Abstract
Introduction: Patients with Hashimoto’s often complain of persistent symptoms despite being on optimal medical therapy. Research suggests that thyroidectomy may have a role in improving this. We investigated the change in Quality of Life (QoL), symptom burden and mental health from baseline to 1 year after total thyroidectomy in patients with underlying thyroiditis.
Methods: We conducted semi-structured interviews with 96 patients at baseline and 1 year to discuss their thyroid-related symptom burden. Patients utilized prompt cards to identify and rank the severity of their thyroid-related symptoms (3 being most bothersome and 0 being no effect at all). Individual symptom scores were added to calculate a Cumulative Symptom Score (CSS). Patients also completed the validated Short Form-12 (SF-12) questionnaire for mental and physical health (scored from 0-100; higher score attributing to better health) and ThyCa-QoL questionnaire (scored from 0-100; higher score attributing more complaints) at these 2 time-points.
Results: Of the 96 patients with available CSS data, there were 37 patients in the Hashimoto’s group (97% had biopsy proven thyroiditis and 24% were on thyroid hormone at baseline) and 59 patients in the control group. At baseline, Hashimoto’s patients had a higher CSS than the control group (9.94 vs. 7.13, p=0.05). Overall, mean CSS, in both groups, declined from baseline to 1 year (7.74 to 6.08, p=0.04), and over half of the individual patients, had a decline in their CSS at 1 year (56% in Hashimoto’s and 54% in control). Although, the Hashimoto’s group started higher at their baseline, they also had a slightly larger decline in CSS at 1 year than the control patients (-2.2, p=0.11 vs. -1.2, p=0.19). On the SF-12, Hashimoto’s patients had a significant improvement in their mental health (+ 6.0 pts, CI 1.8-10.2, p value = 0.007) whereas the control patients did not (+2.4 pts, CI 0.3-5.2, p=0.08). On the ThyCa-QoL, Hashimoto’s patients had worse scores at baseline as compared to the control patients (20.8 vs 16.7, p=0.11) and there was a slight but clinically significant improvement from baseline to 1 year (decrease in mean of 1.18 pts, p=0.5). Analysis of the qualitative data showed that of the 10 patients who were on thyroid hormone pre-operatively, 9 described significant symptom improvement at 1 year, with fatigue being the major symptom that was reported as improved.
Conclusion: Based on the data above, we see that patients with Hashimoto’s do have a higher symptom burden at baseline and thyroidectomy may play a role in symptom alleviation as well as improving mental health and QoL. Our data supports recent findings that thyroidectomy may play a role in alleviating thyroid related symptoms in this patient population and further investigation to better understand this phenomenon is warranted.