Should patients with symptomatic Hashimoto's thyroiditis pursue surgery?

BACKGROUND: In this study, patients with Hashimoto's Thyroiditis and significant symptoms were evaluated for improvement or resolution of preoperative symptoms after thyroidectomy. Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disease characterized by production of antibodies such as anti-thyroperoxidase (TPO), which leads to destruction of the thyroid gland and a decrease in normal thyroid function. Thyroidectomy is not generally recommended because the dense inflammatory process that surrounds the thyroid gland can make resection more difficult. However, patients with HT are considered for surgery if they experience persistent symptoms after conservative therapy. We hypothesized that patients with HT and significant compressive and other associated symptoms may benefit from thyroidectomy for palliation.
METHODS: We identified 1791 patients who underwent thyroidectomy from May 1994 to December 2009. Of those 1791 patients, 311 were diagnosed with HT. Of these 311 patients, 133 had 170 significant preoperative symptoms, and served as our sample population. Patients were subjectively evaluated for improvement or relief of symptoms postoperatively.
RESULTS: The mean age of the group was 46 ± 1 y, and 90% were female. Patients underwent lobectomy (33%), subtotal thyroidectomy (6%), or total thyroidectomy (61%). The overall rate of symptomatic improvement for HT patients was 90% after thyroidectomy. The most frequent preoperative symptom was compression, and >93% of patients experienced relief. In addition, we found high rates of improvement for HT patients with other preoperative symptoms including voice problems (77%), hormone imbalance (84%), and other (90%).
CONCLUSION: The overwhelming majority of HT patients with significant symptoms appear to benefit from thyroidectomy. Therefore, HT patients should consider pursuing surgery for palliation if they suffer from persistent symptoms after conservative therapy.