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Related Experiment Video

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Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
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Thyroidectomy for Euthyroid Patients with Hashimoto Disease and Persistent Symptoms: An Observational,

Geir Hoff1,2, Tomm Bernklev3, Lene Johnsen4

  • 1Department of Research, Telemark Hospital, Skien, Norway.

Journal of Thyroid Research
|April 12, 2024
PubMed
Summary

Total thyroidectomy improved symptoms in Hashimoto disease patients, but complication risks remain high. Further research is needed to understand persistent symptoms and identify surgical candidates.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Immunology

Background:

  • Hashimoto disease can cause persistent symptoms despite hormone replacement.
  • Some patients may have underlying autoimmune pathophysiology contributing to symptoms.
  • Previous randomized trials (RCTs) suggested total thyroidectomy benefits, but with high complication rates.

Purpose of the Study:

  • To validate RCT findings in a broader patient cohort through an observational study.
  • To identify predictors for successful surgical outcomes in Hashimoto disease patients.
  • To further investigate the autoimmune pathophysiology of persistent symptoms.

Main Methods:

  • An observational study included 154 euthyroid patients with Hashimoto disease and persistent symptoms.
  • All patients underwent total thyroidectomy.
  • Outcomes were assessed for 18 months post-surgery, focusing on the General Health (GH) score from the SF-36 survey.

Main Results:

  • Clinically significant improvement in GH was observed 18 months post-surgery, consistent with RCT findings.
  • Anti-TPO antibody titers decreased significantly after surgery.
  • Preoperative factors did not predict surgical outcomes. Complications included recurrent nerve palsy (1.9%) and hypoparathyroidism (3.9%).

Conclusions:

  • Total thyroidectomy offers symptomatic relief for euthyroid Hashimoto disease patients with persistent symptoms.
  • The exact pathophysiology of residual symptoms requires further investigation.
  • High complication rates necessitate performing thyroidectomy in specialized centers by experienced surgeons, ideally within further research studies.