Endocrine Abstracts

Objectives: Hashimoto’s thyroiditis (chronic autoimmune thyroiditis) is one of the most common causes of hypothyroidism globally. Patients frequently experience symptoms of hypothyroidism, for which the current mainstay of treatment is with thyroid hormone repletion with levothyroxine. Despite treatment, there remains a subset of patients who achieve a biochemical euthyroid status, yet experience persistent hypothyroid symptoms. For these patients, there is no clear treatment option for their symptoms despite adequate hormone replacement. However, recent evidence indicates that total thyroidectomy may further improve the quality of life (QoL) in this group of persistently symptomatic patients. This review aims to understand the current literature on how total thyroidectomy compares to levothyroxine alone in improving the QoL of patients with Hashimoto’s thyroiditis (HT).

Methods: Following PRISMA guidelines for scoping review, we searched PubMed, Cochrane, Embase using the search terms “thyroiditis, autoimmune”, “lymphocytic thyroiditis” or “Hashimoto disease” and “quality of life”. Studies comparing the two treatment methods by evaluating patients’ QoL were included.

Results: A total of 5 original studies, and a followup study of the only randomised controlled trial among them, were found comparing the impact of total thyroidectomy to levothyroxine on quality of life (QoL). General indications for thyroidectomy were suspicion of malignancy, cosmetic reasons, compressive goiter, and hypothyroid symptoms despite levothyroxine. All 6 studies reported an improvement in QoL in the group treated with thyroidectomy compared to the group treated with levothyroxine. QoL was measured using the SF-36 (n = 5) and ThyPRO (n = 1). Complication rates were reported in 3 papers and the follow up study of the randomized controlled trial. Reported complications include tracheal perforation (1.4%), infection/haematoma (3.1-6.8%), temporary hypoparathyroidism (3.7-47.4%), permanent hypoparathyroidism (0 - 8.2%), temporary RLN injury (2.7 - 6.3%), permanent RLN injury (0 - 8.2%). The 5 year follow up study also found a significantly elevated long term complication rate of 14%, compared to the initial 8.2% in the randomized controlled trial.

Conclusion: Thyroidectomy may improve the QoL in the subset of Hashimoto’s thyroiditis patients who are persistently symptomatic despite achieving euthyroid status on levothyroxine therapy. However, consideration should be given to the possibility of elevated surgical complication rates in HT patients. Further prospective clinical trials are needed to confirm this observation and determine the mechanism behind the improvement in quality of life.