BACKGROUND
Thyroid cancer has an excellent prognosis and surgery is often the only treatment needed. The surgery options include removing the entire thyroid (total thyroidectomy) or just part of the gland (lobectomy). Patients with thyroid cancer have excellent survival and low rates of cancer recurrence regardless of the extent of surgery. Thyroid hormone therapy is always needed after a total thyroidectomy.

One advantage that lobectomy has over a total thyroidectomy is less need for treatment with thyroid hormone after surgery and, if needed, often lower doses are fine. Some studies suggest that the need for thyroid hormone after surgery affects patient’s quality of life (QOL). A large survey of hypothyroid patients found that a subset of those patients were frustrated with their current treatment, with dissatisfaction mostly related to weight management, fatigue or energy level, mood, and memory. Therefore, decision-making regarding the extent of surgery performed for suspected thyroid cancer may have a substantial impact on health-related QOL. This study compared health-related QOL in patients who underwent thyroid lobectomy with those who underwent total thyroidectomy.

THE FULL ARTICLE TITLE
Yaniv D et al 2022 Quality of life following lobectomy versus total thyroidectomy is significantly related to hypothyroidism. J Surg Oncol. Epub 2022 Jun 11. PMID: 35689620.

SUMMARY OF THE STUDY
Patients who underwent thyroid lobectomy or total thyroidectomy at least 6 months earlier at a universityaffiliated medical center were invited to participate. They completed the 85-question ThyPRO QOL questionnaire, a validated patient-reported tool divided into three main categories assessing the impact of thyroid disease, fatigue/ mental health, and physical symptoms. Information regarding the patients’ history, surgical pathology, other illnesses, and thyroid blood tests were collected from the medical record.

A total of 160 patients took part in the study; most of them were female (83.1%) and the average age was 54 years. Overall, 20% of patients had a benign (non-cancerous) nodule/goiter. Of the patients with cancer, most (73.8%) had papillary thyroid carcinoma. In terms of surgery, 51.8% of patients underwent thyroid lobectomy (51.8%) while 48.2% had a total thyroidectomy. Of those who underwent lobectomy, 30 (36.1%) required levothyroxine supplementation or full replacement therapy. Thus, 107 patients (all of the total thyroidectomy group plus 30 lobectomy patients, 66.8% of the total group) in the study population received levothyroxine.

Patients who underwent total thyroidectomy reported a worse overall thyroid-related QOL than those who underwent lobectomy. Regardless of the extent of their surgery, patients receiving levothyroxine therapy reported an increased negative impact of their disease on their overall QOL as well as significant increases in tiredness, emotional issues and cosmetic symptoms.

Within the subgroup of patients taking levothyroxine after a lobectomy, the overall self-assessment and tiredness scores were better than in patients who underwent lobectomy and did not require L-T4. Patients who were taking TSH-suppressing (defined as TSH <0.5 μIU/ml) doses of levothyroxine reported a worse overall self-assessment score, than patients with normal TSH levels who were taking levothyroxine. QOL parameters did not vary significantly according to menopausal status, receipt of radioactive iodine treatment, or cancer versus no cancer pathology.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that QOL outcomes are associated with the need for levothyroxine therapy rather than with the extent of surgery. While it is important to weigh the risks, and benefits of total thyroidectomy versus thyroid lobectomy, current guidelines support more limited surgery for patients with low-risk thyroid cancers. However, these data suggest that even patients who undergo lobectomy but still require levothyroxine therapy may experience adverse effects on their QOL as compared with patients who did not require any levothyroxine supplementation after lobectomy.

— Alan P. Farwell, MD

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