Long term outcome after toxic nodular goitre
Abstract Background The purpose of treating toxic nodular goitre (TNG) is to reverse hyperthyroidism, prevent recurrent disease, relieve symptoms and preserve thyroid function. Treatment efficacies and long-term outcomes of antithyroid drugs (ATD), radioactive iodine (RAI) or surgery vary in the lit...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | Thyroid Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13044-022-00138-0 |
| _version_ | 1798044389648367616 |
|---|---|
| author | Gabriel Sjölin Torquil Watt Kristina Byström Jan Calissendorff Per Karkov Cramon Helena Filipsson Nyström Bengt Hallengren Mats Holmberg Selwan Khamisi Mikael Lantz Tereza Planck Ove Törring Göran Wallin |
| author_facet | Gabriel Sjölin Torquil Watt Kristina Byström Jan Calissendorff Per Karkov Cramon Helena Filipsson Nyström Bengt Hallengren Mats Holmberg Selwan Khamisi Mikael Lantz Tereza Planck Ove Törring Göran Wallin |
| author_sort | Gabriel Sjölin |
| collection | DOAJ |
| description | Abstract Background The purpose of treating toxic nodular goitre (TNG) is to reverse hyperthyroidism, prevent recurrent disease, relieve symptoms and preserve thyroid function. Treatment efficacies and long-term outcomes of antithyroid drugs (ATD), radioactive iodine (RAI) or surgery vary in the literature. Symptoms often persist for a long time following euthyroidism, and previous studies have demonstrated long-term cognitive and quality of life (QoL) impairments. We report the outcome of treatment, rate of cure (euthyroidism and hypothyroidism), and QoL in an unselected TNG cohort. Methods TNG patients (n = 638) de novo diagnosed between 2003–2005 were invited to engage in a 6–10-year follow-up study. 237 patients responded to questionnaires about therapies, demographics, comorbidities, and quality of life (ThyPRO). Patients received ATD, RAI, or surgery according clinical guidelines. Results The fraction of patients cured with one RAI treatment was 89%, and 93% in patients treated with surgery. The rate of levothyroxine supplementation for RAI and surgery, at the end of the study period, was 58% respectively 64%. Approximately 5% of the patients needed three or more RAI treatments to be cured. The patients had worse thyroid-related QoL scores, in a broad spectrum, than the general population. Conclusion One advantage of treating TNG with RAI over surgery might be lost due to the seemingly similar incidence of hypothyroidism. The need for up to five treatments is rarely described and indicates that the treatment of TNG can be more complex than expected. This circumstance and the long-term QoL impairments are reminders of the chronic nature of hyperthyroidism from TNG. |
| first_indexed | 2024-04-11T23:02:58Z |
| format | Article |
| id | doaj.art-b9c477d842054305a064caff699eca08 |
| institution | Directory Open Access Journal |
| issn | 1756-6614 |
| language | English |
| last_indexed | 2024-04-11T23:02:58Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Thyroid Research |
| spelling | doaj.art-b9c477d842054305a064caff699eca082022-12-22T03:58:04ZengBMCThyroid Research1756-66142022-11-011511810.1186/s13044-022-00138-0Long term outcome after toxic nodular goitreGabriel Sjölin0Torquil Watt1Kristina Byström2Jan Calissendorff3Per Karkov Cramon4Helena Filipsson Nyström5Bengt Hallengren6Mats Holmberg7Selwan Khamisi8Mikael Lantz9Tereza Planck10Ove Törring11Göran Wallin12Faculty of Medicine and Health, Örebro University HospitalDepartment of Medical Endocrinology RigshospitaletDept. of Medicine, Örebro University and University HospitalDepartment of Molecular Medicine and Surgery, Karolinska InstitutetDepartment of Medical Endocrinology RigshospitaletInstitute of Medicine, Sahlgrenska Academy, University of GothenburgDept. of Endocrinology, Skåne University HospitalInstitute of Medicine, Sahlgrenska Academy, University of GothenburgDept. of Endocrinology, Uppsala University HospitalDept. of Endocrinology, Skåne University HospitalDept. of Endocrinology, Skåne University HospitalInstitution for Clinical Science and Education, Karolinska InstitutetFaculty of Medicine and Health, Örebro University HospitalAbstract Background The purpose of treating toxic nodular goitre (TNG) is to reverse hyperthyroidism, prevent recurrent disease, relieve symptoms and preserve thyroid function. Treatment efficacies and long-term outcomes of antithyroid drugs (ATD), radioactive iodine (RAI) or surgery vary in the literature. Symptoms often persist for a long time following euthyroidism, and previous studies have demonstrated long-term cognitive and quality of life (QoL) impairments. We report the outcome of treatment, rate of cure (euthyroidism and hypothyroidism), and QoL in an unselected TNG cohort. Methods TNG patients (n = 638) de novo diagnosed between 2003–2005 were invited to engage in a 6–10-year follow-up study. 237 patients responded to questionnaires about therapies, demographics, comorbidities, and quality of life (ThyPRO). Patients received ATD, RAI, or surgery according clinical guidelines. Results The fraction of patients cured with one RAI treatment was 89%, and 93% in patients treated with surgery. The rate of levothyroxine supplementation for RAI and surgery, at the end of the study period, was 58% respectively 64%. Approximately 5% of the patients needed three or more RAI treatments to be cured. The patients had worse thyroid-related QoL scores, in a broad spectrum, than the general population. Conclusion One advantage of treating TNG with RAI over surgery might be lost due to the seemingly similar incidence of hypothyroidism. The need for up to five treatments is rarely described and indicates that the treatment of TNG can be more complex than expected. This circumstance and the long-term QoL impairments are reminders of the chronic nature of hyperthyroidism from TNG.https://doi.org/10.1186/s13044-022-00138-0HyperthyroidismToxic nodular goitreAnti-thyroid drugsRadioactive iodineThyroidectomyLong-term follow-up |
| spellingShingle | Gabriel Sjölin Torquil Watt Kristina Byström Jan Calissendorff Per Karkov Cramon Helena Filipsson Nyström Bengt Hallengren Mats Holmberg Selwan Khamisi Mikael Lantz Tereza Planck Ove Törring Göran Wallin Long term outcome after toxic nodular goitre Thyroid Research Hyperthyroidism Toxic nodular goitre Anti-thyroid drugs Radioactive iodine Thyroidectomy Long-term follow-up |
| title | Long term outcome after toxic nodular goitre |
| title_full | Long term outcome after toxic nodular goitre |
| title_fullStr | Long term outcome after toxic nodular goitre |
| title_full_unstemmed | Long term outcome after toxic nodular goitre |
| title_short | Long term outcome after toxic nodular goitre |
| title_sort | long term outcome after toxic nodular goitre |
| topic | Hyperthyroidism Toxic nodular goitre Anti-thyroid drugs Radioactive iodine Thyroidectomy Long-term follow-up |
| url | https://doi.org/10.1186/s13044-022-00138-0 |
| work_keys_str_mv | AT gabrielsjolin longtermoutcomeaftertoxicnodulargoitre AT torquilwatt longtermoutcomeaftertoxicnodulargoitre AT kristinabystrom longtermoutcomeaftertoxicnodulargoitre AT jancalissendorff longtermoutcomeaftertoxicnodulargoitre AT perkarkovcramon longtermoutcomeaftertoxicnodulargoitre AT helenafilipssonnystrom longtermoutcomeaftertoxicnodulargoitre AT bengthallengren longtermoutcomeaftertoxicnodulargoitre AT matsholmberg longtermoutcomeaftertoxicnodulargoitre AT selwankhamisi longtermoutcomeaftertoxicnodulargoitre AT mikaellantz longtermoutcomeaftertoxicnodulargoitre AT terezaplanck longtermoutcomeaftertoxicnodulargoitre AT ovetorring longtermoutcomeaftertoxicnodulargoitre AT goranwallin longtermoutcomeaftertoxicnodulargoitre |