J. Kim1, T. S. Wang1, K. M. Doffek1, A. A. Carr1, D. B. Evans1, T. W. Yen1 1Medical College Of Wisconsin,Surgical Oncology,Milwaukee, WI, USA
Introduction: Racial disparities in thyroid cancer are well-documented. However, there is a paucity of information on racial differences in the management of benign thyroid disorders. We sought to determine whether racial disparities exist in the etiology, presentation, and management of hyperthyroid patients prior to surgical intervention.
Methods: A retrospective chart review of a prospectively collected database was performed of hyperthyroid patients who underwent thyroidectomy at a single institution from 01/2009 to 02/2014. Data collected included patient demographics, etiology of hyperthyroidism, type and duration of hyperthyroid symptoms (unintentional weight loss, palpitations, heat intolerance, anxiety, emotional lability, tremor, muscle weakness and eye symptoms), thyroid hormone levels, and use of antithyroid medications and radioactive iodine prior to surgery. Racial differences for etiology, presentation, and pre-surgical management were examined by chi-square or Kruskal-Wallis test.
Results: Of the 191 patients, the majority (73%) were white; 18% (n=34) were black and 9% (n=17) other or unknown races. The most common etiologies of hyperthyroidism were Graves’ disease (51%), toxic multinodular goiter (34%), and toxic thyroid nodule (10%). There was no difference in the etiology of hyperthyroidism by race. At least one symptom was reported in 159 (83%) patients. By race, there was no difference in the presence of reporting at least one symptom, the presence of each of the eight symptoms, the maximum duration of symptoms, or the median duration of each symptom, except for heat intolerance. The median duration of heat intolerance was longer in the non-white patients (10 months in Blacks and 13 months in other races) compared to three months in white patients (p=0.03). The total number of symptoms per patient differed by race; non-white patients reported more symptoms than white patients (4-4.5 vs. 3; p=0.03). There was no difference in preoperative TSH or free T4 values by race. Prior to surgery, 135 (71%) patients received antithyroid medication; there was no difference in receipt or duration of medication by race. Only 14 (7%) patients received radioactive iodine treatment prior to surgery; there was no difference by race.
Conclusion: In this cohort of largely white patients, we found no racial differences in the etiology of hyperthyroidism, presence and duration of symptoms, biochemical level of disease, and preoperative management, except the findings that non-white patients reported longer duration of heat intolerance and presented with more symptoms than white patients. Prospective studies in larger, more racially diverse populations that include hyperthyroid patients who are managed either medically or surgically are needed.