BACKGROUND
Thyroid cancer is very common. Fortunately, most cases of thyroid cancer are low risk cancers with an excellent prognosis. The management of low risk thyroid cancers has been changing, as removal only of the lobe containing the thyroid cancer (lobectomy) has become more common. Indeed, survival appears to be the same if these patients have the whole thyroid removed or just a lobectomy. Thus, the current ATA guidelines state that choice of surgery should be determined individually.

There are studies suggesting that total thyroidectomy may be associated with higher cost, higher rate of complications and lower health related quality of life outcomes (HRQOL). The previous studies are limited either because they look at treatments already performed or have a small number of participants. This study was done to evaluate HRQOL in large number of patients who were planning to have either a total thyroidectomy or lobectomy as treatment for their low risk thyroid cancer.

THE FULL ARTICLE TITLE
Chen W et al W 2021 Association of total thyroidectomy or thyroid lobectomy with the quality of life in patients with differentiated thyroid cancer with low to intermediate risk of recurrence. JAMA Surg. Epub 2021 Dec 22. PMID: 34935859.

SUMMARY OF THE STUDY
The study enrolled over 1000 patients at a single institution in China who were diagnosed with low to intermediate risk thyroid cancer and underwent either total thyroidectomy or lobectomy. They were studies using three different questionnaires of HRQOL before surgery and at 1,3, 6 and 12 months after surgery. Their TSH was also monitored after surgery. Of the patients studied, most were women (78%) with an average age of 38 years.

Total thyroidectomy was performed in 47% of patients and lobectomy in 53%. As compared with the lobectomy group, the total thyroidectomy group was more likely to be married, to have larger cancers (>4 cm), and to have a lymph node dissection and radioactive iodine therapy.

In terms of the HRQOL questionnaire:

• At 1 month after surgery, the total thyroidectomy group reported more anxiety, depression, fatigue, pain, voice change, tingling, and sexual dysfunction.
• At 3 months, the total thyroidectomy group reported more anxiety, fatigue, appetite loss, neuromuscular symptoms, voice changes, tingling, and financial difficulties.
• By 6 and 12 mo there was no difference between the two groups except for sleep disturbance in the total thyroidectomy group.

Both the total thyroidectomy and lobectomy groups had a higher rate of depression and anxiety as compared to evaluation before surgery. TSH was better controlled in the lobectomy group even at 12 mo after surgery. Patient satisfaction between the two groups was unchanged at 1 year after surgery.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study concludes that quality of life outcomes are similar by 6-12 mo after total thyroidectomy compared to lobectomy. Thus, a decision regarding extent of surgery should not be dependent upon this factor. The described changes in HRQOL over the year after surgery can help patients understand what to expect after surgery and allow for reassurance from providers about the course of symptoms over the year.

— Marjorie Safran, MD

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