K.M. HoSang1, S.M. Lawler1, T. Nace2, L. Kuo1 1Temple University, Surgery, Philadelpha, PA, USA 2Temple University, Library, Philadelpha, PA, USA
Introduction: Hashimoto’s thyroiditis (HT) is the most common autoimmune thyroid disease, as well as the most common cause of primary hypothyroidism in the U.S. The primary treatment is thyroid hormone replacement. Despite medical management, some patients continue to experience systemic and local compressive symptoms, and thyroidectomy may alleviate these symptoms. However, the role of surgery for patients with HT has remained controversial. This systematic review evaluates the available literature on the impact on quality of life (QoL) after thyroidectomy in patients with HT.
Methods: Detailed search strategies were developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The search was limited from 2003-2024, and relevant terms included: Hashimoto’s thyroiditis, hypothyroidism, quality of life, thyroidectomy/surgery. Case studies, other literature/systematic reviews, and unfinished clinical trials were excluded, as well as studies involving pregnant or pediatric patients, studies published in foreign languages, and studies related to malignancy. Studies were screened by title and abstract by two blinded, independent reviewers, and repeated for full text article screening and selection. Patient characteristics were noted. The primary outcome was change in QoL, either through validated questionnaires or using changes in symptoms as a proxy for QoL; symptoms were considered either “local” (neck pain, dysphagia, dyspnea) or “physiologic” (fatigue, body pain). The ROB-2 Cochrane and Critical Appraisal Skills Programme (CASP) tools assessed the quality of each study.
Results: A total of 2,604 records were screened, and 8 (0.3%) studies met inclusion criteria: 1 study was a randomized controlled trial, 3 were observational studies, 3 were retrospective studies, and 1 was a prospective study. There were 474 HT patients with persistent symptoms who underwent surgery. The vast majority of studied patients were female (90-100%), with average age in the mid-40s-mid-50s, and all with preoperative scores or symptoms indicating poor QoL. Four studies assessed primary outcomes using the Short Form-36 Health Survey (SF36), which measures QoL in eight subdomains, and one study utilized the ThyPRO questionnaire, a thyroid-specific quality of life survey instrument. The remaining 3 studies did not use validated survey tools to assess QoL specifically, instead assessing whether symptoms improved during routine postoperative visits. 7 out of 8 studies reported evidence that thyroidectomy has a positive impact on QoL in patients with HT, with regard to both local and physiologic symptoms.
Conclusion: This systematic review identified improvements in quality of life after thyroidectomy in patients with HT. Patients should be informed that this is a viable treatment options if symptoms persist despite optimal medical management.