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Total thyroidectomy improves quality of life in children and adolescents with Graves’ disease

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Autoimmune hyperthyroidism, or Graves’ disease, affects 1 in 10,000 in the United States, mostly adults. Treatment options for Graves’ disease include antithyroid drugs, radioactive iodine therapy and surgery (thyroidectomy). Pediatric Graves’ disease is rare, but it is associated with hyperthyroid symptoms that may significantly affect psychosocial and physical functioning. The most common treatment option for Graves’ disease in children and adolescents are antithyroid drugs, but the relapse rate can be as high as 30 to 35% even after 5 years of treatment. Radioactive iodine therapy is less attractive in children and young adults because of the risk of causing or worsening thyroid eye disease. As is the case in adults, thyroid surgery is an effective treatment option in children and adolescents, although less utilized than antithyroid drugs and radioactive iodine therapy.

Health-related quality of life (QoL) has been studied in adults with Graves’ disease, but no data have been reported in children with Graves’ disease. The goal of this study was to describe the impacts on QoL of total thyroidectomy in children with Graves’ disease.

Halada S et al 2022 Impact of definitive surgery for Graves’ disease on adolescent disease-specific quality of life and psychosocial functioning. Thyroid. Epub 2022 Oct 17

Patients 12 to 19 years old who were pursuing total thyroidectomy for Graves’ disease, along with their parents, were recruited to complete surveys before and at least 6 months after undergoing the procedure. Total thyroidectomy was performed by a high-volume, pediatric thyroid surgeon (defined as a surgeon who has completed at least 25 thyroid surgeries annually). Surveys assessed the reasons for pursuing a total thyroidectomy, QoL scores and satisfaction with the surgery.

Prior to surgery, parents shared their perceptions on the severity of their child’s condition and their thoughts about the potential treatments for Graves’ disease. Parents also rated their reasons for considering surgery from a list of potential factors. Disease-specific QoL, psychosocial functioning, and appearance concerns were assessed using questionnaires completed before and after total thyroidectomy. Baseline surveys only were completed by 37 patient– parent pairs, whereas 20 patient–parent pairs completed both the before and after total thyroidectomy surveys. At baseline, patients reported the presence of symptoms, including tiredness, anxiety, and emotional susceptibility, via the ThyPRO QoL questionnaire.

Overall, disease-specific QoL significantly improved following total thyroidectomy, with notable improvements associated with resolution of the goiter, hyperthyroid symptoms, tiredness, anxiety and emotional lability. Physical functioning also significantly improved after total thyroidectomy. Reported Graves’ disease–associated thyroid eye disease symptoms were the second-lowestscoring ThyPRO subscore at baseline, but they improved following surgery. Overall, families reported recovery from the surgery by an average of 2 months, high satisfaction with the outcomes of total thyroidectomy, and minimal concerns over the scar appearance. No permanent surgical complications were noted.

This study shows that total thyroidectomy for Graves’ disease in pediatric populations may have substantial beneficial effects on disease-specific QoL and psychosocial functioning scores. An important aspect of this study was the involvement of high-volume thyroid surgeons, who have been shown to have a much lower complication rate than low-volume surgeons. Indeeed, no permanent surgical complications were noted. Further studies are needed to confirm these findings and to compare the impact of total thyroidectomy versus other treatment options (radioactive iodine therapy or antithyroid drugs) on QoL in children.

— Alan P. Farwell, MD


Thyroidectomy: surgery to remove the entire thyroid gland. When the entire thyroid is removed it is termed a total thyroidectomy. When less is removed, such as in removal of a lobe, it is termed a partial thyroidectomy.

Hyperthyroidism: a condition where the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery.

Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.

Thyroid eye disease (TED): also known as Graves ophthalmopathy. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision.