The Prevalence of Local Symptoms in Benign Thyroid Disease: A Systematic Review with Meta-analysis

This systematic review seeks to evaluate the prevalence of local symptoms in patients with benign thyroid disease as described in the literature.

A literature search was conducted across PubMed, Embase, Medline, and Cochrane databases.

Crude symptom prevalence was obtained by addition of data across studies that reported local symptoms, and adjusted symptom frequency was calculated using a random effects model. Subgroup analysis was conducted to explore heterogeneity.

The final review included 21 studies with 4063 patients, with adjusted symptom prevalence as follows: dyspnoea (29%), dysphagia (23%), dysphonia (18%). Globus and cosmetic concern were frequent in nodule subgroups (54% and 77%, respectively). Patients with goiter were significantly more likely to experience dyspnoea than those with solitary nodules. Symptom prevalence was qualitatively higher in studies that used questionnaires, as compared with studies containing clinician-derived data.

Local symptoms occur frequently in patients with benign thyroid disease, with dyspnoea being most common, followed by dysphagia and dysphonia. Additional large-scale studies with homogenous reporting of symptoms, and data pertaining to thyroid disease size and location, are required to further delineate the relationship between benign thyroid disease and local symptomatology. Furthermore, the disparity in symptom prevalence between questionnaire and clinician-derived data suggests the superiority of questionnaires as a means of symptom assessment, and their potential utility as an instrument to guide patient counseling and outcome expectations. Laryngoscope, 135:1553-1562, 2025.