Patients With Persistent Hashimoto-Related Symptoms. Dilemmas in Advice-Giving and Self-Selection for Thyroidectomy....

Some Hashimoto-related symptoms, persistent despite medically obtained euthyroidism, are believed to be related to autoimmunity. Total thyroidectomy has proved beneficial for patient-reported outcome measures (PROMs), but with a certain risk of complications. Selection criteria for surgery have not been defined. Molecular evidence supporting an autoimmune cause is lacking, and a placebo effect of surgery cannot be excluded. Short of selection criteria for thyroidectomy and no pathophysiologic model to adequately explain persistent symptoms, we wanted to look into factors that may be related to patients' decision for surgery, thus aiming to facilitate patient-physician communication on treatment for persistent Hashimoto-related symptoms.

A total of 177 patients with persistent Hashimoto disease-related symptoms and highly motivated for thyroidectomy completed an 18-month watchful waiting period with biannual consultations before being offered thyroidectomy. PROMs were monitored before and after surgery.

After 18 months of watchful waiting, 131 (74%) of 177 patients proceeded to thyroidectomy whereas 46 declined surgery. There was no difference between the surgery and no-surgery groups regarding sex, age, and thyroid peroxidase antibody levels at 18 months watchful waiting. Compared with the no-surgery group, PROM scores were consistently poorer in the surgery group for all domains in the PROM questionnaires used.

A grace period of 18 months with biannual follow-up before thyroidectomy may be useful to modify exposure to surgery carrying a certain risk of complications. At 18 months, the fatigue score stands out as the most important factor influencing the odds for maintaining a choice to have surgery.