BACKGROUND
Thyroid cancer is common, and we currently have effective treatments that result in an overall excellent prognosis as very few thyroid cancer patients die from their cancer. Despite this excellent prognosis, thyroid cancer patients are exposed to physical distress associated with treatment and the psychological stress induced by the cancer diagnosis. Indeed, thyroid cancer survivors report having fatigue, anxiety, depression, sleep problems and pain. Thus, in addition to efforts to effectively treat thyroid cancer patients, there is now increased focus on improving the quality of life (QOL) of cancer survivors.

The goal of this study was to evaluate changes in the QOL of thyroid cancer patients starting prior to thyroid surgery and for up to 5 years after their initial treatment.

THE FULL ARTICLE TITLE
Kim BH, et al. Longitudinal changes in quality of life before and after thyroidectomy in patients with differentiated thyroid cancer. J Clin Endocrinol Metab 2024;109(6):1505- 1516; doi: 10.1210/clinem/dgad748. PMID: 38141213.

SUMMARY OF THE STUDY
The study included 185 patients who underwent total thyroidectomy for thyroid cancer at a single medical center in Seul, Korea between 2013 and 2017 and completed a serial questionnaire survey for up to 5 years after their initial cancer treatment. The average age was 49 years, 81% of the patients being women. Most patients (97%) had papillary thyroid cancer, the rest having follicular cancer. One surgeon performed all surgical procedures, including 105 conventional thyroidectomies and 80 remote-access thyroidectomies via the axilla or behind the ear approaches. A total of 57% of patients underwent total thyroidectomy, the rest undergoing lobectomy; 84% of patients underwent central neck dissection, while 12% underwent lateral neck dissection. Surgical complications included vocal-cord paralysis in 12 patients (6.5%), which was permanent in 2 patients and hypoparathyroidism in 44 patients (24%), which was permanent in 4 patients. A total of 37% of the patients also received radioactive iodine therapy (RAI) treatment 2-3 months after the thyroid surgery.

The quality of life was assessed using the Korean versions of the University of Washington Quality of Life questionnaire (UW-QOL) designed for head and neck cancer patients and the City of Hope Quality of Life—Thyroid Version questionnaire (QOL-TV) designed for long-term thyroid cancer survivors. The UW-QOL provides three composite scores: physical function, social–emotional, and total composite scores, while the QOL-TV evaluates four aspects: psychological, physical, social, and spiritual well-being. The questionnaires were administered in the oncology clinic at seven time points: 1 day prior to surgery and then 3 months, 6 months, 1 year, 2 years, 3 years, and 5 years after the surgery.

The results of the two questionnaires showed worsening QOL immediately after surgery, with a progressive improvement after the first 3 months over a span of 5 years. Physical wellbeing scores were lower at all times after surgery in patients who underwent total thyroidectomy compared to lobectomy as well as conventional thyroidectomy compared to remote-access thyroidectomy. Patients undergoing remote-access thyroidectomy had higher scores for satisfaction with their appearance than those undergoing conventional surgery. Patients who received RAI therapy had lower taste scores, with those undergoing thyroid hormone withdrawal reporting more sleep, self-concept, and distress issues 3 months postsurgery as compared to those who received recombinant TSH preparation. Postsurgical hypoparathyroidism (short-lived or permanent) was associated with lower physical function scores in the first 3 years after surgery. Weight gain, cold/heat sensitivity, voice change, and fluid retention were reported after surgery, without subsequent recovery. The appearance-related concerns after the surgery did not improve over time. Anxiety and mood changes were significant prior to the surgery, and while there was a continuous improvement after surgery, they remained the most important concerns for thyroid cancer patients throughout the 5-year follow-up period.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study shows that patients with thyroid cancer experience a significant worsening of their quality of life immediately after surgery followed by a progressive improvement over the next 5 years to surpass the preoperative quality of life. More aggressive treatments can impair the quality of life of these patients. Therefore, total thyroidectomy and RAI ablation should be restricted for selected patients with more advanced/aggressive disease. Anxiety and mood changes are major clinical concerns in these patients, both before and after surgery. Psychological support should always be considered when indicated.

— Alina Gavrila, MD, MMSc

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