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Serrao-Brown H, Saadi A, Wong J, Papachristos A, Sywak M, Sidhu S. Outcomes of thyroidectomy in symptomatic, euthyroid Hashimoto's patients: a case control study. ANZ J Surg 2024. [PMID: 39011996 DOI: 10.1111/ans.19155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/01/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
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.
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Affiliation(s)
- Hazel Serrao-Brown
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Amna Saadi
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jessica Wong
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Alexander Papachristos
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark Sywak
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stan Sidhu
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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2
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Alnefaie SM. Surgical Decision-Making in Thyroiditis: A Review Article. Cureus 2023; 15:e46055. [PMID: 37900438 PMCID: PMC10604427 DOI: 10.7759/cureus.46055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
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.
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3
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Dedivitis RA, Matos LLD, Souza FGS, Bogado Ortiz JL. Association between Thyroiditis and Multifocality in Papillary Thyroid Carcinoma. Int Arch Otorhinolaryngol 2020; 25:e219-e223. [PMID: 33968223 PMCID: PMC8096513 DOI: 10.1055/s-0040-1710307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/12/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction
Hashimoto thyroiditis (HT) shares many characteristics with papillary thyroid carcinoma (PTC), and some studies show that, when associated, PTC is diagnosed mostly with smaller lesions and multifocal pattern.
Objective
To evaluate the relationship between HT and PTC.
Methods
A retrospective study of 155 patients who underwent total thyroidectomy from 2009 to 2015. Demographical, clinical and ultrasonographical data, as well as anatomopathological findings were evaluated.
Results
There were signs of thyroidits in 35 patients, and 114 patients had a unifocal disease. There was no statistical significance between the variables studied and thyroiditis. However, when compared with the occurrence of unifocal or multifocal lesions, there was statistical significance regarding age (
p
= 0.038) and mass (
p
= 0.031). There was no direct relationship between thyroiditis and multifocality (
p
= 0.325) nor between thyroiditis and cervical extension of the disease (
p
= 0.300 e
p
= 0.434).
Conclusion
There was no relationship between thyroiditis and multifocality in cases of PTC.
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Affiliation(s)
- Rogério Aparecido Dedivitis
- Department of Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Department of Head and Neck Surgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Leandro Luongo de Matos
- Department of Surgery, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,Department of Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, São Paulo, Brazil
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Anti-Thyroid Antibodies and TSH as Potential Markers of Thyroid Carcinoma and Aggressive Behavior in Patients with Indeterminate Fine-Needle Aspiration Cytology. World J Surg 2019; 44:363-370. [DOI: 10.1007/s00268-019-05153-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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5
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Heggie K, Yeung M, Grodski S, Lee J, Serpell J. Total thyroidectomy for pressure symptoms in patients with Hashimoto's thyroiditis. ANZ J Surg 2017; 88:359-362. [PMID: 28419663 DOI: 10.1111/ans.13943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 11/14/2016] [Accepted: 01/24/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is rarely on its own the indication for thyroidectomy. However, surgery in patients with HT will be undertaken when there is malignancy and may be required for pressure symptoms. Therefore, this study aimed to investigate the indications for surgery in HT patients. METHODS The Monash University Endocrine Surgery Database was analysed from 1994 to 2013 for patients with HT. Patients with HT were compared to a similar group of patients with no HT on histopathology. Patient demographics, indication for surgery, histopathology, gland weight and complications were analysed. RESULTS A total of 2346 patients underwent total thyroidectomy during the study period. The median age was 55 years. Eleven percent of patients had HT on final pathology (259/2346). HT patients reported more pressure symptoms, 25.5% compared to those with other pathology, 18.9% (P = 0.01). Patients with pressure symptoms had heavier glands, 113 g compared to 85 g in those with other indications for surgery (P = 0.048). Within the HT cohort, the median gland weight was 66 g compared to 93 g in those without HT (P < 0.01). On multivariate analysis, pressure symptoms as an indication for surgery was associated with HT (P < 0.01), but age, gender and gland weight were not associated. In patients operated for pressure with HT as the only pathology, 90% had relief of pressure symptoms. CONCLUSION Patients with HT were more likely to have pressure symptoms as an indication for surgery independent of gland weights.
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Affiliation(s)
- Katrina Heggie
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - Meei Yeung
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - Simon Grodski
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - James Lee
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
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6
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Preece J, Grodski S, Yeung M, Bailey M, Serpell J. Thyrotoxicosis does not protect against incidental papillary thyroid cancer. Surgery 2014; 156:1153-6. [DOI: 10.1016/j.surg.2014.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 04/14/2014] [Indexed: 10/24/2022]
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7
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Anand A, Singh KR, Kushwaha JK, Hussain N, Sonkar AA. Papillary Thyroid Cancer and Hashimoto's Thyroiditis: An Association Less Understood. Indian J Surg Oncol 2014; 5:199-204. [PMID: 25419066 DOI: 10.1007/s13193-014-0325-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/16/2014] [Indexed: 01/21/2023] Open
Abstract
Hashimoto's thyroiditis (HT), part of the spectrum of autoimmune thyroid diseases is a major cause of thyroid hypofunction worldwide. Papillary thyroid carcinoma (PTC), the most prevalent of all thyroid carcinomas has been associated with HT. Literature on this association are based on preoperative FNA or post thyroidectomy histopathology reports, which are subject to potential biases. Molecular, hormonal and histopathalogical basis of this association has been hypothesized, however a definite causal association has not been proved till date. This review aims to study the basis of this association and clinical features and management of HT concurrent with PTC. There are no distinctive clinical or radiological features that categorically differentiates HT concurrent with PTC from PTC or which can pick up a nodule harboring PTC in setting of HT. Smaller nodule size and radiological features like hypoechogenecity; hyper vascularity and calcification in a clinical setting of hypothyroidism have a higher odds ratio for malignancy and merit further investigations. PTC associated with HT has been seen to be less aggressive with earlier presentation with lesser chances of extra thyroidal extension and lymph nodal metastasis. The management and follow up of PTC in HT is no different from that of PTC alone. The prognosis of PTC concurrent with HT is better compared to age and stage matched PTC in terms of lower recurrence and disease free and overall survival.
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Affiliation(s)
- Akshay Anand
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
| | - Kul Ranjan Singh
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
| | | | - Nuzhat Hussain
- RML Institute of Medical Sciences, Lucknow, U.P. India 226001
| | - Abhinav Arun Sonkar
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
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Mok VM, Oltmann SC, Chen H, Sippel RS, Schneider DF. Identifying predictors of a difficult thyroidectomy. J Surg Res 2014; 190:157-63. [PMID: 24750986 DOI: 10.1016/j.jss.2014.03.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/05/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify preoperative variables predictive of a more difficult thyroidectomy using the TDS. METHODS A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (P<0.05) variables from a univariate analysis. RESULTS A total of 189 patients were scored using TDS. Of them, 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimotos, 34 (18.0%) from thyroid cancer, and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugols potassium iodide (81.6% DT versus 58.1% NDT, P=0.032), presence of ophthalmopathy (31.6% DT versus 9.7% NDT, P=0.028), and presence of (>4 IU/mL) antithyroglobulin antibodies (34.2% DT versus 12.9% NDT, P=0.05). Using multivariate analysis, hyperthyroidism (odds ratio [OR], 4.35, 95% confidence interval [CI], 1.23-15.36, P=0.02), presence of antithyroglobulin antibody (OR, 3.51, 95% CI, 1.28-9.66, P=0.015), and high (>150 ng/mL) thyroglobulin (OR, 2.61, 95% CI, 1.06-6.42, P=0.037) were independently associated with DT. CONCLUSIONS Using TDS, we demonstrated that a diagnosis of hyperthyroidism, preoperative elevation of serum thyroglobulin, and antithyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.
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Affiliation(s)
- Valerie M Mok
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Sarah C Oltmann
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Herbert Chen
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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9
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Wong SL, Grodski S, Yeung MJ, Serpell JW. Anti-thyroid antibodies as a predictor of thyroid cancer. ANZ J Surg 2013; 85:849-53. [DOI: 10.1111/ans.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Sze Ling Wong
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Simon Grodski
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Meei J. Yeung
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Jonathan W. Serpell
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
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10
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Jankovic B, Le KT, Hershman JM. Clinical Review: Hashimoto's thyroiditis and papillary thyroid carcinoma: is there a correlation? J Clin Endocrinol Metab 2013; 98:474-82. [PMID: 23293329 DOI: 10.1210/jc.2012-2978] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The link between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) has long been a topic of controversy. There are conflicting reports; some suggest that these two are positively correlated, whereas other studies report no relationship. EVIDENCE ACQUISITION We performed a systematic literature review of original studies that investigated the correlation between HT and PTC. The two main search engines used to identify articles were OVID Medline and PubMed. The included studies were categorized into a fine-needle aspiration biopsy (FNAB) group and an archival thyroidectomy specimen group. EVIDENCE SYNTHESIS There is no clear evidence to support the correlation between HT and PTC. Population-based FNAB studies report no linkage, whereas many of the studies of thyroidectomy specimens report a positive relationship. The average prevalence rate of PTC in patients with HT was 1.20% in 8 FNA studies of 18 023 specimens and 27.56% in 8 archival thyroidectomy studies of 9 884 specimens. The relative risk ratio of finding evidence of PTC in HT specimens ranged from .39 to 1.00 in the FNA group (average RR = .69) in contrast to 1.15 to 4.16 from the archival thyroidectomy studies (average RR = 1.59). In addition, there are many studies in the literature that propose a genetic link between HT and PTC involving the PI3K/Akt pathway and RET/PTC gene rearrangements. CONCLUSION Although limited by the lack of definitive pathology, population-based FNA studies did not find a statistically significant correlation between HT and PTC. Thyroidectomy studies, which reported a statistically significant positive correlation, are subject to selection bias. More prospective studies with longer follow-up are needed to further elucidate this relationship.
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Affiliation(s)
- Bojana Jankovic
- Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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