患有持续的哈希莫托相关症状的患者. 咨询和自我选择甲状腺切除术的困境. 一个观察性研究
Geir Hoff1, Tomm Bernklev2, Jan Terje Kvaløy3
1Department of Research, Telemark Hospital, Skien, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
概括
一个18个月的警等待期帮助了许多哈西莫托病患者重新考虑甲状腺切除术. 疲劳显著影响了继续进行手术的决定,强调了需要更好的患者与医生的沟通.
科学领域:
- 内分泌学 在内分泌学.
- 自免疫性疾病 自免疫性疾病
- 外科手术决策 - - 进行外科手术的决策
背景情况:
- 哈西莫托病的持续症状,即使甲状腺激素水平正常化,也经常被归因于自身免疫.
- 整体甲状腺切除术可以改善患者报告的结果测量 (PROM),但会带来手术风险.
- 缺乏明确的选择标准和对持续症状的强大的病理生理学模型.
研究的目的:
- 调查影响患者关于甲状腺切除术决定的因素,以发现持续的哈西莫托病症状.
- 改善患者与医生的沟通,了解持续症状的治疗选择.
- 评估警等待期对手术决策的影响.
主要方法:
- 177名患有持续性哈西莫托病症状的患者经历了18个月的警等待期,每两年进行一次咨询.
- 患者报告的结果措施 (PROMs) 在警等待期之前和之后进行评估.
- 支持或反对甲状腺切除术的决定是在18个月后记录的.
主要成果:
- 74%的患者 (131/177) 在警等待期后选择了甲状腺切除术;46人拒绝了.
- 在手术和非手术组之间没有观察到性别,年龄或甲状腺过氧化酶抗体水平的显著差异.
- 与拒绝手术的患者相比,接受手术的患者在所有领域报告了较差的PROM得分.
结论:
- 一个18个月的警等待期和定期随访可以帮助患者重新考虑甲状腺切除术,减轻手术风险.
- 患者的疲劳成为影响进行甲状腺切除术的决定的最重要因素.
- 这种方法可能有助于完善选择标准,并加强患者与医生之间的对话.
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