Hemithyroidectomy linked to better quality of life for adults with low-risk thyroid cancer
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Key takeaways:
- Most studies found adults with low-risk differentiated thyroid cancer had a better quality of life after a hemithyroidectomy vs. total thyroidectomy.
- More prospective and randomized studies are needed.
Hemithyroidectomy is associated with better quality of life after surgery than total thyroidectomy for adults with low-risk differentiated thyroid cancer, though more studies are needed, according to findings from a systematic review.
“The long-term data are mixed on how the extent of surgery affects health-related quality of life in patients with low-risk differentiated thyroid cancer,” Susan C. Pitt, MD, MPHS, FACS, associate professor of surgery and director of engagement, Center for Healthcare Outcomes and Policy at the University of Michigan, told Healio. “Many studies favor hemithyroidectomy over total thyroidectomy, while some show no difference. No studies favor total thyroidectomy.”
Pitt and colleagues conducted a systematic review of studies that examined health-related quality of life among adults with low-risk differentiated thyroid cancer after undergoing a hemithyroidectomy or a total thyroidectomy. Researchers searched the PubMed, CINAHL, Cochrane, PsycINFO and Scopus databases for studies published from 2011 to 2022. Studies comparing quality of life measures for adults who underwent a hemithyroidectomy vs. a total thyroidectomy were included in the review.
The findings were published in Thyroid.
Better quality of life after hemithyroidectomy
There were 16 studies in the systematic review, of which 68.8% were retrospective cohort studies and 31.3% were prospective cohort studies. Six different quality of life measurement tools were used in the studies, with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Thyroid Cancer-Specific Quality of Life questionnaire being the most common.
The 16 studies included 4,957 patients (77.6% women; mean age, 46.6 years). Of the study population, 26.6% underwent a total thyroidectomy without central neck dissection, 19.5% had a total thyroidectomy with central neck dissection, 15% underwent a total thyroidectomy without central neck dissection specified, 19.1% underwent a hemithyroidectomy without central neck dissection, 7.4% had a hemithyroidectomy performed with central neck dissection and 12.6% underwent a hemithyroidectomy without central neck dissection specified.
Of the studies, six found hemithyroidectomy conferred better quality of life than total thyroidectomy, and two found hemithyroidectomy was associated with a better quality of life than total thyroidectomy with central neck dissection, but not total thyroidectomy alone. There were two studies that found quality of life was better short term for adults who had a hemithyroidectomy, but not 6 months or later after surgery. Two studies found a hemithyroidectomy was associated with a better quality of life only on certain domains of their questionnaire or after propensity score matching. Four studies found no difference in quality of life between the procedures. Total thyroidectomy was not associated with better quality of life compared with hemithyroidectomy in any of the studies.
Among six studies where adults underwent central neck dissection, two found total thyroidectomy with central neck dissection was associated with a worse quality of life than total thyroidectomy alone or a hemithyroidectomy with or without central neck dissection. In one study, total thyroidectomy with central neck dissection was linked to worse quality of life than hemithyroidectomy with central neck dissection. Another study found total thyroidectomy with central neck dissection was associated with worse quality of life than total thyroidectomy or hemithyroidectomy alone. In the remaining two studies, researchers found central neck dissection did not impact quality of life.
Few long-term improvements observed
Among four studies using the SF-36, at least two studies found hemithyroidectomy was associated with moderate improvements in role limits due to physical health, vitality, social function, role limits due to emotional health, physical component summary score and mental component summary score. Among five studies using the Thyroid Cancer-Specific Quality of Life questionnaire, at least two studies reported improvements in neuromuscular voice and psychological domains after a hemithyroidectomy.
When time of surgery was examined, three studies that measured outcomes less than 1 year after surgery found hemithyroidectomy improved quality of life. Among seven retrospective studies that measured outcomes more than 1 year after surgery, four found no difference in quality of life between hemithyroidectomy and total thyroidectomy, whereas two found hemithyroidectomy was linked to better quality of life when compared with a total thyroidectomy with central neck dissection. Two retrospective studies found that hemithyroidectomy conferred better quality of life 1 and 3 months after surgery compared with total thyroidectomy, but no difference was observed at 6 months or later.
“Patients and their physicians may be able to use our study as one piece of information to inform treatment decisions,” Pitt said. “Clinical information and patient preferences should also be taken into consideration.”
Pitt said more studies that are adequately powered and prospective in design are needed to better determine the effects of surgical options on quality of life.
Ideally, future studies would engage stakeholders and determine how to successfully randomize patients and recruit a multinational cohort,” Pitt said.
For more information:
Susan C. Pitt, MD, MPHS, FACS, can be reached at scpitt@med.umich.edu.
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