Does Thyroidectomy Offer Quality of Life Advantage for Autoimmune Thyroiditis Patients?

Abstract

Introduction: Significant reduction of subjective health status is frequently reported by many patients with Hashimoto thyroiditis despite adequate thyroxine replacement therapy. Studies have shown that thyroidectomy improves quality of life (QoL) in patients with HT and persistence symptoms, however there are conflicting evidence and we do not have our own data. QoL is an important aspect in management of chronic diseases like hypothyroidism which is less well touched in our population. Our findings highlight the potential of thyroidectomy in enhancing QoL for HT patients, contributing to the ongoing research on optimal management strategies for this condition. Objectives: To assess the QoL in patients with Hashimoto's thyroiditis (HT) who are biochemically euthyroid on thyroxine replacement therapy and to compare the QoL between patients managed medically and those who have undergone thyroidectomy with histologically confirmed HT. Methodology: We conducted a case-control study to compare the QoL using the SF-36 questionnaire among two groups of euthyroid Hashimoto’s thyroiditis patients: those receiving medical management and those who are post-thyroidectomy, as well as a healthy matched control group. Confounders that could affect QoL were rigorously excluded, and parametric tests were utilized for data analysis. Results: A significantly lower overall QoL was noted in the medically managed group (n=23) compared to the thyroidectomy group (n=24), with mean scores of 63.72 versus 84.25, respectively (P-value < 0.0001). This trend was consistent across all domains of the SF-36 QoL questionnaire. The QoL scores of patients who underwent surgery were similar to those of the healthy control group. Additionally, no significant correlation was found between thyroperoxidase (TPO) antibody titers and QoL in the regression analysis. Conclusion: Overall, patients with Hashimoto's thyroiditis on medical management exhibit significantly poorer QoL, despite adequate thyroxine replacement. This may be attributable to a complex interplay of immunological factors associated with an intact thyroid gland. Thyroidectomy could serve as a viable treatment alternative for these individuals. It is essential to develop algorithms to identify patients who would benefit most from thyroidectomy, ensuring they are thoroughly informed about the risks and benefits. Ongoing studies and the establishment of therapeutic guidelines are crucial for improving the management of patients with Hashimoto's thyroiditis.

Keywords

• hypothyroidism
• hashimoto’s thyroiditis
• quality of life
• thyroidectomy
• sri lanka