Hazel Serrao-Brown, Amna Saadi, Jessica Wong, Alexander Papachristos, Mark Sywak, Stan Sidhu
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引用次数: 0
Abstract
Background: Hashimoto's thyroiditis (HT) is managed with thyroid hormone replacement to maintain a euthyroid state. A subset of patients have refractory symptoms, which improve with thyroidectomy (TT). There remains a reluctance to proceed with surgery due to perceptions of complications, and limited data availability regarding improvements in quality of life (QoL). This retrospective case control study aims to analyse the outcomes and QoL scores for symptomatic euthyroid HT patients who underwent TT.
Methods: Thirty euthyroid patients who underwent TT for the management of HT between 2017 and 2022 were identified. An age-matched control group of patients who underwent TT for symptomatic multinodular goitre (MNG) were randomly selected. Demographics, biochemistry, histology, outcomes, and pre- and post-operative SF-36 and ThyPRO-39 scores were compared between groups.
Results: There were no surgical complications in the HT group, whilst two MNG patients had complications. There was a similar rate of parathyroid auto-transplantation in both groups, more glands were transplanted in the HT group. There was a significant difference in pre- and post-operative QoL scores for both groups. Comparison revealed a significant improvement in hyperthyroid symptoms, social life and daily life scores in the HT group. There was a significant difference in pre- and post-operative anti-TPO, anti-TG and TSH levels in the HT group.
Conclusion: Patients with symptomatic Hashimoto's thyroiditis, despite being euthyroid, may benefit from total thyroidectomy however this remains under-utilized. This study demonstrated that thyroidectomy was associated with an improvement in validated post-operative quality of life scores and was not associated with increased complication rates for appropriately selected patients.
背景:桥本氏甲状腺炎(HT)需要通过补充甲状腺激素来维持甲状腺功能正常。一部分患者有难治性症状,甲状腺切除术(TT)可改善这些症状。由于认为会出现并发症,且有关生活质量(QoL)改善情况的数据有限,患者仍不愿意接受手术治疗。这项回顾性病例对照研究旨在分析接受TT的无症状甲状腺功能亢进患者的治疗效果和QoL评分:确定了2017年至2022年间接受TT治疗甲状腺功能亢进的30名甲状腺功能亢进患者。随机选取因症状性多结节性甲状腺肿(MNG)接受TT治疗的患者作为年龄匹配的对照组。对两组患者的人口统计学、生物化学、组织学、疗效、术前术后SF-36和ThyPRO-39评分进行比较:结果:HT组无手术并发症,而MNG组有两名患者出现并发症。两组患者的甲状旁腺自体移植率相似,但HT组移植的腺体更多。两组患者术前和术后的 QoL 评分有明显差异。比较显示,HT组的甲状腺功能亢进症状、社交生活和日常生活评分明显改善。HT组患者术前和术后抗TPO、抗TG和促甲状腺激素水平有明显差异:结论:有症状的桥本氏甲状腺炎患者尽管是甲状腺功能亢进,但仍可从全甲状腺切除术中获益,但这种方法仍未得到充分利用。这项研究表明,甲状腺切除术与术后生活质量有效评分的改善有关,而且对于经过适当选择的患者来说,甲状腺切除术与并发症发生率的增加无关。
期刊介绍:
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.