Thyroidectomy more effective than medication for Hashimoto disease with persisting symptoms

1. In this randomized controlled study, complete surgical removal of the thyroid in patients with persistent Hashimoto disease symptoms resulted in greater improvements to patient quality of life compared to medical treatment.

2. The authors observed that patients who received surgical management of Hashimoto disease also had normalized serum antithyroid peroxidase (anti-TPO) antibodies during follow-up.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hashimoto disease, also known as Hashimoto’s thyroiditis,  is a T-cell-mediated autoimmune disease that results in an inflammatory response leading to hypothyroidism. Symptoms of Hashimoto’s thyroiditis include poor sleep quality, fatigue, dry eyes and mouth, and muscle and joint tenderness, among others. Typically, patients are treated with thyroid hormone substitution; however, some patients’ symptoms persist despite adequate levothyroxine supplementation. Unfortunately, there is no specific treatment for patients with these persisting symptoms. The authors of this study aimed to evaluate the role of thyroidectomy on improving symptoms in patients with Hashimoto thyroiditis who have persisting symptoms despite normal thyroid gland function with thyroid supplementation. They found that thyroidectomy is more effective than medical management with hormone substitution for this group of patients. The limitations of the study include lack of long-term follow up, as patient follow-up was limited to 18 months. Furthermore, the authors stated that baseline reporting data was collected utilizing patient-reported outcome measures (PROMs), which were dependent on patient subjective judgment.

Click to read the study, published today in Annals of Internal Medicine

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In-Depth [randomized controlled trial]: The authors of this study conducted a randomized, open-label, controlled trial. A total of 150 patients were included who had persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy. Participants also had serum anti-TPO antibody titers greater than 1000 IU/mL Patients either received a total thyroidectomy or medical management with hormone substitution to achieve euthyroid status. The authors then measured general health score on the Short Form-36 Health Survey at 18 months, as well as numerous secondary outcomes, such as serum anti-TPO antibody titers at 6, 12, and 18 months. The main conclusion from this study was that thyroidectomy is a more effective treatment than medication for this group of patients with Hashimoto disease, as only the surgical group demonstrated improvement in study outcomes during follow-up. For example, the mean general health score of the surgical group increased to 64 points from 34 points at 18 months, resulting in a group difference of 29 (95%CI, 22 to 35 points). Additionally, the anti-TPO antibody titers at 18 months in the surgical group were normal in almost all patients, compared to the control group where they were only modestly reduced. Specifically, the median post-treatment serum anti-TPO antibodies at 18 months decreased from 2232 IU/mL to 152 IU/mL in the surgical group, compared to the control group where they only decreased from 2052 IU/mL to 1300 IU/mL with an estimated median difference of 1148 IU/mL (95%CI 1080 to 1304 IU/mL).

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