Total Thyroidectomy and Quality of Life in Patients With Hashimoto Thyroiditis: A Systematic Scoping Review

Hashimoto thyroiditis is one of the most common causes of hypothyroidism globally. Patients frequently experience symptoms of hypothyroidism, for which the current mainstay of treatment is thyroid hormone repletion with levothyroxine. Despite treatment, some patients who achieve biochemical euthyroid status experience persistent hypothyroid symptoms for which there is no clear treatment. However, recent evidence indicates that total thyroidectomy may improve quality of life (QoL) in this group of patients. This review aims to understand the current literature on how total thyroidectomy compares to levothyroxine alone in improving QoL of patients with Hashimoto thyroiditis.

Following PRISMA guidelines for scoping review, we searched PubMed, Cochrane, Embase, and Scopus using the search terms "thyroiditis, autoimmune," "lymphocytic thyroiditis," "Hashimoto disease," and "quality of life." Articles comparing the two treatments by evaluating patients' QoL were included.

A total of four studies and a follow-up report on the only randomized controlled trial among the four were found. Indications for thyroidectomy are generally extrathyroidal symptoms despite thyroid hormone replacement (mainly levothyroxine). All four studies reported an improvement in QoL after thyroidectomy compared to those treated medically. QoL was measured using the SF-36 in three studies and ThyPRO in the other. Two studies reported a statistically significantly greater decline in antithyroid peroxidase antibody levels postthyroidectomy compared to thyroid hormone replacement. A total of 151 patients in the four studies underwent thyroidectomy (98% total or near-total thyroidectomy). The pooled risks of temporary or permanent recurrent laryngeal nerve palsy and temporary or permanent hypoparathyroidism were 4.0%, 2.6%, 13.9%, and 4.0%, respectively. Infection or hematoma occurred in 3.1% and 6.8% of patients in the two studies that reported these complications. A case of tracheal perforation was also reported.

Total thyroidectomy may improve QoL in a subset of Hashimoto thyroiditis patients who are persistently symptomatic despite being euthyroid on levothyroxine therapy. However, a higher surgical complication rate is possible. Further prospective clinical trials are needed to confirm this observation and determine the mechanism behind the improvement in QoL.