Post-thyroidectomy chronic asthenia: self-deception or disease?

Abstract

There is clinical evidence that post-total thyroidectomy (TT) patients can present persistent asthenia. The aim of this study was to evaluate the prevalence of asthenia symptoms in such patients, assess whether a chronic asthenia syndrome could be caused by TT or become evident after it. An observational study was carried out comparing two groups of 100 patients each, all with homogeneous characteristics. Group A was treated with total lobectomy (TL), Group B with TT. All patients presented normal thyroid hormone levels. The patients were interviewed in order to identify the ones affected by post-operative asthenia persisting for at least six months, with reduced ability to perform physical and mental work, not showing improvement with rest. The severity of the symptoms has been measured by means of the brief fatigue inventory (BFI). Statistical analysis was performed to evaluate statistically significative differences between groups and prognostic factors in TT group. The incidence of post-operative asthenia was 0 % after TL and 25 % after TT, with the operation being the only significant variable. Asthenia is well known as symptom of post-thyroidectomy, but it has not been adequately investigated as consequence of surgery. We demonstrated that the complete removal of the thyroid gland could determine chronic post-thyroidectomy asthenia, although with intensity limited to low/moderate. Post-thyroidectomy asthenia is a relevant sequela interfering with quality of life of at least 25 % of patients operated, suggesting the need to identify its real causes and limit the indication to TT only when strictly required.

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

“…Thus, it is plausible that the more careful method of analyzing various aspects of fatigue might result in more precise and reproducible answers. A previous study that specifically analyzed the correlation between chronic asthenia and thyroidectomy found patients who had undergone TT frequently complained of tiredness or asthenia in performing physical tasks and mental work [12]. It is well known that hypothyroidism, hyperthyroidism, and Hashimoto's thyroiditis may be associated with chronic asthenia [39,42].…”

“…One study reported improved scores in a thyroid-specific questionnaire given to a group of patients who had undergone treatment with DTE [50]. Unfortunately, the DTE is not commonly available and substances other than T3 and T4 are excluded by official pharmacopeia [12].…”

“…This system is reliable and is validated for a wide range of diseases (both benign and malignant) [23,24]. The tool investigates the current level of asthenia in patients for the last 24 h and any interference with general activity, work, and relationships with other people [12,24]. We obtained permission to use this tool (Italian version) online.…”

“…Another study showed the advantages of thyroidectomy in reducing post-operative fatigue by evaluating a cohort of patients with various hormone levels [8]. A recent study [12] reported that TT is frequently accompanied by chronic low-moderate asthenia. The asthenia can result in impaired QoL due to feelings of tiredness and a reduced ability to perform physical or mental tasks.…”

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders

“…As commonly observed, they can also precede the surgery, and, in some cases, they can be explained as a consequence of the thyroid disease (3). These complaints, together with other, may affect the quality of life (21)(22)(23). Both symptoms are very frequent even in nonthyroidectomized patients (24,25).…”