Thyroid symptoms, quality of life improve after total thyroidectomy with Graves’ disease
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Adults with Graves’ disease who undergo a total thyroidectomy experience improvements in quality of life and thyroid-specific symptoms both shortly after and longer after surgery, according to findings published in Thyroid.
“This is the first study to examine patient-reported outcomes in Graves’ disease patients undergoing thyroidectomy in North America and the first to analyze patient characteristics associated with patient-reported outcomes before and after thyroid surgery,” Hadiza S. Kazaure, MD, an endocrine surgery fellow at Duke University School of Medicine, and colleagues wrote. “We found that patient-reported symptoms, including quality of life and thyroid-specific symptoms, of Graves’ patients improved significantly from prior to surgery shortly after, within 30 days of surgery, and longer after the surgery.”
Researchers analyzed data from 85 adults aged at least 18 years with Graves’ disease who underwent a total thyroidectomy and had patient-reported outcomes data available in the Private Diagnostic Clinic’s outcomes research team database at Duke University (median age, 42 years; 83.5% women). Data were collected from 2015 to November 2020. Patient-reported outcomes were measured with the MD Anderson Symptom Inventory. The questionnaire includes three categories: core symptoms, quality of life and thyroid symptoms, with lower scores indicating fewer symptoms. Symptom scores were collected before surgery, short term within 30 days of surgery, and long term 30 days or more after surgery.
Mean thyroid symptom score improved from 13.88 before surgery to 8.62 in the short term after surgery (P < .001) and 7.29 long term (P = .02). Mean quality of life symptom score improved from 16.16 before surgery to 9.14 short term after surgery (P < .001) and 10.04 long term (P = .02). Core symptoms scores improved from 27.78 before surgery to 21.84 in the short term after surgery (P = .04), but significant improvements were not observed long term. Similarly, the total symptom burden score improved from 56.88 before surgery to 39.6 in the short term after surgery (P < .001), but there was not a significant improvement long term.
After multivariate adjustment, total thyroidectomy was associated with short-term (RR = 0.55; 95% CI, 0.42-0.72) and long-term improvements in thyroid symptoms (RR = 0.59; 95% CI, 0.44-0.79). Quality of life also improved short term (RR = 0.57; 95% CI, 0.4-0.81) and long term (RR = 0.43; 95% CI, 0.28-0.65) after thyroidectomy. There was no significant change in core symptoms either short term or long term after surgery. The study cohort had a significant improvement in total symptom burden short term after surgery (RR = 0.67; 95% CI, 0.53-0.85) but not long term.
Older age and male sex were both associated with improvements in core symptoms and total symptom burden. Men also had a significant improvement in quality of life (RR = 0.36; 95% CI, 0.18-0.71), whereas older age was associated with improved thyroid symptoms (RR = 0.98; 95% CI, 0.97-1). Adults who were non-Hispanic other, or multiple races, had significantly better thyroid symptoms after surgery compared with white adults (RR = 0.22; 95% CI, 0.1-0.5), whereas Black adults had worse core symptoms (RR = 1.8; 95% CI, 1.18-2.73), quality of life (RR = 2.77; 95% CI, 1.5-5.12) and total symptom burden (RR = 1.66; 95% CI, 1.05-2.64) compared with white participants.
“Patient-reported symptoms, including quality of life and thyroid-specific symptoms, of Graves’ patients improved significantly from their baseline prior to surgery both shortly after and longer after the surgery,” the researchers wrote. “This comprehensive analysis can be used to guide clinicians and their patients with Graves’ disease on what outcomes to expect as they undergo thyroidectomy.”
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