoL were assessed by the Thyroid-specific Patient-Reported Outcome measure. Cohen’s effect size was used to evaluate changes.

Results

Sixty-two patients were included, 55 of whom completed all examinations. Three weeks after surgery, a blinded VLS examination showed signs of paresis of either the recurrent laryngeal nerve or the external branch of the superior laryngeal nerve (RLN/EBSLN) in 13 patients (24%). A paresis corresponded to a 12 ± 28 point increase in VHI ( P = .002) and was associated with a significant 4.3 ± 7.5 semitone decrease in the maximum fundamental frequency ( P < .001) and a 5.3 ± 8.2 dB reduction in maximum intensity. Further, it was associated with a 4.5 ± 11.2 second reduction in MPT ( P = .001) and an increase of 0.40 ± 1.19 in grade, 0.42 ± 1.41 in roughness, and 0.36 ± 1.11 in breathiness. Signs of postoperative RLN/EBSLN paresis correlated with an 11.0-point ( P = .02) poorer improvement in goiter symptoms at both 3 weeks and 6 months after surgery.

Conclusion

Signs of RLN/EBSLN paresis after thyroidectomy were associated with less pronounced improvement in goiter symptoms in patients with thyroid nodular disease. However, thyroidectomy was associated with an overall improved DSQoL by 6 months after surgery.

Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial

BACKGROUND

Hashimoto disease is a chronic autoimmune thyroiditis. Despite adequate hormone substitution, some patients have persistent symptoms that may be the result of immunologic pathophysiology.

OBJECTIVE

To determine whether thyroidectomy improves symptoms in patients with Hashimoto thyroiditis who still have symptoms despite having normal thyroid gland function while receiving medical therapy.

DESIGN

Randomized trial. (ClinicalTrials.gov: NCT02319538).

SETTING

Secondary care hospital in Norway.

PATIENTS

150 patients aged 18 to 79 years with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy and with serum antithyroid peroxidase (anti-TPO) antibody titers greater than 1000 IU/mL.

INTERVENTION

Total thyroidectomy or medical management with hormone substitution to secure euthyroid status in both groups.

MEASUREMENTS

The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) at 18 months. Secondary outcomes were adverse effects of surgery, the other 7 SF-36 subscores, fatigue questionnaire scores, and serum anti-TPO antibody titers at 6, 12, and 18 months.

RESULTS

During follow-up, only the surgical group demonstrated improvement: Mean general health score increased from 38 to 64 points, for a between-group difference of 29 points (95% CI, 22 to 35 points) at 18 months. Fatigue score decreased from 23 to 14 points, for a between-group difference of 9.3 points (CI, 7.4 to 11.2 points). Chronic fatigue frequency decreased from 82% to 35%, for a between-group difference of 39 percentage points (CI, 23 to 53 percentage points). Median serum anti-TPO antibody titers decreased from 2232 to 152 IU/mL, for a between-group difference of 1148 IU/mL (CI, 1080 to 1304 IU/mL). In multivariable regression analyses, the adjusted treatment effects remained similar to the unadjusted effects.

LIMITATION

Results are applicable only to a subgroup of patients with Hashimoto disease, and follow-up was limited to 18 months.

CONCLUSION

Total thyroidectomy improved health-related quality of life and fatigue, whereas medical therapy did not. This improvement, along with concomitant elimination of serum anti-TPO antibodies, may elucidate disease mechanisms.

PRIMARY FUNDING SOURCE

Telemark Hospital.

Changes in Swallowing Symptoms and Esophageal Motility After Thyroid Surgery: A Prospective Cohort Study

INTRODUCTION

Swallowing difficulties, the pathophysiology behind which is incompletely understood, have been reported in 47-83% of goiter patients referred for thyroidectomy. We aimed at examining the influence of thyroid surgery on swallowing symptoms and esophageal motility.

METHODS

Thirty-three patients with benign nodular goiter undergoing thyroid surgery were included. All completed high-resolution esophageal manometry examinations and the goiter symptom scale score, assessed by the thyroid-specific patient-reported outcome measure. The evaluations were performed before and 6 months after surgery.

RESULTS

Before surgery, the goiter symptom score was median 39 points (range 2-61), which improved to median five points (range 1-52) after surgery (p < 0.001). The motility parameters were within the limits of normal swallowing physiology, both before and after surgery. Only the upper esophageal sphincter (UES) pressure increased significantly from 70.6 ± 27.7 to 87.7 ± 43.2 mmHg after surgery (p = 0.04). Using regression analyses, there was no significant correlation between change in goiter symptoms and weight of the removed goiter, motility parameters, or motility disturbances. However, patients undergoing total thyroidectomy experienced a larger reduction in pressure in the area of the UES and former thyroid gland after surgery in comparison with patients undergoing less extensive surgery.

CONCLUSIONS

Goiter symptoms improved significantly after thyroidectomy, but without correlation to esophageal motility disturbances. This information is essential when interpreting dysphagia in patients with nodular goiter, and when balancing patients' expectations to surgical goiter therapy.

REGISTRATION NUMBER

NCT03100357 ( www.clinicaltrials.org ).

The compensatory enlargement of the remaining thyroid lobe following hemithyroidectomy is small and without impact on symptom relief

According to previous studies, hemithyroidectomy results in growth of the remaining thyroid lobe by up to 30% in first 12 months after surgery. However, this estimate is based on imprecise methods, high inter- and intra-observer variability, and lack of blinding of the measurements. Furthermore, it is unknown whether enlargement of the remaining hemi-thyroid interferes with the improvement in symptoms after surgery for goiter. We aimed to assess the impact of postoperative thyroid growth on goiter symptom relief following hemithyroidectomy in patients with benign nodular goiter. Outcomes were measured before and 6 months after hemithyroidectomy in 44 patients. Thyroid volumes were determined by two independent and blinded observers using magnetic resonance imaging (MRI). Inter- and intra-observer variability was visualized by Bland-Altman plots. Goiter symptoms were assessed by the Thyroid-Specific Patient-Reported-Outcome Questionnaire (ThyPRO) on a scale from 0 to 100 points. After hemithyroidectomy, the remaining thyroid lobe was 13.7 ± 6.4 mL, and enlarged by a mean of 1.8 mL over 6 months [95% confidence interval (CI) (1.6; 2.1), p < 0.001], corresponding to an increase of 17% [95% CI (12; 22)]. The Goiter Symptom score improved by 27 points [95% CI (21; 34), p < 0.0001] from median 39 points (range 2-86) at baseline, and was unaffected by the compensatory thyroid growth. Six months after hemithyroidectomy, using blinded MRI evaluations, we demonstrated a small but significant postoperative growth of the remaining hemi-thyroid, which did not significantly affect the considerable improvement in goiter symptoms.

Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study

BACKGROUND

Using the thoroughly validated Thyroid-Related Quality-of-Life Patient-Reported Outcome (ThyPRO) questionnaire, the purpose of this study was to investigate changes in disease-specific quality of life (QOL) after surgical treatment in patients with benign nontoxic multinodular goiters.

METHOD

Patients with goiters scheduled for thyroid surgery (n = 106) and individuals from the general population (n = 739) were studied. The ThyPRO data before, 3 months, and 6 months after surgery were compared with normative scores from the general population using a linear mixed model and t tests.

RESULTS

Before surgery, patients with goiters experienced poorer scores on all scales compared to the general population. After surgery, moderate to large improvements were seen in goiter symptoms, tiredness, anxiety, and overall QOL. After surgery, all scales returned to values equal to the general population. The degree of anxiety was, in fact, lower than in the general population.

CONCLUSION

Thyroid surgery leads to significant benefit among patients with benign nontoxic goiters by restoring QOL equal to that in the general population.

Is thyroid autoimmunity itself associated with psychological well-being in euthyroid Hashimoto's thyroiditis?

Recent studies imply that euthyroid Hashimoto's thyroiditis (HT) might be related with impaired HRQoL, depression and anxiety. Ninety three patients with euthyroid HT and 31 age- and gender-matched euthyroid control subjects were enrolled into this study. SF-36 questionnaire, Beck Depression Inventory and Beck Anxiety Inventory tests were used for evaluating HRQoL, depression and anxiety. Beck Depression Inventory scores were higher in patients with HT compared to control subjects (7.5 (4.0-14.75) vs. 5.0 (2.25-9.0), p=0.008). Beck Anxiety Questionnaire scores were also higher in patients with HT than controls (9.50 (5.0-17.0) vs. 5.0 (2.0-11.75), p=0.021). In SF-36 questionnaire; physical functioning (26.0 (20.0-28.0) vs. 29.0 (26.0-30.0), p=0.038), general health (16.4 (13.4-20.4) vs. 19.4 (16.3-21.2), p=0.026) and mental health (20.5 (16.0-23.0) vs. 23.0 (21.0-25.0), p=0.001) scores were lower in patients with HT than control subjects. There were no significant differences between patients with HT under levothyroxine replacement therapy compared to those without therapy in terms of depression and anxiety scores and components of SF-36 questionnaire. Beck Depression Inventory scores were positively correlated with TSH (r=0.250, p=0.01). In SF-36, role physical (r=0.192, p<0.05) and vitality (r=0.181, p<0.05) were positively correlated with fT4. Role emotional was negatively correlated with TSH (r=-0.185, p<0.05) and anti-TPO (r=-0.234, p<0.05). Mental health was negatively correlated with anti-TPO (r=-0.287, p<0.01). HRQoL is impaired and depression and anxiety scores are high in patients with euthyroid HT independent of levothyroxine replacement. Therefore, our results indicate that thyroid autoimmunity itself may have an impact on psychological well-being in euthyroid patients with HT.

Autoimmunity affects health-related quality of life in patients with Hashimoto's thyroiditis

Hashimoto's thyroiditis (HT) is the most common endocrine disorder leading to hypothyroidism. HT is characterized by the presence of elevated circulating antibodies, especially anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg). In our study, we aimed to reveal the effects of autoimmunity on health-related quality of life of euthyroid HT patients. Patients who were admitted to the Adnan Menderes University Outpatient Clinic were enrolled. The medical records of the patients were surveyed and their demographical data were collected. By using communication data, the patients were invited to our clinic, to inform them about our study and to fill out the health-related quality of life questionnaire. A total of 84 euthyroid HT patients older than 18 years who completed the short form-36 questionnaire, were enrolled. As all patients were euthyroid, there was a significant negative correlation between each domain score and the antibody levels, individually. Patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores (p < 0.001). There was statistically no significant correlation between the antibody levels and thyroid function tests (p > 0.05). Additionally, all dimension scores were significantly higher both in the anti-Tg and anti-TPO negative groups, indicating a better quality of life than that in the antibody positive groups. Our study revealed that higher thyroid antibody levels were negatively correlated with life quality scores. Thus, patients who had higher anti-TPO and anti-Tg levels had significantly lower quality of life domain scores. We believe that apart from hypothyroidism, a high antibody level was one of the contributing factors for the development of HT-associated symptoms, leading to a lower quality of life. Other probable contributing factors such as selenium deficiency, thyroid hormone fluctuation, and disease awareness should keep in mind.