Thyroidectomy significantly Enhances Quality of Life in euthyroid Hashimoto's Patients: Study

A recent extension of a randomized trial published in the Annals of Internal Medicine found that total thyroidectomy significantly enhances patient-reported general health in euthyroid Hashimoto's thyroiditis for up to 5 years. The study, led by Geir Hoff and team at the University of Oslo, Norway, followed 65 patients over 60 months post-surgery, using the Short Form-36 Health Survey to measure their quality of life.

Before surgery, patients averaged a general health score of around 40 on a 0-100 scale. Following total thyroidectomy, their score surged to around 70 and maintained this level five years post-surgery. This improvement was in stark contrast to patients managed solely with hormonal medications.

The initial 18-month trial, published in close to 2019 indicated a 29-point higher score on the Short Form-36 Health Survey for those undergoing total thyroidectomy compared to those on medical management alone.

Despite the sustained improvement in quality of life, patients who underwent total thyroidectomy faced hurdles. During follow-up, 14% experienced long-term complications, including recurrent laryngeal nerve paralysis, hypoparathyroidism, and postoperative hematoma or infection. Another 13 had short-term complications lasting less than a year.

The lead acknowledged the high complication rate but noted that it didn't seem to impact the general health scores of patients and cautioned against recommending total thyroidectomy as a treatment option for this patient population due to the risk of complications.

Grounded in the hypothesis that residual auto-antigen thyroid tissue might contribute to persistent symptoms, the study highlighted a lack of documented pathophysiological mechanisms explaining the findings. The study suggested that total thyroidectomy might improve the sense of good health but emphasized the need for caution and further research.

This study helps understand the complexities surrounding thyroid surgery in euthyroid patients with Hashimoto's disease. While the procedure seems to enhance general health, the high complication rate associated with, calls for a more cautious approach and centralized treatment in dedicated centers as part of ongoing research efforts.

Reference:

Hoff, G., Bernklev, T., Johnsen, L., Reitsma, L., Sina, D., Lauzike, A., Gibbs, C., Carlsen, E., Lende, T. H., Narvestad, J. K., Kildahl, R., Omdal, R., Kvaløy, J. T., & Søiland, H. (2023). Thyroidectomy for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m23-1593