Long term outcome after toxic nodular goitre.

Area of Science:

• Endocrinology
• Thyroidology
• Clinical Medicine

Background:

• Toxic nodular goitre (TNG) management aims to resolve hyperthyroidism, prevent recurrence, alleviate symptoms, and maintain thyroid function.
• Existing literature shows varied treatment efficacies and long-term outcomes for antithyroid drugs (ATD), radioactive iodine (RAI), and surgery.
• Persistent symptoms and impairments in cognitive function and quality of life (QoL) are noted post-euthyroidism.

Purpose of the Study:

• To evaluate treatment outcomes, cure rates (euthyroidism and hypothyroidism), and quality of life (QoL) in an unselected cohort of toxic nodular goitre (TNG) patients.
• To compare the long-term efficacy and impact of different TNG treatment modalities.

Main Methods:

• A cohort of 638 patients with newly diagnosed TNG between 2003-2005 was followed for 6-10 years.
• 237 patients completed questionnaires on therapies, demographics, comorbidities, and QoL (ThyPRO).
• Treatments administered included ATD, RAI, or surgery, adhering to clinical guidelines.

Main Results:

• One RAI treatment cured 89% of patients; surgery cured 93%.
• Levothyroxine supplementation was required by 58% of RAI patients and 64% of surgical patients by study end.
• Approximately 5% of patients required three or more RAI treatments for cure, and patients reported worse thyroid-related QoL than the general population.

Conclusions:

• The potential advantage of RAI over surgery may be diminished by similar hypothyroidism rates.
• The complexity of TNG treatment is highlighted by cases requiring up to five RAI interventions.
• Long-term QoL impairments underscore the chronic nature of hyperthyroidism associated with TNG.