In the Journals

Thyroidectomy reduces severe Hashimoto's disease symptoms

For adults with Hashimoto’s disease, total thyroidectomy can reduce symptoms of pain and fatigue that remain even after euthyroid status is achieved with standard medical therapy, according to findings published in the Annals of Internal Medicine.

“To date, no specific treatment exists for patients (with Hashimoto’s disease) whose symptoms persist despite adequate thyroid hormone replacement,” Ivar Guldvog, MD, PhD, of the department of breast and endocrine surgery at Telemark Hospital in Skien, Norway, and colleagues wrote. “Complete removal of the antigenic tissue via total thyroidectomy has been hypothesized to attenuate the autoimmune response and relieve symptoms.”

Guldvog and colleagues enrolled 147 adults with Hashimoto’s disease from Telemark Hospital for a randomized controlled trial. Participants were recruited between Feb. 13, 2012, and April 10, 2015, and randomly assigned to thyroidectomy (n = 73; mean age, 48 years; 93.2% women) or standard care (n = 74; mean age, 49.2 years; 90.5% women).

The follow-up period for the trial was 18 months, with visits every 3 months. Researchers measured serum antithyroid peroxidase (anti-TPO) antibody titers and thyroid-stimulating hormone, free thyroxine, free triiodothyronine, calcium and parathyroid hormone levels during follow-up. Participants also completed the SF-36 and a fatigue-specific questionnaire to assess quality of health and other symptoms related to Hashimoto’s disease. Higher scores indicated worse health measures.

The average health quality score for participants who underwent thyroidectomy rose 26 points (95% CI, 21-31) after surgery compared with before (64 vs. 38). In the standard medical care group, the researchers found a 3-point drop in scores from 38 before intervention to 35 after, making for a mean difference between the two groups of 29 points (95% CI, 22-35).

The researchers also found improvements in reported levels of fatigue in participants who underwent thyroidectomy. Specifically, there was a 9-point decrease (95% CI, 7-10) in fatigue scores, from 23 before surgery to 14 after operation. Only 35% of participants in the thyroidectomy group reported chronic fatigue after surgery compared with 82% before the procedure. In contrast, no significant change was found in fatigue scores for the group that received standard medical care, whereas chronic pain prevalence fell from 84% before intervention to 74% at the trial’s conclusion.

Thyroidectomy appeared to normalize anti-TPO antibody titers, with levels falling by an average of 92% (interquartile range, 87-96) to 152 IU/mL (interquartile range, 100-286) in the surgery group while the median measurement for the standard care group was 1,300 IU/mL after intervention.

“Total thyroidectomy seems to be a safe and effective treatment option for patients who have Hashimoto’s disease with severe Hashimoto-related symptoms, if these symptoms are not relieved by adequate hormone replacement therapy alone,” the researchers wrote. “Because symptom relief is the dominant goal for many patients, we encourage further studies using symptoms as the endpoint, with longer follow-up, and including differentiation among subgroups of patients with Hashimoto’s disease.” – by Phil Neuffer

Disclosures: Guldvog reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

For adults with Hashimoto’s disease, total thyroidectomy can reduce symptoms of pain and fatigue that remain even after euthyroid status is achieved with standard medical therapy, according to findings published in the Annals of Internal Medicine.

“To date, no specific treatment exists for patients (with Hashimoto’s disease) whose symptoms persist despite adequate thyroid hormone replacement,” Ivar Guldvog, MD, PhD, of the department of breast and endocrine surgery at Telemark Hospital in Skien, Norway, and colleagues wrote. “Complete removal of the antigenic tissue via total thyroidectomy has been hypothesized to attenuate the autoimmune response and relieve symptoms.”

Guldvog and colleagues enrolled 147 adults with Hashimoto’s disease from Telemark Hospital for a randomized controlled trial. Participants were recruited between Feb. 13, 2012, and April 10, 2015, and randomly assigned to thyroidectomy (n = 73; mean age, 48 years; 93.2% women) or standard care (n = 74; mean age, 49.2 years; 90.5% women).

The follow-up period for the trial was 18 months, with visits every 3 months. Researchers measured serum antithyroid peroxidase (anti-TPO) antibody titers and thyroid-stimulating hormone, free thyroxine, free triiodothyronine, calcium and parathyroid hormone levels during follow-up. Participants also completed the SF-36 and a fatigue-specific questionnaire to assess quality of health and other symptoms related to Hashimoto’s disease. Higher scores indicated worse health measures.

The average health quality score for participants who underwent thyroidectomy rose 26 points (95% CI, 21-31) after surgery compared with before (64 vs. 38). In the standard medical care group, the researchers found a 3-point drop in scores from 38 before intervention to 35 after, making for a mean difference between the two groups of 29 points (95% CI, 22-35).

The researchers also found improvements in reported levels of fatigue in participants who underwent thyroidectomy. Specifically, there was a 9-point decrease (95% CI, 7-10) in fatigue scores, from 23 before surgery to 14 after operation. Only 35% of participants in the thyroidectomy group reported chronic fatigue after surgery compared with 82% before the procedure. In contrast, no significant change was found in fatigue scores for the group that received standard medical care, whereas chronic pain prevalence fell from 84% before intervention to 74% at the trial’s conclusion.

Thyroidectomy appeared to normalize anti-TPO antibody titers, with levels falling by an average of 92% (interquartile range, 87-96) to 152 IU/mL (interquartile range, 100-286) in the surgery group while the median measurement for the standard care group was 1,300 IU/mL after intervention.

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“Total thyroidectomy seems to be a safe and effective treatment option for patients who have Hashimoto’s disease with severe Hashimoto-related symptoms, if these symptoms are not relieved by adequate hormone replacement therapy alone,” the researchers wrote. “Because symptom relief is the dominant goal for many patients, we encourage further studies using symptoms as the endpoint, with longer follow-up, and including differentiation among subgroups of patients with Hashimoto’s disease.” – by Phil Neuffer

Disclosures: Guldvog reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.