Role of Total Thyroidectomy in Painful (Symptomatic) Hashimoto’s Thyroiditis: Descriptive Study

Abstract

Hakura Hashimoto described Hashimoto’s Thyroiditis (HT) in 1912. In HT, there occurs formation of antibodies against the self (thyroid), which causes enlargement of the thyroid gland as a whole and decreased thyroid hormone levels. Most of the patients with HT are given medical line of management (hypo/hyperthyroidism). The indications for surgical line of management for HT are due to pressure symptoms over the trachea and oesophagus, pain in the thyroid gland and for chance of malignancy. Surgical treatment gives complete relief from pain and pressure symptoms and also prevents the risk of malignancy. To evaluate the outcome and complications of total thyroidectomy in painful (symptomatic) Hashimoto’s thyroiditis. It was a Hospital based Descriptive study conducted in tertiary care teaching hospital by ENT Department, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry from Nov 2017 to May 2019. Sample size was 30. All patients with symptomatic (painful) HT was given trail of medical therapy (steroids and NSAIDS), following repeated attempts of failed medical therapy, surgical management (total thyroidectomy) was preferred. Visual Analog Scale (VAS) was used to assess the pain grading pre and post operatively. MS Excel and SPSS trial version 20 software was used to analyze the data. The Wilcoxan Signed Ranked test was used as test of significance to identify the difference between ordinal variables. In this study, all the 30 patients had pain as the predominant symptom. Visual Analog Scale was used to grade the pain in all the patients preoperatively and 2 weeks postoperatively. All the patients had significant reduction in the pain following total thyroidectomy, when compared to pre-operative VAS grading. Total thyroidectomy is the technique of choice in surgical treatment of symptomatic Hashimoto’s thyroiditis (pain, tenderness and pressure symptoms) which warrants a radical and definitive control of the disease, without any risk of relapse and without the side effects of medical management. Moreover in longstanding cases of HT, the risk of malignant transformation is prevented due to total thyroidectomy. In experienced hands it assures total relief of compressive and painful symptoms and low incidence of/nil major complications.

Surgical Decision-Making in Thyroiditis: A Review Article

“…All these studies have shown that patients with thyroiditis had significantly improved preoperative symptoms after thyroidectomy and benefitted regarding QoL. With more elaboration, there was a complete improvement in compressive and painful symptoms [7]. Most symptomatic HT patients had relief of their symptoms after surgery [12].…”

“…The locations of the publishing authors demonstrated good variation, including the United States, Europe, Asia, and Australia. Of these studies, 10 were designed as retrospective reviews [4][5][6][9][10][11][12][13][14]17], four as prospective studies [7,15,16,19], and two as systematic reviews [8,18]. The sample size ranged from 10 to 18,955 patients.…”

“…Six studies looked at the thyroid cancer association with thyroiditis [4,7,9,11,13,14]. Some studies reported an increased risk of cancer [4,14], while others did not [9,13].…”

“…Patients with diffuse or nodular goiter are at low risk of carcinoma, whereas those with a single or prominent nonfunctioning or cold thyroid nodule on radioiodine scan are at high risk of thyroid carcinoma [11]. One study concluded that "in longstanding cases of HT, the risk of malignant transformation is prevented due to total thyroidectomy" [7].…”

“…Postoperative improvement of local symptoms and quality of life (QoL) were discussed in five studies [7,12,13,15,16]. All these studies have shown that patients with thyroiditis had significantly improved preoperative symptoms after thyroidectomy and benefitted regarding QoL.…”