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

[holyshedballs]

DOI: 10.7326/M18-0284

annals.org/aim/article-abst...

I cant access the full paper. The Abstract doesn't say what dose the patients were on or why the could say that the patients were adequately treated yet signs and symptoms persisted. The Abstract doesn't say what dose the thyroidectomised patients were on before and after surgery. But it could be something worth a discussion if another forum member can access the full paper.

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

[SilverAvocado]

I believe this paper has been posted on the forum recently. I am not very good at finding things, but will have a try in a minute.

These days the word Euthyroid always gives me a sinking feeling when reading anything. It's one of those 'protest too much' things. If the people discussed actually had healthy thyroids no one would be bothering to mention it.

I looked up exactly what the word meant to see if there is anything fishy about it, and it means just what I'd thought: "having a normally functioning thyroid gland". I couldn't find any definition that includes a mention that a person whose thyroid gland isn't functioning could achieve this status using medication. Everything I saw had some word like "function" in it to suggest that the gland itself is doing the work of making hormone.

To me it looks like this means every paper that uses it to describe thyroid patients whose blood test are considered healthy is actually using the term wrongly. Unless they were very specifically using it to make the distinction that Euthyroid people and thyroid patients with adequate hormone replacement will have quite different blood tests.

[holyshedballs in reply to SilverAvocado]

Exactly!! How can they say that there is adequate hormone replacement if there are still signs and symptoms!!

They are just looking at the lab results - it seems to me. I think it is not good science or medicine.

[SilverAvocado]

Found it! PR4NOW and Helvella both posted it a couple of weeks ago: healthunlocked.com/thyroidu...