The question that this paper attempts to answer has been asked quite a number of times here, over the years.
I'd like to think that, post-thyroidectomy, the patient would receive whatever thyroid hormone medication works best for them of course. Which could continue to be an issue even if the operation sets them off in a good direction.
I'd also like to think that the option should be provided to patients to fully discuss and choose. It should not be artificially restricted, nor promoted, by health organisation, post-code or whatever.
Ann Intern Med. 2019 Mar 12. doi: 10.7326/M18-0284. [Epub ahead of print]
Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial.
Guldvog I1, Reitsma LC1, Johnsen L2, Lauzike A1, Gibbs C1, Carlsen E1, Lende TH3, Narvestad JK2, Omdal R3, Kvaløy JT4, Hoff G1, Bernklev T5, Søiland H3.
Author information
1 Telemark Hospital, Skien, Norway (I.G., L.C.R., A.L., C.G., E.C., G.H.).
2 Stavanger University Hospital, Stavanger, Norway (L.J., J.K.N.).
3 Stavanger University Hospital, Stavanger, Norway, and University of Bergen, Bergen, Norway (T.H.L., R.O., H.S.).
4 University of Stavanger and Stavanger University Hospital, Stavanger, Norway (J.T.K.).
5 Telemark Hospital, Skien, Norway, Vestfold Hospital, Tønsberg, Norway, and University of Oslo, Oslo, Norway (T.B.).
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.
PMID: 30856652
DOI: 10.7326/M18-0284
Normal TSH but all the symptoms of Hypothyroidism and I have Hashimoto disease. Help! 
Hashimoto - how to bring persistently high Anti-TPO level down?
TSH is either a faulty indicator of treatment or if not, patients are often incorrectly treated by T4 (a logical challenge)
