Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial.

Abstract

Background:

Hashimoto disease is a chronic autoimmune thyroiditis. Despite adequate hormone substitution, some patients have persistent symptoms that may be the result of immunologic pathophysiology.

Objective:

To determine whether thyroidectomy improves symptoms in patients with Hashimoto thyroiditis who still have symptoms despite having normal thyroid gland function while receiving medical therapy.

Design:

Randomized trial. (ClinicalTrials.gov: NCT02319538).

Setting:

Secondary care hospital in Norway.

Patients:

150 patients aged 18 to 79 years with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy and with serum antithyroid peroxidase (anti-TPO) antibody titers greater than 1000 IU/mL.

Intervention:

Total thyroidectomy or medical management with hormone substitution to secure euthyroid status in both groups.

Measurements:

The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) at 18 months. Secondary outcomes were adverse effects of surgery, the other 7 SF-36 subscores, fatigue questionnaire scores, and serum anti-TPO antibody titers at 6, 12, and 18 months.

Results:

During follow-up, only the surgical group demonstrated improvement: Mean general health score increased from 38 to 64 points, for a between-group difference of 29 points (95% CI, 22 to 35 points) at 18 months. Fatigue score decreased from 23 to 14 points, for a between-group difference of 9.3 points (CI, 7.4 to 11.2 points). Chronic fatigue frequency decreased from 82% to 35%, for a between-group difference of 39 percentage points (CI, 23 to 53 percentage points). Median serum anti-TPO antibody titers decreased from 2232 to 152 IU/mL, for a between-group difference of 1148 IU/mL (CI, 1080 to 1304 IU/mL). In multivariable regression analyses, the adjusted treatment effects remained similar to the unadjusted effects.

Limitation:

Results are applicable only to a subgroup of patients with Hashimoto disease, and follow-up was limited to 18 months.

Conclusion:

Total thyroidectomy improved health-related quality of life and fatigue, whereas medical therapy did not. This improvement, along with concomitant elimination of serum anti-TPO antibodies, may elucidate disease mechanisms.

Primary Funding Source:

Telemark Hospital.

• Authors: Ivar Guldvog, Laurens Cornelus Reitsma, Lene Johnsen, Andromeda Lauzike, Charlotte Gibbs, Eivind Carlsen, Tone Hoel Lende, Jon Kristian Narvestad, Roald Omdal, Jan Terje Kvaløy, Geir Hoff, Tomm Bernklev, Håvard Søiland
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 170 Issue 7 Pg. 453-464 (04 02 2019) ISSN: 1539-3704 [Electronic] United States
• PMID: 30856652 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antibodies
• Triiodothyronine
• Iodide Peroxidase
• Thyroxine

Topics

• Adolescent
• Adult
• Aged
• Antibodies (blood)
• Drug Therapy, Combination
• Fatigue (prevention & control)
• Female
• Follow-Up Studies
• Hashimoto Disease (immunology, physiopathology, surgery, therapy)
• Hormone Replacement Therapy
• Humans
• Iodide Peroxidase (immunology)
• Male
• Middle Aged
• Patient Reported Outcome Measures
• Postoperative Complications
• Quality of Life
• Thyroid Gland (physiology)
• Thyroidectomy (adverse effects)
• Thyroxine (therapeutic use)
• Triiodothyronine (therapeutic use)
• Young Adult