ABSTRACT
Introduction:
Thyroidectomy, which consists of partial or total removal of the thyroid gland, is a commonly performed surgery to treat various thyroid diseases. In recent years, the trend has been toward partial thyroidectomies, due to their association with lower complication rates and the fact that they may be sufficient for adequate management.
Objective:
To evaluate the impact of partial and total thyroidectomy on quality of life.
Methods:
This study used the ThyPro questionnaire, which assesses the quality of life of patients with thyroid disorders, to investigate the impact of different thyroidectomy approaches on patients’ quality of life.
Results:
The postoperative complications were transient unilateral recurrent nerve paralysis (6.5%) and transitory hypoparathyroidism (22.4%). The quality of life outcomes after thyroidectomy were favorable. The extension of the thyroidectomy did not present statistical difference (p = 0.982). Significantly lower scores were associated with female gender and neck dissection.
Conclusion:
Quality of life scores were high, with lower scores among women and neck dissection.
Keywords: Thyroidectomy, Quality of Life, Postoperative Complications, Dysphonia, Hypoparathyroidism
RESUMO
Objetivo:
A tireoidectomia, remoção parcial ou total da glândula tireoide, é uma cirurgia comumente realizada para diversas doenças da tireoide. Recentemente, tem-se observado uma tendência pelo uso de tireoidectomias parciais, devido às taxas de complicações mais baixas e resultados terapêuticos adequados.
Objetivo:
Avaliar o impacto da tireoidectomia parcial e total na qualidade de vida.
Métodos:
O questionário ThyPRO-39 foi utilizado para avaliar os resultados específicos de qualidade de vida relacionados à tireoide em pacientes que se submeteram a diferentes abordagens de tireoidectomia.
Resultados:
As complicações pós-operatórias foram paralisia unilateral transitória do nervo recorrente (6,5%) e hipoparatireoidismo transitório (22,4%). Os resultados de qualidade de vida após a tireoidectomia foram favoráveis. A extensão da tireoidectomia não apresentou diferença estatística (p = 0,982). Escores significativamente mais baixos foram associados ao gênero feminino e ao esvaziamento cervical.
Conclusão:
Os escores de qualidade de vida foram elevados, com escores mais baixos entre as mulheres e na presença de esvaziamento cervical.
Palavras-chave: Tireoidectomia, Qualidade de Vida, Complicações Pós-Operatórias, Disfonia, Hipoparatireoidismo
INTRODUCTION
Thyroidectomy can be partial or total 1 . With the increase in safety and efficacy of these procedures, there is a growing preference for less than total thyroidectomy, as it is associated with reduced complication rates while providing adequate management for low-risk tumors and benign conditions 2 , 3 .
Thyroid surgery complications may impact patients’ quality of life. The main ones are permanent or transient hypocalcemia, permanent or transient recurrent laryngeal nerve paralysis, 5 as well as hemorrhage and hematoma. Total thyroidectomy is associated with higher hypoparathyroidism rates compared with hemithyroidectomy 4 , 5 .
In recent years, the discussion about the quality of life in patients undergoing thyroidectomy has gained prominence. Health-related quality of life can be defined as the global impact that diseases and their treatments have on all relevant dimensions of the patient’s life. This concept can only be evaluated by the patient himself/herself, as it is subjective and includes different aspects of well-being, such as physical, mental, and social. Standardized questionnaires are used to measure it 6 .
An instrument that is used to evaluate specific thyroid treatment results is the Thyroid-Related Patient-Reported Outcome (ThyPRO) questionnaire, developed by Watt et al. 7 , 8 at the Rigshospitalet, in Copenhagen, Denmark, which evaluates the quality of life of patients with benign thyroid disorders, including thyroid dysfunction and goiter. The questionnaire includes 12 domains covering physical and mental aspects, symptoms, well-being, function, as well as the impact of thyroid diseases on social and daily life and, in general, on the quality of life of patients with benign thyroid disorders. The PRO suffix denotes “patient-reported outcome”. The questionnaire originally underwent the four phases of development: phase I (generation edition), where questions related to quality of life and possible relevance were identified in relation to thyroid diseases; phase II (operationalization), where selected relevant questions were converted to items of a draft questionnaire; phase III (pre-test), where a draft of the questionnaire was tested and revised based on the cognitive interview technique; and phase IV (quantitative validation), where the internal consistency, reliability, and validity (Cronbach’s) of the constructed scales were tested in a large sample of patients. The questionnaire has been validated and considered useful in clinical studies 9 , 10 .
In 2015, an abbreviated version of this questionnaire, with 39 questions, was developed and named ThyPRO-39. This new questionnaire showed good measurement properties and was recommended for clinical use 11 . This same version was translated and satisfactorily validated into Brazilian Portuguese and is known as ThyPRO-39br 12 .
Although initially constructed to evaluate the results in benign thyroid diseases, ThyPRO can be applied to patients undergoing thyroidectomy, regardless of surgical indication and including suspected or confirmed malignancy 13 , 14 . Based on this, in our study we did not consider malignancy as an exclusion factor.
The aim of this study was to investigate the differences in the impact on the patient’s quality of life by comparing total and partial thyroidectomy and to analyze potential risk factors for worse quality of life in patients undergoing the procedure due to benign and malignant disease.
METHODS
The research was approved by the Human Ethics in Research Committee (CEPSH) of the Lusíadas University Center (UNILUS), under protocol number 895/2024, CAAE number 80501324.9.0000.5436.
This is a cross-sectional, observational study, in which we applied a questionnaire on quality of life in patients with thyroid diseases, the Thyroid-Related Patient-Reported Outcome-39 (ThyPRO-39), validated for Brazilian Portuguese by Dr. Jônatas Catunda 12 .
We included consecutive patients undergoing thyroidectomy and being followed up at the Head and Neck Surgery Center of Santos. They underwent total or partial thyroidectomy between 2021 and 2023, with a postoperative follow-up time of at least twelve months. Considering previous validation 13 , 14 , we enrolled patients operated on for benign and malignant diseases. We excluded those under 18 years of age or unable to perform any of the study assessments. We collected epidemiological and clinical data from medical records.
Patients were asked to fill out the ThyPRO-39br 12 on the Google Forms platform. The first field to be filled in was the Informed Consent Form and then the questionnaire. Data collection was carried out between May and September 2024.
After answering the questions for sample segmentation, the participant answered the ThyPRO-39br questionnaire. Responses are scored from 0 to 4, following a Likert scale (where ‘’0’’ equals ‘’no’’ and ‘’4’’ equals ‘’very’’), always considering the perception during the last four weeks.
The results are distributed in 13 aspects or scales, and a final composite result generates a score from 0 to 100 for each of them. The higher the score, the higher the frequency of symptoms of the respective scale and the greater the impact on quality of life.
The scales are: 1. Goiter symptoms; 2. Hyperthyroidism symptoms; 3. Hypothyroidism symptoms; 4. Ocular symptoms; 5. Fatigue; 6. Cognitive problems; 7. Anxiety; 8. Depression; 9. Emotional; 10. Impact on social life; 11. Impact on daily life; 12. Complaints of appearance; and 13. Quality of life in general. The way the results of the ThyPRO-39br are calculated are in the Annex.
The outcome of the methods used was to create comparative scores of the results of the ThyPRO-39br scales with the categorical variables sex, age, anatomopathological outcome, presence of thyroiditis, thyroidectomy extension, neck dissection, radioiodine therapy, unilateral nerve palsy, loss of vocal extension, hypoparathyroidism, need for definitive calcium replacement, and need for definitive thyroid hormone replacement.
As for statistical analysis, we used the frequency distribution to describe the categorical variables (number of cases and relative percentage) and the measures of central tendency (mean and median) and variability (minimum, maximum and standard deviation) for the numerical variables. The associations between the scores and independent categorical variables with two categories were assessed with the Mann-Whitney U test, and with three or more categories, with the Kruskal-Wallis test. We adopted a significance level of 5% for all statistical tests. We used the statistical software Stata, version 18, to perform all statistical analyses 15 .
RESULTS
We included 107 patients who answered the questionnaire. There was a predominance of females (77.6%) and the mean age was 50.9 years. Regarding the anatomopathological diagnosis, 57.9% were goiter or adenoma, and thyroiditis was not observed in 83.2%. Total thyroidectomy was performed in 81.3% (87); 86.9% did not undergo neck dissection; and 92.5% did not receive adjuvant radioiodine therapy. Regarding complications, seven patients (6.5%) had transient unilateral recurrent nerve palsy, 24 (22.4%) had hypoparathyroidism, and 98.1% (105) did not require calcium replacement (Table 1).
Table 1. Sample demographics and clinical variables - 107 patients.
| Variable | Category / Measurements | Freq. (%) / Measures |
|---|---|---|
| Sex | Female Male |
83 (77.6) 24 (22.4) |
| Age (years) | Range Median Mean (Standard Deviation) |
25 - 84 51 50.9 (13.4) |
| Anatomopathological | Goiter/Adenoma Well-differentiated carcinoma |
62 (57.9) 45 (42.1) |
| Thyroiditis | No Yes |
89 (83.2) 18 (16.8) |
| Extension of thyroidectomy | Partial Total |
20 (18.7) 87 (81.3) |
| Neck dissection | No Single-sided central compartment Bilateral central compartment Lateral Modified radical |
93 (86.9) 1 (0.9) 0 12 (11.2) 1 (0.9) |
| Neck dissection | No Yes |
93 (86.9) 14 (13.1) |
| Radioiodine therapy | No Yes |
99 (92.5) 89 (7.5) |
| Unilateral nerve palsy | No Transitory Definitive |
100 (93.5) 7 (6.5) 0 |
| Hypoparathyroidism | No Yes |
83 (77.6) 24 (22.4) |
| Calcium replacement | No Yes |
105 (98.1) 2 (1.9) |
| Thyroid hormone replacement | No Hormone replacement Suppression of TSH |
22 (20.6) 47 (43.9) 38 (35.5) |
The ThyPRO-39 questionnaire allowed the sample to be distributed according to the symptoms scales. Among the symptoms reported, those standing out were fatigue, with a median of 33 and an average score of 42.2, depression, with a median of 22 and a mean of 28.1, and anxiety, with a median of 18 and a mean of 23.6. The emotional aspect showed a median of 28 and a mean of 32.8. Cognitive problems had a median of 14 and a mean of 20.2 (Table 2).
Table 2. Sample distribution according to symptom scales - 107 cases.
| Variable | Measures | Measures |
|---|---|---|
| Goiter symptoms | Range Median Mean (standard deviation) |
2 - 73 10 12.2 (13.8) |
| Hyperthyroidism symptoms | Range Median Mean (standard deviation) |
2 - 84 8 11.6 (12.8) |
| Hypothyroidism symptoms | Range Median Mean (standard deviation) |
0 - 87.5 6.25 15.8 (18.5) |
| Ocular symptoms | Range Median Mean (standard deviation) |
1 - 68 1 8.3 (12.2) |
| Fatigue | Range Median Mean (standard deviation) |
0 - 100 33 42.2 (28.7) |
| Cognitive problems | Range Median Mean (standard deviation) |
1 - 76 14 20.2 (20.5) |
| Anxiety | Range Median Mean (standard deviation) |
1 - 79 18 23.6 (20.5) |
| Depression | Range Median Mean (standard deviation) |
0 - 97 22 28.1 (22.4) |
| Emotional | Range Median Mean (standard deviation) |
1 - 95 28 32.8 (25.2) |
| Variable | Measures | Measures |
| Impact on social life | Range Median Mean (standard deviation) |
0 - 75 0 11.9 (17.8) |
| Impact on day-to-day life | Range Median Mean (standard deviation) |
0 - 98 0 17.2 (22.8) |
| Appearance complaints | Range Median Mean (standard deviation) |
1 - 87 1 18.1 (23.1) |
The average overall impact on quality of life was 18.9 (Table 3).
Table 3. Sample distribution according to the aspect Quality of Life in General and the composite symptoms scale - 107 cases.
| Variable | Measures | Measures |
|---|---|---|
| Quality of life in general | Range Median Mean (standard deviation) |
0 - 100 0 18.9 (26.6) |
| Composite symptoms scale | Range Median Mean (standard deviation) |
1.1 - 71.6 23.9 25.8 (16.7) |
There was a predominance of goiter symptoms in females and among individuals who required calcium replacement, and these symptoms were more pronounced among individuals who underwent neck dissection. Females and those under 50 years of age had greater hyperthyroidism symptoms. Patients undergoing total thyroidectomy had higher scores for hypothyroidism symptoms, while neck dissection showed an increase in the manifestation of ocular symptoms. Female patients and those undergoing neck dissection had higher scores in the fatigue aspect. Female sex and hypoparathyroidism showed higher scores for anxiety. The depression aspect was higher among women, patients aged up to 50 years, and among those who underwent radioiodine therapy. The evaluation of the scores of the emotional sensitivity aspect revealed higher rates among women, aged up to 50 years and in well-differentiated thyroid carcinoma. The analysis of the impact on social life and the impact on day-to-day life aspects revealed higher scores in females and in case of neck dissection. Investigation of the appearance complaints aspect revealed a greater impact after total thyroidectomy.
Demographics and clinical variables did not show significant differences when related to the Quality of Life in General aspect, except for neck dissection (Table 4). As for the ThyPRO-39 composite scale, female sex and neck dissection were related to higher scores (Table 5).
Table 4. Demographics and clinical variables according to ThyPro Overall impact on quality of life aspects - 107 patients.
| Variable | Measures | N | Range | Median | Medium (±SD) | p-value |
|---|---|---|---|---|---|---|
| Sex | Female Male |
83 24 |
0 - 100 0 - 75 |
0 0 |
21.4 (± 27.9) 10.4 (± 19.4) |
0.081 |
| Age (years) | ≤ 50 > 50 |
53 54 |
0 - 100 0 - 75 |
0 0 |
22.6 (± 29.5) 15.3 (± 23.0) |
0.193 |
| Anatomopathology | Goiter/Adenoma Well-differentiated carcinoma |
62 45 |
0 - 75 0 - 100 |
0 0 |
17.7 (± 24.1) 20.5 (± 29.8) |
0.896 |
| Thyroiditis | No Yes |
89 18 |
0 - 100 0 - 75 |
0 25 |
17.4 (± 26.5) 26.4 (± 26.4) |
0.097 |
| Extension of thyroidectomy | Partial Total |
20 87 |
0 - 75 0 - 100 |
0 0 |
17.5 (± 23.1) 19.2 (± 27.4) |
0.982 |
| Neck dissection | No Yes |
93 14 |
0 - 100 0 - 100 |
0 25 |
16.9 (± 25.0) 32.1 (± 33.1) |
0.058 |
| Radioiodine therapy | No Yes |
99 8 |
0 - 100 0 - 100 |
0 25 |
17.9 (± 26.0) 31.2 (± 32.0) |
0.108 |
| Unilateral nerve palsy | No Transitory |
100 7 |
0 - 100 0 - 50 |
0 0 |
19.2 (± 27.0) 14.3 (± 19.7) |
0.822 |
| Variable | Measures | N | Range | Median | Medium (±SD) | p-value |
| Hypoparathyroidism | No Yes |
83 24 |
0 - 100 0 - 75 |
0 0 |
19.9 (± 27.0) 15.6 (± 25.3) |
0.468 |
| Calcium replacement | No Yes |
105 2 |
0 - 100 0 |
0 0 |
19.3 (± 26.7) 0 |
NA |
| Thyroid hormone replacement | No Hormone replacement Suppression of TSH |
22 47 38 |
0 - 75 0 - 75 0 - 100 |
0 0 0 |
13.6 (± 21.4) 19.1 (± 25.1) 21.7 (± 30.8) |
0.669* |
p-value obtained by the Mann-Whitney U test; * p-value obtained by the Kruskal-Wallis test; NA = Not statistically evaluable.
Table 5. Demographics and clinical variables according to ThyPro Composite scale - 107 patients.
| Variable | Measures | N | Range | Median | Medium (±SD) | p-value |
|---|---|---|---|---|---|---|
| Sex | Female Male |
83 24 |
1.1 - 71.6 2.3 - 46.6 |
27.3 12.5 |
28.6 (± 17.2) 16.0 (± 10.6) |
<0.001 |
| Age group (years) |
≤ 50 > 50 |
53 54 |
2.3 - 71.6 1.1 - 56.8 |
28.4 20.4 |
29.5 (± 18.5) 22.2 (± 14.0) |
0.051 |
| Anatomopathology | goiter/adenoma Well-differentiated carcinoma |
62 45 |
1.1 - 71.6 2.3 - 69.3 |
20.4 25.0 |
23.3 (± 15.9) 29.2 (± 17.4) |
0.086 |
| Thyroiditis | No Yes |
89 18 |
1.1 - 69.3 3.4 - 71.6 |
22.7 25 |
25.5 (± 16.3) 27.4 (± 19.0) |
0.780 |
| Extension of thyroidectomy | Partial Total |
20 87 |
3.4 - 56.8 1.1 - 71.6 |
20.4 25 |
21.4 (± 13.6) 26.8 (± 17.3) |
0.220 |
| Neck dissection | No Yes |
93 14 |
1.1 - 71.6 20.4 - 67.0 |
20.4 30.1 |
24.3 (± 16.4) 35.5 (± 16.1) |
0.018 |
| Radioiodine therapy | No Yes |
99 8 |
1.1 - 71.6 11.4 - 67.0 |
22.7 34.1 |
25.0 (± 16.2) 36.1 (± 21.1) |
0.118 |
| Unilateral nerve palsy | No Transitory |
100 7 |
1.1 - 71.6 4.5 - 36.4 |
23.9 9.1 |
26.4 (± 16.8) 17.4 (± 13.4) |
0.144 |
| Hypoparathyroidism | No Yes |
83 24 |
1.1 - 71.6 6.8 - 59.1 |
22.7 31.8 |
24.6 (± 17.2) 30.0 (± 14.5) |
0.055 |
| Calcium replacement | No Yes |
105 2 |
1.7 - 71.6 19.3 - 35.2 |
23.9 27.3 |
25.8 (± 16.9) 27.3 (± 11.2) |
0.757 |
| Thyroid hormone replacement | Hormone replacement Suppression of TSH |
22 47 38 |
3.4 - 56.8 1.1 - 71.6 2.3 - 69.3 |
17.6 23.9 27.3 |
20.7 (± 13.6) 24.3 (± 15.2) 30.6 (± 19.2) |
0.135* |
p-value obtained by the Mann-Whitney U test; * p-value obtained by the Kruskal-Wallis test.
DISCUSSION
The quality-of-life results obtained in our study were good. One hundred and seven patients participated in the study and the overall impact on quality of life of ThyPRO-39 had a mean of 18.9, while the median for the composite symptom scale was 23.9. Symptoms predominated in females, among patients on calcium replacement, and among those who underwent neck dissection. Women tend to have higher levels of anxiety related to the diagnosis of thyroid nodule or cancer, even in low-risk cases. This amplifies the negative perception of residual symptoms and limitations in the postoperative period 16 .
Impairment in quality of life is more frequent in a one-year follow-up after thyroidectomy. This may have been attributed to postoperative complications such as hypocalcemia, vocal cord paralysis, or hematoma during the one-year postoperative period 17 .
Post-thyroidectomy quality of life can vary between patients and depends on several factors, such as the presence of complications, the need for hormone replacement therapy, and adaptation to postoperative changes. Complications are not uncommon 18 , so the advantages of partial thyroidectomy, including lower risk of recurrent laryngeal nerve injury and hypoparathyroidism, are important. In addition, there is a growing awareness that thyroid replacement therapy imperfections and postoperative scarring have effects on well-being 19 .
We found an association between hypoparathyroidism and anxiety. Partial thyroidectomy minimizes the risk of hypoparathyroidism. By preserving part of the thyroid and therefore the parathyroid glands on the unmanipulated side, surgery reduces the likelihood of damage or removal of the parathyroids. However, even in partial thyroidectomies, there is still some risk of hypoparathyroidism. Postoperative follow-up is important to monitor parathyroid function and calcium levels 20 , 21 .
Dysphonia after thyroidectomy is relatively common and can occur due to trauma to the vocal folds, intubation, or inflammation of the healing process. As the patients were evaluated one year after surgery, definitive vocal fold paralysis is the outcome with the potential to impact vocal quality. In partial thyroidectomy, it may have a lower risk compared to total thyroidectomy, in which both sides are manipulated 22 . We did not find dysphonia in long-term evaluations.
Neck scarring is one of the potential factors that can affect quality of life 23 . Patients are usually satisfied with their scars in the short term 24 . However, there is little evidence on the long-term evolution of patients’ perceptions 25 . Although it tends to improve over time, cervical scarring after thyroidectomy can compromise quality of life, especially in women, by accentuating anxiety, aesthetic concern, and social impact. Nonetheless, in most patients the scar is discreet and aesthetically acceptable, with high satisfaction. We did not find significant aesthetic complaints, but this was significantly higher in the total thyroidectomy group. The literature does not share these findings, and there is no significant difference in scar scores between hemithyroidectomy and total thyroidectomy, which would be intuitive, since the scar in both conditions tends to be similar 26 .
Reasons for a worse prognosis after thyroidectomy include fear of recurrence, adjustment to normal TSH, and postoperative complications 27 , 28 . The fact that scores related to mental health and vitality, as well as limitations due to physical or emotional problems, did not deteriorate within the period examined, signals that thyroidectomy does not affect patients’ long-term quality of life. The diagnosis and treatment of cancer can lead to a series of changes in the mental/psychological capacity of the patient, in the social role he plays in society, in his personal life and, finally, in everything that involves appearance 29 .
The persistence of higher levels of depression in patients requiring multiple levothyroxine dosage adjustments to maintain euthyroidism compared with patients not requiring adjustments may be due to depressive symptoms requiring a longer period of euthyroidism to disappear after surgical treatment. This explains the higher rates of hypothyroidism symptoms among patients who underwent total thyroidectomy in our study. Remission of depressive symptoms after pharmacological treatment of thyroid disease has been widely demonstrated 19 .
The extent of thyroidectomy in the initial surgical management of differentiated thyroid carcinoma has generated significant debate. There are clear and widely accepted indications for total thyroidectomy: overt bilateral disease, extrathyroidal extension, aggressive variants, and regional or distant metastases. In the absence of these characteristics, different indications arise as to extension. One of the arguments to support hemithyroidectomy is that it has less impact on patients’ quality of life 30 .
The present series reveals good quality of life in patients undergoing thyroidectomy related to the low rate of complications. The limitations of this study are its retrospective nature and the fact that the sample size is moderate, though sufficient for statistical analysis.
CONCLUSION
Quality of life after thyroidectomy was good overall, being influenced by specific clinical and demographic variables. Females had worse scores in multiple domains (fatigue, anxiety, depression, emotional sensitivity, social impact, and appearance). Neck dissection was associated with greater global impairment of quality of life, with increased symptoms of goiter, fatigue, social and ocular impact. Total thyroidectomy was associated with higher scores for hypothyroidism symptoms and worse aesthetic perception. Hypoparathyroidism correlated with greater anxiety, although it rarely required continuous calcium replacement. Radioiodine therapy and age <50 years were associated with greater depression and symptoms of hyperthyroidism.
ACKNOWLEDGEMENTS
We thank Dr. Jônatas Catunda for his help and for making available the ThyPRO-39 questionnaire validated for Portuguese, as well as for calculating the scores 12.
Footnotes
Data Availability Datasets related to this article will be available upon request to the corresponding author.
Funding source: none.
REFERENCES
- 1.Dent P, Kumar A. Thyroidectomy Surgery. Oxford. 2024;42(4):246–251. doi: 10.1016/j.mpsur.2024.01.001. [DOI] [Google Scholar]
- 2.Scott B, Wong RJ. Step-by-Step Thyroidectomy-Incision, Nerve Identification, Parathyroid Preservation, and Gland Removal. Otolaryngol Clin North Am. 2024;57(1):25–37. doi: 10.1016/j.otc.2023.08.007. [DOI] [PubMed] [Google Scholar]
- 3.Marciniak C, Lenne X, Clément G, Bruandet A, Lifante JC, Sebag F, Mirallié E, Mathonnet M, Brunaud L, Donatini G, Tresallet C, Ménégaux F, Theis D, Pattou F, Caiazzo R. on the behalf of AFCE Study Group Partial Versus Total Thyroidectomy What Influences Most Surgeons' Decision? Analysis of a Nationwide Cohort of 375,810 Patients Over 10 Years. Ann Surg. 2021;274(5):829–835. doi: 10.1097/SLA.0000000000005134. [DOI] [PubMed] [Google Scholar]
- 4.Baral S, Borgohain R, Timungpi G. Complications of thyroidectomy Insights from a single-centre study in northeast India. J Otorhinolaryngol Allied Sci. 2023;6(4):113–118. doi: 10.18231/j.ijoas.2023.026. [DOI] [Google Scholar]
- 5.Daba SA, Teklewold B, Suga Y, Biratu TD, Hassen IK. Post-Thyroidectomy Complications at St Paul's Hospital Millennium Medical College, Ethiopia Associated Factors and Outcomes', Open Access. Surg. 2023;16:77–86. doi: 10.2147/OAS.S428155. [DOI] [Google Scholar]
- 6.Boronat M, González-Lleó A, Rodríguez-Pérez C, Feldt-Rasmussen U, López-Plasencia Y, Rasmussen ÅK, Alberiche-Ruano MP, Hegedüs L, Alvarado-Martel D, Bonnema SJ, Marrero-Arencibia D, Groenvold M, Bjorner JB, Watt T. Adaptation and cross-cultural validation of the Spanish version of the Thyroid-Related Quality-of-Life Patient-Reported Outcome questionnaire. Endocrinol Diabetes Nutr (Engl Ed) 2018;65(9):500–507. doi: 10.1016/j.endinu.2018.06.010. [DOI] [PubMed] [Google Scholar]
- 7.Watt T, Hegedüs L, Rasmussen AK, Groenvold M, Bonnema SJ, Bjorner JB, Feldt-Rasmussen U. Which domains of thyroid-related quality of life are most relevant Patients and clinicians provide complementary perspectives. Thyroid. 2007;17(7):647–654. doi: 10.1089/thy.2007.0069. [DOI] [PubMed] [Google Scholar]
- 8.Watt T, Rasmussen AK, Groenvold M, Bjorner JB, Watt SH, Bonnema SJ, Hegedüs L, Feldt-Rasmussen U. Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing. Qual Life Res. 2008;17(7):1009–1017. doi: 10.1007/s11136-008-9364-z. [DOI] [PubMed] [Google Scholar]
- 9.Watt T, Bjorner JB, Groenvold M, Rasmussen AK, Bonnema SJ, Hegedüs L, Feldt-Rasmussen U. Establishing construct validity for the thyroid-specific patient reported outcome measure (ThyPRO) an initial examination. Qual Life Res. 2009;18(4):483–496. doi: 10.1007/s11136-009-9460-8. [DOI] [PubMed] [Google Scholar]
- 10.Watt T, Hegedüs L, Groenvold M, Bjorner JB, Rasmussen AK, Bonnema SJ, Feldt-Rasmussen U. Validity and reliability of the novel thyroid-specific quality of life questionnaire, ThyPRO. Eur J Endocrinol. 2010;162(1):161–167. doi: 10.1530/EJE-09-0521. [DOI] [PubMed] [Google Scholar]
- 11.Watt T, Bjorner JB, Groenvold M, Cramon P, Winther KH, Hegedüs L, Bonnema SJ, Rasmussen ÅK, Ware JE, Jr, Feldt-Rasmussen U. Development of a Short Version of the Thyroid-Related Patient-Reported Outcome ThyPRO. Thyroid. 2015;25(10):1069–1079. doi: 10.1089/thy.2015.0209. [DOI] [PubMed] [Google Scholar]
- 12.Freitas JC. Validação do questionário thypro-39br e desenvolvimento de aplicativo para avaliar a qualidade de vida em pacientes com doenças da tireoide. Ceará: Universidade Federal do Ceará; 2021. [Google Scholar]
- 13.Dwivedi S, Kumar S, Saxena V, Dutta A, Dinker Y, Dwivedi S, Majumdar SS, Varshaney A, Sharma M. Evaluation of Scar Cosmesis and Quality of Life After Thyroid Surgery A Retrospective Study. Indian J Otolaryngol Head Neck Surg. 2025;77(3):1505–1512. doi: 10.1007/s12070-025-05368-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Honkanen J, Molnár K, Karhumaa T, Kakko S, Koivunen P, Franssila H, Koskela U, Erkinaro T, Liisanantti J. Patients undergoing thyroid surgery suffer preoperatively from poor quality of life. J Endocrinol Invest. 2025 doi: 10.1007/s40618-025-02661-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.StataCorp . Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC; 2023. [Google Scholar]
- 16.Monzani ML, Piccinini F, Boselli G, Corleto R, Margiotta G, Peeters RP, Simoni M, Brigante G. Changes in quality of life after thyroidectomy in subjects with thyroid cancer in relation to the dose of levothyroxine. J Endocrinol Invest. 2023;46(2):319–326. doi: 10.1007/s40618-022-01903-6. [DOI] [PubMed] [Google Scholar]
- 17.Yu HW, An AR, Kang HI, Suh YJ, Kwon H, Kim SJ, Chai YJ, Choi JY, Choi H, Lee KE, Cho B. Does Thyroidectomy Impact Quality of Life Retrospective Case-Control Study of Post-Thyroidectomy Patients and Matched Individuals from the General Population. Medicina (Kaunas) 2020;56(11):603–603. doi: 10.3390/medicina56110603. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, Lausen I. Complications to thyroid surgery results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393(5):667–673. doi: 10.1007/s00423-008-0366-7. [DOI] [PubMed] [Google Scholar]
- 19.Ritchie M, Yeap BB. Thyroid hormone Influences on mood and cognition in adults. Maturitas. 2015;81(2):266–275. doi: 10.1016/j.maturitas.2015.03.016. [DOI] [PubMed] [Google Scholar]
- 20.Caglià P, Puglisi S, Buffone A, Bianco SL, Okatyeva V, Veroux M, Cannizzaro MA. Post-thyroidectomy hypoparathyroidism, what should we keep in mind. Ann Ital Chir. 2017;6:371–381. [PubMed] [Google Scholar]
- 21.Dedivitis RA, Aires FT, Cernea CR. Hypoparathyroidism after thyroidectomy prevention, assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2017;25(2):142–146. doi: 10.1097/MOO.0000000000000346. [DOI] [PubMed] [Google Scholar]
- 22.Kim GJ, Bang J, Shin HI, Kim SY, Bae JS, Kim K, Kim JS, Hwang YS, Shim MR, Sun DI. Persistent subjective voice symptoms for two years after thyroidectomy. Am J Otolaryngol. 2023;44(3):103820–103820. doi: 10.1016/j.amjoto.2023.103820. [DOI] [PubMed] [Google Scholar]
- 23.Kurumety SK, Helenowski IB, Goswami S, Peipert BJ, Yount SE, Sturgeon C. Post-thyroidectomy neck appearance and impact on quality of life in thyroid cancer survivors. Surgery. 2019;165(6):1217–1221. doi: 10.1016/j.surg.2019.03.006. [DOI] [PubMed] [Google Scholar]
- 24.Linos D, Economopoulos KP, Kiriakopoulos A, Linos E, Petralias A. Scar perceptions after thyroid and parathyroid surgery comparison of minimal and conventional approaches. Surgery. 2013;153(3):400–407. doi: 10.1016/j.surg.2012.08.008. [DOI] [PubMed] [Google Scholar]
- 25.Dordea M, Aspinall SR. Short and long-term cosmesis of cervical thyroidectomy scars. Ann R Coll Surg Engl. 2016;98(1):11–17. doi: 10.1308/rcsann.2016.0022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Felix C, Russell JO, Juman S, Medford S. Cervical scar satisfaction post conventional thyroidectomy. Gland Surg. 2019;8(6):723–728. doi: 10.21037/gs.2019.11.17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Hedman C, Djärv T, Strang P, Lundgren CI. Effect of Thyroid-Related Symptoms on Long-Term Quality of Life in Patients with Differentiated Thyroid Carcinoma A Population-Based Study in Sweden. Thyroid. 2017;27(8):1034–1042. doi: 10.1089/thy.2016.0604. [DOI] [PubMed] [Google Scholar]
- 28.Rogers SN, Mepani V, Jackson S, Lowe D. Health-related quality of life, fear of recurrence, and emotional distress in patients treated for thyroid cancer. Br J Oral Maxillofac Surg. 2017;55(7):666–673. doi: 10.1016/j.bjoms.2016.09.001. [DOI] [PubMed] [Google Scholar]
- 29.Bãrbus E, Pestean C, Larg MI, Piciu D. Quality of life in thyroid cancer patients a literature review. Clujul Med. 2017;90(2):147–153. doi: 10.15386/cjmed-703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Mishra A, Sabaretnam M, Chand G, Agarwal G, Agarwal A, Verma AK, Mishra SK. Quality of life (QoL) in patients with benign thyroid goiters (pre- and post-thyroidectomy) a prospective study. World J Surg. 2013;37(10):2322–2329. doi: 10.1007/s00268-013-2133-3. [DOI] [PubMed] [Google Scholar]