A comparison of patients who made total and subtotal thyroidectomy due to benign multinodular goitre in terms of long-term quality of life results
Abstract
In the literature, the subject of which of total thyroidectomy or subtotal thyroidectomy should be preferred; It is usually in the direction of complications of surgery, disease recurrence and treatment of incidental malignancies. However, there is no study in the literature comparing these two surgical methods in terms of their effects on quality of life. The aim of this study; To compare the long-term quality of life outcomes of patients who underwent total and subtotal thyroidectomy for benign multinodular goiter in our clinic.
In this study, 191 patients who underwent total and subtotal thyroidectomy for benign multinodular goiter were analyzed cross-sectionally. Patients who developed permanent nerve damage, had an incidental malignancy, were operated for thyrotoxicosis, and had co-morbidities that would affect their quality of life were excluded from the study. 57 patients who agreed to participate in the study and met the criteria were included in the study. Total thyroidectomy was performed in 30 of 57 patients (52.6%), subtotal thyroidectomy was performed in 27 (47.4%), 51 women (89.5%), 6 men (10.5%), age their mean was 49.5±12.8. The mean follow-up period of the patients was approximately 3.5 years. The patients' quality of life was evaluated with the SF-36 form, and their anxiety and depression status was evaluated using the Hospital Anxiety and Depression Scale.
In the comparison of both groups of patients, a statistically significant difference was observed between the quality of life scale and the hospital depression scale (p<0.05). There was no difference in terms of hospital anxiety scale.
The significant decrease in the quality of life in patients after total thyroidectomy and the significant increase in the anxiety-depression measurement reveals the necessity of re-discussing these surgical options from these perspectives.
Project Number
1378680
References
- 1.Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngos-cope, 2003;113: 1820-1826.
- 2.Yetkin E. Tiroid Hastalıkları ve cerrahisi,Tiroidektomi komplikasyonları,.In: İşgör A.(Ed.), Avrupa tıp kitapçılık baskı 1,Bölüm, 2000, s:583-595.
- 3. Yujie Li, Yangjun Li, Xiaodong Zhou; Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis. ORL 2016;78(3):167–175.
- 4. Bharath S, Yadav SK, Sharma D, Jha CK, Mishra A, Mishra SK, Shekhar S. Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis. Langenbeck's archives of surgery, 2023;408(1):200.
- 5. Kaliszewski K, Wojtczak B, Grzegrzółka J, et al. Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?-A Retrospective Study of 2032 Patients. Int J Endocrinol. 2018;2018:4735436.
- 6.Gaurav Agarwal Æ Vivek Aggarwal. Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An evidence-based review. World J Surg 2008;32:1313-1324.
- 7. Kiminori Sugino, Mitsuji Nagahama, Wataru Kitagawa, Keiko Ohkuwa, Takashi Uruno, Kenichi Matsuzu, Akifumi Suzuki, Chisato Tomoda, Kiyomi Y Hames, Junko Akaishi, Chie Masaki, Yuna Ogimi, Tomonori Yabuta, Koichi Ito Endocrine journal, 2019;66(2):181-186.
- 8.Delbridge L. Total thyroidectomy: the evolution of surgical technique. Aust N Z J Surg 2003;73: 761-768.
- 9.Rios A, Rodrı´guez JM, Galindo PJ et al. Surgical treatment of multinodular goiter in young patients. Endocrine 2005;27:245–252.
- 10.Reeve TS, Delbridge L, Cohen A et al. Total thyroidectomy. The preferred option for multi-nodular goiter. Ann Surg 1987;206:782–786.
- 11.Pappalardo G, Guadalaxara A, Frattaroli FM et al. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164:501–506.
- 12.Zaraca F, Di Paola M, Gossetti F et al () Benign thyroid disease: 20-year experience in surgical therapy. Chir Ital 2000;52:41–47.
- 13.Ozbas S, Kocak S, Aydintug S et al. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 2005;52:199-205.
- 14.Olson SE, Starling J, Chen H () Symptomatic benign multinodular goiter: unilateral or bilateral thyroidectomy? Surgery 2007;142:458-461. Discussion 461-462.
- 15.Sandonato L, Graceffa G, Cipolla C et al. Benign diseases of the thyroid: indications for surgical treatment and the current role of total thyroidectomy. Chir Ital 2003;55:179-187.
- 16.Prades JM, Dumollard JM, Timoshenko A et al. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol, 2002;259:217-221.
- 17.La Gamma A, Letoquart JP, Kunin N et al. Nodular goiter. Retrospective analysis of 608 cases. J Chir (Paris) 1993;130:391–396.
- 18.Giles Y, Boztepe H, Terzioglu T et al. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004;139:179–182.
- 19.Miccoli P, Minuto MN, Galleri D et al. Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease. Aust N Z J Surg 2006;76:123–126.
- 20.Soh EY, Clark OH. Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am 1996;25:115–139.
- 21.Hisham AN, Azlina AF, Aina EN et al. Total thyroidectomy: the procedure of choice for multinodular goiter. Eur J Surg 2001;167:403–405.
- 22.Erbil Y, Barbaros U, Salmaslioglu A et al. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter. Langenbecks Arch Surg 2006;391:567–573.
- 23.Koyuncu A, Dokmetas HS, Turan M et al. Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J 2003;50:723–727.
- 24.Zambudio AR, Rodriguez J, Riquelme J et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240:18–25.
- 25.Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg 2003;74:437–443.
- 26.Tagay S, Herpertz S, Langkafel M, Erim Y, Bockisch A, Senf W, Gorges R.Health-related Quality of Life, depression and anxiety in thyroid cancer patients. Qual Life Res. 2006;15(4):695-703.
- 27.Arjun Sharma, Helena Gabriel, Albert A. Nem-cek, Ritu Nayar, Hongyang Du, Paul Nikolaidis. Subcentimeter Thyroid Nodules: Utility of So-nographic Characterization and Ultrasound-Guided Needle Biopsy. Am J Roentgenol 2011;197(6):W1123-1128.
- 28.Morris LF, Waguespack SG, Warneke CL, Ryu H, Ying AK, Anderson BJ, Sturgis EM, Clayman GL, Lee JE, Evans DB, Grubbs EG, Perrier ND. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy. Surgery. 2012;152(6):1165-1171.
BENİGN MULTİNODÜLER GUATR NEDENİ İLE TOTAL VE SUBTOTAL TİROİDEKTOMİ YAPILAN HASTALARDA UZUN DÖNEM HAYAT KALİTESİ SONUÇLARI AÇISINDAN KARŞILAŞTIRILMASI
Abstract
Literatürde total tiroidektomi ile subtotal tiroidektomi ameliyatlarından hangisinin tercih edileceği konusu; genellikle ameliyatın komplikasyonları, hastalık nüksü ve insidental malignitelerin tedavisi yönünde olmaktadır. Ancak bu iki ameliyat yöntemini hayat kalitesine etkileri açısından karşılaştıran bir çalışma literatürde mevcut değildir. Bu çalışmada amaç; kliniğimizde benign Multinoduler Guatr nedeni ile total ve subtotal tiriodektomi yapılan hastaların uzun dönem hayat kalitesi sonuçlarını karşılaştırmaktır.
Bu çalışmada, benign multinoduler guatr nedeniyle total ve subtotal tiroidektomi yapılan 191 hasta, kesitsel olarak olarak incelendi.. Kalıcı sinir hasarı gelişen, insedental malignite tespit edilen, tirotoksikoz nedeniyle opere edilen ve yaşam kalitesini etkileyecek yandaş hastalıkları olan hastalar çalışma dışı tutuldu. Çalışmaya katılmayı kabul eden ve kriterlere uyan 57 hasta çalışmaya dahil edildi. 57 hastanın 30’una total tiroidektomi (%52,6), 27’sine subtotal tiroidektomi (%47,4) yapıldı, 51’i kadın (%89,5), 6’sı erkek (%10,5), yaş ortalamaları 49,5±12.8 idi. Hastaların ortalama takip süreleri yaklaşık 3,5 yıl idi. Hastaların yaşam kalitesi SF-36 formu ile, anksiyete ve depresyon durumu Hastane Anksiyete ve Depresyon ölçeği kullanılarak değerlendirildi.
Her iki grup hastanın karşılaştırılmasında yaşam kalitesi ölçeği ve hastane depresyon ölçeği arasında istatistiksel olarak anlamlı fark gözlendi (p<0,05). Hastane anksiyete ölçeği açısından ise fark saptanmadı.
Total tiroidektomi sonrası hastalarda hayat kalitesindeki anlamlı düşüş ve anksiyete depresyon ölçümündeki anlamlı yükseliş bu ameliyat seçeneklerinin bu açılardan tekrar tartışılma gereğini ortaya koymaktadır.
Keywords
Project Number
1378680
References
- 1.Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngos-cope, 2003;113: 1820-1826.
- 2.Yetkin E. Tiroid Hastalıkları ve cerrahisi,Tiroidektomi komplikasyonları,.In: İşgör A.(Ed.), Avrupa tıp kitapçılık baskı 1,Bölüm, 2000, s:583-595.
- 3. Yujie Li, Yangjun Li, Xiaodong Zhou; Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis. ORL 2016;78(3):167–175.
- 4. Bharath S, Yadav SK, Sharma D, Jha CK, Mishra A, Mishra SK, Shekhar S. Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis. Langenbeck's archives of surgery, 2023;408(1):200.
- 5. Kaliszewski K, Wojtczak B, Grzegrzółka J, et al. Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?-A Retrospective Study of 2032 Patients. Int J Endocrinol. 2018;2018:4735436.
- 6.Gaurav Agarwal Æ Vivek Aggarwal. Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An evidence-based review. World J Surg 2008;32:1313-1324.
- 7. Kiminori Sugino, Mitsuji Nagahama, Wataru Kitagawa, Keiko Ohkuwa, Takashi Uruno, Kenichi Matsuzu, Akifumi Suzuki, Chisato Tomoda, Kiyomi Y Hames, Junko Akaishi, Chie Masaki, Yuna Ogimi, Tomonori Yabuta, Koichi Ito Endocrine journal, 2019;66(2):181-186.
- 8.Delbridge L. Total thyroidectomy: the evolution of surgical technique. Aust N Z J Surg 2003;73: 761-768.
- 9.Rios A, Rodrı´guez JM, Galindo PJ et al. Surgical treatment of multinodular goiter in young patients. Endocrine 2005;27:245–252.
- 10.Reeve TS, Delbridge L, Cohen A et al. Total thyroidectomy. The preferred option for multi-nodular goiter. Ann Surg 1987;206:782–786.
- 11.Pappalardo G, Guadalaxara A, Frattaroli FM et al. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164:501–506.
- 12.Zaraca F, Di Paola M, Gossetti F et al () Benign thyroid disease: 20-year experience in surgical therapy. Chir Ital 2000;52:41–47.
- 13.Ozbas S, Kocak S, Aydintug S et al. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 2005;52:199-205.
- 14.Olson SE, Starling J, Chen H () Symptomatic benign multinodular goiter: unilateral or bilateral thyroidectomy? Surgery 2007;142:458-461. Discussion 461-462.
- 15.Sandonato L, Graceffa G, Cipolla C et al. Benign diseases of the thyroid: indications for surgical treatment and the current role of total thyroidectomy. Chir Ital 2003;55:179-187.
- 16.Prades JM, Dumollard JM, Timoshenko A et al. Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol, 2002;259:217-221.
- 17.La Gamma A, Letoquart JP, Kunin N et al. Nodular goiter. Retrospective analysis of 608 cases. J Chir (Paris) 1993;130:391–396.
- 18.Giles Y, Boztepe H, Terzioglu T et al. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004;139:179–182.
- 19.Miccoli P, Minuto MN, Galleri D et al. Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease. Aust N Z J Surg 2006;76:123–126.
- 20.Soh EY, Clark OH. Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am 1996;25:115–139.
- 21.Hisham AN, Azlina AF, Aina EN et al. Total thyroidectomy: the procedure of choice for multinodular goiter. Eur J Surg 2001;167:403–405.
- 22.Erbil Y, Barbaros U, Salmaslioglu A et al. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter. Langenbecks Arch Surg 2006;391:567–573.
- 23.Koyuncu A, Dokmetas HS, Turan M et al. Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J 2003;50:723–727.
- 24.Zambudio AR, Rodriguez J, Riquelme J et al. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240:18–25.
- 25.Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg 2003;74:437–443.
- 26.Tagay S, Herpertz S, Langkafel M, Erim Y, Bockisch A, Senf W, Gorges R.Health-related Quality of Life, depression and anxiety in thyroid cancer patients. Qual Life Res. 2006;15(4):695-703.
- 27.Arjun Sharma, Helena Gabriel, Albert A. Nem-cek, Ritu Nayar, Hongyang Du, Paul Nikolaidis. Subcentimeter Thyroid Nodules: Utility of So-nographic Characterization and Ultrasound-Guided Needle Biopsy. Am J Roentgenol 2011;197(6):W1123-1128.
- 28.Morris LF, Waguespack SG, Warneke CL, Ryu H, Ying AK, Anderson BJ, Sturgis EM, Clayman GL, Lee JE, Evans DB, Grubbs EG, Perrier ND. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy. Surgery. 2012;152(6):1165-1171.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | General Surgery |
| Journal Section | Research Article |
| Authors | |
| Project Number | 1378680 |
| Publication Date | January 8, 2024 |
| Submission Date | October 21, 2023 |
| Acceptance Date | November 29, 2023 |
| Published in Issue | Year 2024 Volume: 17 Issue: 1 |
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