Patients Face Quality of Life Challenges Post-Thyroidectomy

Thyroid Gland: © Anatomy Insider - stock.adobe.com

While most thyroid cancers are low-risk and have positive prognoses, quality of life (QOL) challenges can still exist for patients who undergo partial or complete thyroid removal, according to findings from recent analyses. However, the length of time that these challenges exist may vary.

A 2023 systematic review identified that health-related QOL (HRQOL) tended to be better after hemithyroidectomy (HT) vs total thyroidectomy (TT) or TT and central neck dissection (CND) in patients with differentiated thyroid cancer (DTC).¹

Six of 14 studies that were evaluated identified that patients had better HRQOL outcomes after HT compared with TT. Two studies concluded that HT resulted in better HRQOL compared with TT with CND, and 2 studies identified that the HRQOL benefit with HT was minimal by 6 months post-operation. The HRQOL benefits were seen across physical, psychological, and emotional health domains, and the benefits were observed across age, life stage, and marital status subgroups. However, differences in HRQOL between HT and TT were not observed in 4 studies. Additionally, TT was not associated with improved HRQOL over HT in any of the studies.

The review analyzed 16 out of 1402 prospective and retrospective studies, totaling data from 4957 patients. The mean age of patients was 46.6 years and 77.6% were women. Study data from 2011 to 2022 was collated from PubMed, CINAHL, Cochrane, PsycINFO, and Scopus databases. The 14 studies analyzed used 6 different HRQOL measurement tools; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Thyroid-Cancer Specific Quality of Life questionnaire were the most used across the studies.

Findings from a 2020 study identified that patients who underwent a thyroidectomy reported worse QOL responses compared with control patients with no subjective health concerns, and these differences were observed up to a year post-thyroidectomy.² 

A 2021 study identified that the HRQOL disparities in patients who receive TT vs lobectomy appear to dissipate after a year. One-month post-TT, patients reported greater levels of anxiety, depression, fatigue, pain, voice change, tingling, and sexual dysfunction than patients who underwent lobectomy. At 3 months, the TT group reported more anxiety, fatigue, appetite disturbances, neuromuscular syndromes, voice changes, and tingling. However, by 6 and 12 months, the TT only reported greater levels of sleep disturbance, signaling that HRQOL complaints for patients undergoing TT may resolve after 6 months to 1 year post-operation.³

Overall, experts must further identify prospective and ideally randomized data to fully determine the impact of the extent of surgery on HRQOL among patients with low-risk thyroid cancer.

REFERENCES:

1. Bach K, Ansari P, Ansari H, et al. Health-related quality of life in patients with low-risk differentiated thyroid cancer: A systematic review examining the extent of thyroidectomy. Thyroid. Published online November 14, 2023. doi: 10.1089/thy.2023.0328

2. Yu HW, An AR, Kang HI, et al. Does thyroidectomy impact quality of life: retrospective case-control study of post-thyroidectomy patients and matched individuals from the general population. Medicina (Kaunas). 2020;56(11):603. Published 2020 Nov 10. doi:10.3390/medicina56110603

3. Prescott, J. Quality of life after thyroid cancer surgery if parathyroid hormone levels are low after surgery. Clin. Thyroidol. 2021; 14(2):9-10.