Endocrine Abstracts

Background: Appropriate management of thyroid diseases is crucial, as outcomes directly affect quality-of-life. High-volume thyroid surgeons provide best results, least complications. We aim to assess if a dedicated endocrine-surgery unit influences treatment-decisions(TD) of patients in an endocrine-surgeon naïve area.

Method: Study of 153-patients at Maax Superspecialty Hospitals(Shivamogga, India), from November/2021-October/2023. Previously diagnosed & under treatment elsewhere, referred for or sought expert opinion. These patients had deferred definitive-treatment(fear of complications arising from pre-surgical discussion with physician) or desired radical surgery for low risk lesions where observation was an option("may turn into cancer" as a result of discussion with physician or information obtained from other sources). Multiple consults and difference of opinions also added to this issue. Six questions were asked as a part of self-assessment- Did we add additional information/value with respect to: Q1-Diagnosis? Q2-Overall condition/course-of-disease? Q3-Treatment options? Q4-(a)Why surgery, Q4-(b)why observation? Q5-Advanced procedures? Q6-Complications, how we tackle it? Responses were recorded with a 3-point Likert scale: 1-No useful/convincing additional information 2-New information provided, but not enough to influence TD 3-Meaningful additional information, positive influence on TD.

Results: F:M=147:6. Sixty-nine had multinodular goitre (14:compressive-symptoms, 9:retro-sternal, 3:toxic-MNG, 4:thyroiditis, 33:high-risk, 9:low-risk), 18-Graves’ disease, 12-Diffuse goitre, 51-solitary nodules (25:high-risk, 26:low-risk). On multiple regression analysis, Q1-3 did not significantly influence TD, while Q4, Q5 & Q6 resulted in significant change in TD(p-value: <0.001). Q4, Q5 & Q6 strongly correlated with change in TD(ρ=0.79, 0.84, 1 respectively).

Conclusions: Dedicated endocrine-surgery unit leads to better acceptance of treatment-plan, reduces fear/anxiety, and unnecessary surgeries. Objective discussion, availability of advanced procedures & reduced fear of complications positively influence TD.