Standard treatment for differentiated thyroid cancer (DTC) is surgery, which includes either a total thyroidectomy or hemithyroidectomy. Surgery may then be followed by radioactive iodine treatment and, for some, treatment with thyroid hormone to suppress thyrotropin levels. All patients undergoing thyroidectomy, and a small proportion undergoing hemithyroidectomy, require thyroid hormone replacement. All these treatments have the potential for adverse consequences. Thyroidectomy carries well-documented risks of vocal cord paralysis and hypoparathyroidism, and these risks are higher for total thyroidectomy versus hemithyroidectomy. Recent guidelines now suggest more conservative treatment options for patients diagnosed with small DTC, recommending hemithyroidectomy over total thyroidectomy. Despite the excellent prognosis of DTC, several comparative studies have demonstrated that people treated for DTC report poorer health-related quality of life (HRQOL) compared with the general population, as measured through validated questionnaires. Concerns around possible overdiagnosis and overtreatment of differentiated thyroid cancer (DTC) have been raised. The authors of this study aimed to assess HRQOL outcomes and whether these outcomes vary by the type of surgery the patient received.

In this survey of 1005 patients with differentiated thyroid cancer, 775 (77.1%) reported issues in their health-related quality of life. These issues were more prevalent in those who received a total thyroidectomy compared with those who received a hemithyroidectomy. The common concerns were fatigue, struggling with daily activities, inconvenience of lifelong medication, pain or soreness in the neck, swallowing difficulties and change in voice.

Given the recent concerns regarding over diagnosis and overtreatment in thyroid cancer, hemithyroidectomies offer fewer adverse effects of treatment and better health-related quality of life outcomes than total thyroidectomies for patients with differentiated thyroid cancer.

Health-Related Quality of Life After Diagnosis and Treatment of Differentiated Thyroid Cancer and Association with Type of Surgical Treatment.
Nickel B, Tan T, Cvejic E, et al.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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