Thyroidectomy for Graves’ Disease Rapidly Improves Symptoms and Quality of Life

• Background:
  • Graves’ disease is a common cause of hyperthyroidism that impacts quality of life
  • Treatment choices for Graves’ disease include:
    • Antithyroid drugs
    • Radioactive iodine (RAI)
    • Thyroidectomy
  • Patients are frequently treated with longterm anti-thyroid drugs or RAI:
    • With relief of biochemical hyperthyroidism as a common treatment end point
  • However, euthyroid patients with Graves’ disease:
    • May continue to have impaired quality of life
  • Validated tools that study patient-reported outcomes for benign thyroid disease identify general quality-of-life indicators and thyroid-specific symptoms
  • This study prospectively evaluated, at three intervals (preoperative, short-term postoperative, and long-term postoperative), patients with Graves’ disease undergoing thyroidectomy to assess differences in thyroid-specific symptoms, quality of life, and symptom burden over time
    • Clin Thyroidol 2022;34:17–19
• Methods:
  • Adult patients who underwent total thyroidectomy for Graves’ disease between 2015 and 2020 were administered the MD Anderson Symptom Inventory (MDASI) survey:
    • A thyroid-specific patient-reported outcomes (PRO) survey, and a core symptom score to develop a composite Total Symptom Burden Score
  • Patient factors collected included age, race/ethnicity, sex, marital status, employment status, religion, and insurance status
  • Timing of survey data was defined as presurgery (< 120 days prior to surgery), short-term postsurgery (< 30 days), and long-term postsurgery (> 30 days)
  • In addition to measuring general quality-of-life indicators, the tool assesses common hyperthyroid patient symptoms, including hoarseness, heat and cold sensitivity, palpitations, dysphagia, and diarrhea
• Results:
  • The 85 patients included in this study had:
    • A median age of 42 years
    • 83.5% were female
  • Of these patients, 38.8% were obese (BMI >30)
  • Long-term postsurgery data were collected at a median of 205 days (range, 94–548 days) following thyroidectomy
  • Nearly all patients (95.3%) had started and were still taking an antithyroid drug
  • From the overall cohort, 63.5% of patients had a normal serum free thyroxine (FT4) level prior to surgery
  • The Thyroid Symptom Score improved significantly from before surgery to after, in both the short and the long term, with the most significant improvement realized between preoperative and short-term assessments
  • Specific thyroid symptoms that improved significantly after surgery included “feeling hot,” “racing heartbeat,” “diarrhea,” and “difficulty swallowing.”
  • The quality-of-life symptoms that significantly improved at short-term assessment included “general activity,” “mood,” “relationships with other people,” “walking,” “enjoyment of life,” and “work.”
  • The Total Symptom Burden Score improved significantly within 30 days after surgery
• Conclusions:
  • In this cohort study of patients with Graves’ disease who underwent thyroidectomy, nearly all patients were treated initially with antithyroid drugs and 63.5% of the overall sample had normal serum FT4 levels before undergoing thyroid surgery
  • Patient-reported outcomes, including thyroid-specific symptoms and the Total Symptom Burden Score, improved significantly within 30 days of surgery
• This study highlights important improvements in quality of life in patients with Graves’ disease who undergo thyroidectomy
• The most significant improvement in symptoms was realized at short-term follow-up (<30 days):
  • Emphasizing the utility of thyroidectomy for treatment of Graves’ disease in patients who are seeking immediate remedy of symptoms
• By contrast, a longitudinal study of the efficacy of Graves’ disease treatment in Sweden (with only 4.6% of participants treated with thyroidectomy) found that by 6 to 10 years posttreatment, over one quarter of patients reported that they had not fully recovered
• Understanding the anticipated time course for treatment effects is critical to effective patient counseling
• Nearly two thirds of patients in this study were euthyroid at the time of initial assessment
• Although prior studies have recognized more pronounced impairments in quality of life in hyperthyroid Graves’ disease patients:
  • This research demonstrated that even patients who were euthyroid preoperatively experienced significant improvement in thyroid symptoms and quality of life
  • This finding argues for a nuanced approach to long-term management of patients with Graves’ disease beyond achieving a biochemically euthyroid state
  • Many patients with Graves’ disease request or self-refer for evaluation for thyroidectomy
  • Their thyroid-specific neck symptoms, including local symptoms of dysphagia, compression, perceived shortness of breath, and neck tightness, may be discounted, particularly if their hyperthyroidism is biochemically controlled
  • Recognizing the immediate and substantial symptom improvement after thyroidectomy should prompt consideration of thyroidectomy in initial, rather than last resort, Graves’ disease management, even in patients who are able to be rendered euthyroid with antithyroid drugs

#Arrangoiz #ThyroidSurgeon #ThyroidExpert #GravesDisease #Hyperthyroidism #Teacher #HeadandNeckSurgeon #CancerSurgeon