TOPLINE:
In patients with Hashimoto disease and persistent symptoms despite adequate medical treatment, total thyroidectomy had a beneficial effect up to 5 years but with a substantially higher risk for complications than initially anticipated.
METHODOLOGY:
- The 5-year follow-up of 65 participants in a randomized, open-label trial of thyroidectomy plus medical management vs medical management alone aimed at testing the hypothesis that persistent symptoms despite adequate thyroxine replacement may be related to extrathyroidal autoimmune reactions and that complete removal of thyroid tissues may attenuate autoimmune responses and relieve symptoms.
- Patients in the control group were given the option of having surgery 18 months after enrollment, depending on trial results.
- The primary outcome was patient-reported health-related quality of life measured by the dimensional general health score in the generic Short Form-36 Health Survey questionnaire.
TAKEAWAY:
- The positive treatment effect seen after 18 months was maintained throughout the 3-year follow-up.
- In the intervention group, the improved general health score remained at the same level during the 5-year follow-up.
- Results were similar for the other Short Form-36 Health Survey domains and for total fatigue and chronic fatigue.
- Short-term (<12 months) or longer-lasting complications occurred in 23 patients, including 6 with recurrent laryngeal nerve paralysis (4 were long-term) and 12 with hypoparathyroidism (6 long-term, including 3 permanent).
- Five patients had postoperative hematoma and/or infection requiring intervention.
IN PRACTICE:
"The improvements in patient-reported outcome measures reported at 18 months after surgery were maintained at 5 years after surgery in the intervention group. In contrast, no spontaneous improvement was seen during 3 years in the control group."
"Long-term complications in 10 of 73 (14%) patients despite use of meticulous dissection to achieve total thyroidectomy is unacceptably high. Medication and compensatory mechanisms for hypoparathyroidism and unilateral recurrent nerve injury, respectively, did alleviate symptoms."
SOURCE:
This study was published on November 27, 2023, in Annals of Internal Medicine, by Geir Hoff, MD, PhD, of the Department of Research, Telemark Hospital, Skien, and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway, and colleagues.
LIMITATIONS:
None listed.
DISCLOSURES:
None.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on X (formerly known as Twitter): @MiriamETucker.
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