Assessing Quality of Life After Thyroidectomy

Patients diagnosed with differentiated thyroid cancer (DTC), particularly those who underwent total thyroidectomies vs hemithyroidectomies, report a wide range of health-related quality of life (HRQOL) issues, found a recent study published in JAMA Otolaryngology-Head & Neck Surgery.

“This study documents that patients who can get away with hemithyroidectomy when appropriately selected are going to be happier long-term than people with total thyroidectomy,” said Christopher Umbricht, MD, PhD, an associate professor of oncology at Johns Hopkins Sidney Kimmel Cancer Center, in an interview with Cancer Network.

Researchers conducted a content analysis of survey responses from 1,005 patients with DTC. A total of 775 (77.1%) reported issues in HRQOL following diagnosis and current treatment regimens for DTC. These issues were more frequent in those who had a total thyroidectomy-without neck dissection-than in those who had a hemithyroidectomy.

Four HRQOL themes were noted during the content analysis of survey results, including physical effects (663 [66.0%]), psychological effects (187 [18.6%]), lifestyle effects (82 [8.2%]), and no issue or adverse effect (246 [24.5%]). Patients who received a total thyroidectomy (without neck dissection) were 1.5 times more prone to report an HRQOL issue or an adverse effect of treatment vs patients who received a hemithyroidectomy (odds ratio, 1.49; 95% CI, 1.04–2.12).

Of the 1,005 patients with DTC (72.2% female; mean age, 52 years), 88.6% were diagnosed with papillary thyroid cancer, 56.4% had tumors smaller than 2 cm, and 78.7% had total thyroidectomy.

Umbricht said he is not surprised by the results of the current study. “You would expect that the outcome in patient satisfaction, which is a function of complications, and the possible need for lifelong thyroid hormone dosing, is going to be directly proportional to whether patients have a hemithyroidectomy or total thyroidectomy,” he said. “That is balanced by the increased risk of potentially having invisible disease that is not adequately treated by hemithyroidectomy.”

He also pointed to several more specific concerns seen with total thyroidectomy. “Any time you do a total thyroidectomy, your patient needs to take supplemental hormones for the rest of their life,” said Umbricht. “And if you’re comparing with hemithyroidectomy, intuitively you’re doubling the risk that the surgery is going to damage some of the very sensitive anatomy around the neck. Particularly, the two nerves that go down and innervate the vocal cords on either side.” Umbricht also noted adverse effects caused by removal of the parathyroid glands, which may be a complication of total thyroidectomy.

Patients with small, localized DTCs should be considered for hemithyroidectomy in light of fewer adverse effects and improved HRQOL, but this approach is not always feasible, according to Umbricht. “The choice of surgery is also influenced by the degree of disease,” he said. “So, the patients who undergo hemithyroidectomy typically have less extensive disease, so they’re in better shape to begin with than those who needed total thyroidectomy.”