Quality of life after thyroidectomy in patients with nontoxic nodular goiter: A prospective cohort study

Uslar

Endocrino Diabet & Metabol

et al. 2020

Objective: Quality of life (QoL) has so far seldom been taken into account by default in decision-making for surgical indication in thyroid surgery. Therefore, we compared pre-and postoperative QoL of patients using the EuroQoL-5D (EQ-5D) questionnaire. The influence of certain socio-economic factors on QoL as a second end-point was considered.Design: Prospective cohort study.Patients: About 153 patients with euthyroid symptomatic benign goitre after hemiand total thyroidectomy (follow-up 83.6%) have been included. Measurements:The EQ-5D questionnaire was used prior to and 1 year after surgery.In addition, a questionnaire for assessment of socio-economic status was collected. Results: For n = 90 (n = 67 female, n = 23 male), total thyroidectomy (TT) and, for n = 63 (n = 45 female, n = 18 male), hemithyroidectomy (HT) were performed. None permanent dysfunction of the vocal cord was recorded. Transient symptomatic hypocalcaemia was detected in 9% of the thyroidectomy group (8/90 patients). At follow-up, 86% of patients showed either no change or improved QoL. About 14% of patients complained of deteriorated QoL, regardless of the extent of surgery. Socioeconomic factors did not influence postoperative QoL. Conclusions:Results indicate that in pre-operative consultation of patients with benign goitre, the improvement of QoL should be taken into account for decision-making in cases of ambiguous surgical indication. Contrary to current discussions that too much thyroid surgery is performed in Germany, we can recommend presenting surgery as an equivalent option to watchful waiting as QoL is at least preserved or improved. The extension of the resection should, however, be decided individually. K E Y W O R D SEQ-5D, health-related quality of life, hemithyroidectomy, patient-reported outcome, PRO, QoL, total thyroidectomy

Section: Discussionmentioning

confidence: 99%

Quality of life is not affected by thyroid surgery in nontoxic benign goitre in long‐term surveillance—A prospective observational study

Uslar

Endocrino Diabet & Metabol

et al. 2020

“…One explanation may be that the ES related to the changes in the airflow parameters were of much smaller magnitudes than those found for the tracheal dimensions. In addition, many other factors – beyond the physical dimensions of the thyroid gland and the related neck structures – are involved in the increase in HRQoL experienced by patients undergoing thyroid surgery, as we have recently shown [7]. …”

Section: Discussionmentioning

confidence: 99%

“…Some of the presented HRQoL data have previously been included in our recent study, where HRQoL after thyroidectomy was the focus [7]. …”

Section: Methodsmentioning

confidence: 99%

“…The treatment strategy depends on a number of factors, including risk or fear of malignancy, as well as patient discomfort and preference, with the overall goal of improving health-related quality of life (HRQoL). Current treatment options comprise surgery [6], shown to substantially improve HRQoL [7], radioiodine [8, 9], ethanol sclerotherapy [10, 11], and ultrasound-guided interventional ablation, with laser or radiofrequency as the most used modalities [5, 11, 12]. …”

Section: Introductionmentioning

confidence: 99%

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Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study

Sørensen¹,

Lauridsen²,

Døssing³

et al. 2017

Eur Thyroid J

Self Cite

Objective: A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. Methods: Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen’s effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2–0.5 were defined as small, 0.5–0.8 as moderate, and values >0.8 as large. Results: Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14–642 mL) before surgery with surgical removal of a median of 43 g (range, 8–607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. Conclusions: In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.

“…This study is a substudy of a larger cohort study investigating changes in tracheal anatomy, swallowing physiology, and QoL after thyroid surgery [7, 16, 19, 26, 27]. In part, the data have been reanalyzed, for the purpose of addressing a completely different issue.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Esophageal Compression on Goiter Symptoms before and after Thyroid Surgery

Brinch¹,

Døssing²,

Nguyen³

et al. 2018

Eur Thyroid J

Self Cite

Introduction: Benign nodular goiter may be associated with swallowing difficulties, but insight into the associated pathophysiology is limited. The aim of this study was to investigate the effect of surgery on the degree of esophageal compression, and its correlation to swallowing difficulties. Methods: Esophageal compression and deviation were evaluated blindly on magnetic resonance imaging (MRI) of the neck, prior to and 6 months after thyroid surgery for symptomatic benign goiter. Goiter symptoms and swallowing difficulties were measured by the Goiter Symptom Scale of the Thyroid-Specific Patient-Reported Outcome (ThyPRO) questionnaire. Cohen’s d was used for evaluating effect sizes (ES). Results: Sixty-four patients completed the study. Before surgery, median goiter volume was 57 (range 14–642) mL. The smallest cross-sectional area of the esophagus (SCAE) increased from a median of 95 (47–147) to 137 (72–286) mm² (ES = 1.31, p < 0.001). Median esophagus width increased from 15 (range 10–21) to 17 (range 12–24) mm (ES = 0.94, p < 0.001) after surgery, while no statistically significant change was observed for the sagittal dimension (anterior-to-posterior), thus reflecting an increasingly ellipsoid esophageal shape. Median esophageal deviation decreased moderately after surgery from 4 (0–23) to 3 (0–10) mm (ES = 0.54, p = 0.005). The goiter symptom score improved considerably from (mean ± SD) 40 ± 21 to 10 ± 10 points (ES = 1.5, p < 0.001) after surgery, and the improvements were associated with improvements in SCAE (p = 0.03). Conclusions: In patients with goiter, thyroidectomy leads to substantial improvements in esophageal anatomy, as assessed by MRI, and this correlates with improved swallowing symptoms. This information is valuable in qualifying the dialogue with goiter patients, before deciding on the mode of therapy. Clinicaltrials.gov (NCT03072654).