Thyroidectomy for Euthyroid Patients with Hashimoto Disease and Persistent Symptoms: An Observational, Postrandomization Study.

Autor: Hoff, Geir, Bernklev, Tomm, Johnsen, Lene, Reitsma, Laurens, Sina, Dirk, Lauzike, Andromeda, Gibbs, Charlotte, Hoel Lende, Tone, Narvestad, Jon Kristian, Kildahl, Rasmus, Omdal, Roald, Kvaløy, Jan Terje, Søiland, Håvard
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Zdroj: Journal of Thyroid Research; 4/4/2024, Vol. 2024, p1-7, 7p
Abstrakt: Background. Despite adequate hormone substitution in Hashimoto disease, some patients may have persistent symptoms with a possible autoimmune pathophysiology. A recent randomized trial (RCT) using patient-reported outcome measures as the primary endpoint showed benefit in total thyroidectomy, but at a cost of high complication rates. Objective. To verify results from the RCT in an observational study including a wider range of patients and explore means of predicting who may benefit from such surgery. Design. A total of 154 patients with Hashimoto disease, euthyroid with or without thyroid hormone substitution, and persistent Hashimoto-related symptoms were subjected to total thyroidectomy and followed for 18 months after surgery. The primary outcome was the General Health (GH) dimensional score in the Short Form-36 Health Survey (SF-36). Results. Eighteen months after surgery, a clinically significant improvement in GH was seen, similar to the findings in the previous RCT. Anti-TPO antibody titers were markedly reduced after surgery, but preoperative titers or other preoperative parameters could not predict the outcome of surgery. Three (1.9%) of 154 patients experienced permanent unilateral recurrent nerve palsy and six (3.9%) experienced hypoparathyroidism after surgery. Conclusions. Thyroidectomy had a beneficial symptom-reducing effect in euthyroid patients with Hashimoto disease and persistent symptoms. The pathophysiology of residual symptoms remains unclear, and surgical complication rates are high. If thyroidectomy is considered as a treatment option, it should be performed in dedicated centers with experienced endocrine surgeons and as part of further studies on persistent symptoms. This trial is registered with NCT-02319538. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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