Thyroidectomy for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms

Abstract

Letters28 November 2023Thyroidectomy for Euthyroid Patients With Hashimoto Disease and Persisting SymptomsGeir Hoff, MD, PhD*, Tomm Bernklev, PhD*, Lene Johnsen, MD, Laurens Reitsma, MD, Dirk Sina, MD, Andromeda Lauzike, MD, Charlotte Gibbs, MD, PhD, Eivind Carlsen, MD, Tone Hoel Lende, MD, PhD, Jon Kristian Narvestad, MD, Rasmus Kildahl, MD, Roald Omdal, MD, PhD, Jan Terje Kvaløy, PhD†, Håvard Søiland, MD, PhD†Geir Hoff, MD, PhD*Department of Research, Telemark Hospital, Skien, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway, Tomm Bernklev, PhD*Institute of Clinical Medicine, University of Oslo, Oslo, and Department of Research, Vestfold Hospital, Tønsberg, Norway, Lene Johnsen, MDDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway, Laurens Reitsma, MDDepartment of Breast and Endocrine Surgery, Akershus University Hospital, Campus Oslo, Lørenskog, Norway, Dirk Sina, MDDepartment of Breast and Endocrine Surgery, Telemark Hospital, Skien, Norway, Andromeda Lauzike, MDDepartment of Breast and Endocrine Surgery, Telemark Hospital, Skien, Norway, Charlotte Gibbs, MD, PhDDepartment of Medicine, Telemark Hospital, Skien, Norway, Eivind Carlsen, MDDepartment of Pathology, Telemark Hospital Skien, Norway, Tone Hoel Lende, MD, PhDDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway, Jon Kristian Narvestad, MDDepartment of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway, Rasmus Kildahl, MDDepartment of Surgery, Telemark Hospital, Skien, Norway, Roald Omdal, MD, PhDDepartment of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway, Jan Terje Kvaløy, PhD†Department of Research, Stavanger University Hospital, and Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway, Håvard Søiland, MD, PhD†Department of Research, Stavanger University Hospital, Stavanger, and Department of Clinical Science, University of Bergen, Bergen, NorwayAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1593 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Even when thyroxine is adequately replaced for hypothyroidism, patients with Hashimoto disease may report persistent extrathyroidal symptoms, including chronic fatigue, muscle and joint tenderness, dry mouth and eyes, and poor sleep quality (1).It has been hypothesized that these persistent symptoms may be related to extrathyroidal autoimmune reactions and that complete removal of thyroid tissues may attenuate autoimmune responses and relieve symptoms (2). This hypothesis was tested in a randomized trial of thyroidectomy plus medical management versus medical management alone with 18-month follow-up (3) (ClinicalTrials.gov: NCT02319538). At inclusion, patients in the control group were given the option of having ...References1. Punzi L, Betterle C. Chronic autoimmune thyroiditis and rheumatic manifestations. Joint Bone Spine. 2004;71:275-283. [PMID: 15288851] doi:10.1016/j.jbspin.2003.06.005 CrossrefMedlineGoogle Scholar2. Promberger R, Hermann M, Pallikunnel SJ, et al. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis. Am J Surg. 2014;207:974-979. [PMID: 24070662] doi:10.1016/j.amjsurg.2013.05.005 CrossrefMedlineGoogle Scholar3. Guldvog I, Reitsma LC, Johnsen L, et al. Thyroidectomy versus medical management for euthyroid patients with Hashimoto disease and persisting symptoms. A randomized trial. Ann Intern Med. 2019;170:453-464. [PMID: 30856652] doi:10.7326/M18-0284 LinkGoogle Scholar4. Liu T, Yu CP. Placebo analgesia, acupuncture and sham surgery. Evid Based Complement Alternat Med. 2011;2011:943147. [PMID: 21785643] doi:10.1093/ecam/neq030 CrossrefMedlineGoogle Scholar5. Wartolowska K, Judge A, Hopewell S, et al. Use of placebo controls in the evaluation of surgery: systematic review. BMJ. 2014;348:g3253. [PMID: 24850821] doi:10.1136/bmj.g3253 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Geir Hoff, MD, PhD; Tomm Bernklev, PhD; Lene Johnsen, MD; Laurens Reitsma, MD; Dirk Sina, MD; Andromeda Lauzike, MD; Charlotte Gibbs, MD, PhD; Eivind Carlsen, MD; Tone Hoel Lende, MD, PhD; Jon Kristian Narvestad, MD; Rasmus Kildahl, MD; Roald Omdal, MD, PhD; Jan Terje Kvaløy, PhD; Håvard Søiland, MD, PhDAffiliations: Department of Research, Telemark Hospital, Skien, and Institute of Clinical Medicine, University of Oslo, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, and Department of Research, Vestfold Hospital, Tønsberg, NorwayDepartment of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, NorwayDepartment of Breast and Endocrine Surgery, Akershus University Hospital, Campus Oslo, Lørens