BACKGROUND
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.

THE FULL ARTICLE TITLE
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

SUMMARY OF THE STUDY
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.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
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

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