Thyroidectomy, the surgical removal of the thyroid gland, has been shown to significantly improve the general health and quality of life in patients with euthyroid Hashimoto’s thyroiditis. A recent extension of a randomized trial conducted by Geir Hoff, MD, PhD, and colleagues from the University of Oslo in Norway, revealed that the positive impact on patient-reported general health was sustained for up to 5 years post-surgery. However, the high complication rate associated with total thyroidectomy raises concerns about its widespread recommendation as treatment for this particular patient population.
The study included 65 patients with euthyroid Hashimoto’s thyroiditis who underwent total thyroidectomy and were followed for 60 months post-surgery. The patients’ general health was assessed using the Short Form-36 Health Survey, which utilizes a 0-100 scale, with higher scores indicating better health and less disability. Prior to surgery, the average general health score was around 40. However, immediately after total thyroidectomy, patients experienced a significant increase in their general health score, with an improvement of 29 points (95% CI 22-35 points) compared to those who received hormonal medical management only. This improvement was maintained after 5 years, with patients still reporting an average general health score of around 70.
The researchers acknowledged that the primary endpoint of the study, patient experience of general health, is subjective and could be influenced by placebo effects. While the observed positive effects seen after 18 months could potentially be attributed to a placebo mechanism, the sustained improvement in general health after 5 years suggests that there may be other factors at play. Despite this finding, the lack of a documented pathophysiological mechanism to explain these results and the high complication rate associated with total thyroidectomy warrant caution in recommending this treatment option for euthyroid Hashimoto’s thyroiditis patients with persistent symptoms.
During the follow-up period, 14% of the total-thyroidectomy patients experienced long-term complications, including recurrent laryngeal nerve paralysis, hypoparathyroidism, and postoperative hematoma or infection. An additional 13 patients suffered from short-term complications lasting less than a year. While these complications did not seem to significantly impact the patients’ general health scores, they highlight the potential risks associated with total thyroidectomy, particularly when performed with a more stringent dissection to achieve complete removal of auto-antigen thyroid tissue.
The findings of this study suggest that total thyroidectomy may offer an improved sense of general health for euthyroid patients with Hashimoto’s thyroiditis and persistent symptoms. However, the high complication rate and the lack of a satisfactory pathophysiological mechanism to explain these findings raise concerns about recommending this treatment option in a broader context. The researchers emphasize the importance of centralizing total thyroidectomy procedures to dedicated centers where further research can be conducted to better understand its potential benefits and risks.
Total thyroidectomy has been shown to have a significant and sustained positive impact on patient-reported general health in euthyroid Hashimoto’s thyroiditis for up to 5 years post-surgery. Despite the potential placebo effect and the high complication rate associated with the procedure, it may be considered as a treatment option for euthyroid patients with persistent symptoms. However, further research is needed to better understand the underlying mechanisms and to determine the optimal context for recommending total thyroidectomy in these cases.