If all you have is a knife... Obviously the concept of identifying and removing the triggers has alluded them. PR
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.
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.
What a strange research question. I had a search for the complete text but seems to be behind a paywall. I wondered if they had given any theoretical background or discussion of the mechanism they think is achieving this! Is the argument that all those negative symptoms were caused by antibodies?
I do wonder if this is a regression to the mean type effect. The rationale of the sample is 'Hashimotos patients we aren't helping with hormone replacement', and then with half that group they've done something different, and with the other half continued the same (? Can't think what else medical treatment would be?).
It's a bit garbled because the patients are described as "having normal thyroid gland function", but given the context of the rest of the abstract I think they mean 'having euthyroid blood tests'. Of course no detail in the abstract on which set of blood tests they mean or whether all they mean is within the reference range.
Even if we assume this research and write up were good faith, which I don't think we can, I'd definitely want to see follow-ups at perhaps 1 year, 5 years, 10 and 20 years to see if any improvement holds long term. I'd also like to see much larger numbers in the sample. If we assume that 80% of people respond well to T4 mono therapy, which is the kind of numbers mainstream medicine gives, and the proportion in this sample match that, this sample equates to 30 relevant patients. But I guess that's the problem Diogenes often mentions with different patient groups being lumped together.
My apologies to Helvella, I'm afraid I had missed his post. Medpage Today and Medscape both had articles about this study in the last couple of days. I hope they learn that it is possible to improve peoples lives without cutting their thyroid gland out. Treatment was with Levo only I believe. Link to Medpage article which may or may not work. PR
Thanks PR4NOW, the link does work, and this piece contains several big quotations from the full paper.
The mechanism as they describe is entirely to reduce antibodies. I don't have Hashimoto's so haven't experienced them, but do feel a bit skeptical that antibodies can mirror so many of the effects of being hypothyroid in the first place.
A quote I found pretty frustrating: "no specific treatment exists for patients whose symptoms persist despite adequate thyroid hormone replacement". When of course there is the option to try T3 or NDT, or on the other hand take steps to reduce antibodies!
Some interesting comments discussing what a strong placebo effect surgery can have. Not something I'd really considered, but a commenter suggests the controls should have a sham surgery. Might be difficult to get people to sign up for a study that might include that. I wonder if the sham surgery includes cutting patients open, I suppose it must do!
MissGrace, some T3 might have helped but identifying the triggers and removing them would have been much more benign. I'll be the first to admit that changing personal habits can be difficult but if you don't you are something like 30% more likely to develop a second or third autoimmune condition. You have to stop the autoimmune attack on the body. PR
A trial that is basically flawed if the "adequate hormone substitution" was levothyroxine.
Only NDT is suitable after a TT.
The follow-up period of 18 months is also totally inadequate as a TT is likely to improve health after a TT and noticeable deterioration may not be obvious to this sort of patient for quite some time.
A review of the patients needs to be done annually for several years.
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Normal TSH but all the symptoms of Hypothyroidism and I have Hashimoto disease. Help! 
Thyroidectomy and Patient response
has anyone managed to talk sense into their GP when reviewing medication for hashimotos in the UK?
Lab results confusion
