j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 7 2 4 e7 3 0
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Improved quality of life in hyperthyroidism patients after surgery Branka Bukvic, MD,a,b,* Vladan Zivaljevic, MD, PhD,c Sandra Sipetic, MD, PhD,a Aleksandar Diklic, MD, PhD,c Katarina Tausanovic, MD,c Dragos Stojanovic, MD, PhD,d Dejan Stevanovic, MD, PhD,d and Ivan Paunovic, MD, PhDc a
Department for Doctoral Studies, Institute for Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia b Department of Gynecology and Obstetrics, General Hospital Uzice, Health Center Uzice, Uzice, Serbia c Department of Surgery, Faculty of Medicine, University of Belgrade, Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia d Department of Surgery, Zemun Hospital, Belgrade, Serbia
article info
abstract
Article history:
Background: The most common causes of hyperthyroidism are Graves disease (GD) and
Received 20 June 2014
toxic nodular goiter (TNG). GD and TNG might influence patients’ quality of life (QoL). The
Received in revised form
aim of our study was to analyze and compare the QoL of patients with GD with that of TNG
16 July 2014
patients and to evaluate the influence of surgical treatment on their QoL.
Accepted 23 July 2014
Materials and methods: A prospective case-control study was conducted at the Center for
Available online 30 July 2014
Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively.
Keywords:
Results: All patients were receiving antithyroid drugs, and none of the patients were overtly
Graves disease
hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD
Toxic goiter
patients was worse than that of the TNG patients, with significant differences in eye symp-
Surgery
toms, anxiety, and sex life domains (P < 0.001, P ¼ 0.005, and P ¼ 0.004, respectively), preop-
QoL
eratively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P ¼ 0.001,
ThyPRO
P ¼ 0.027, P ¼ 0.005 and P ¼ 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P ¼ 0.066). Conclusions: The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Hyperthyroidism is a type of thyroid dysfunction that is characterized by elevated synthesis and secretion of thyroid
hormones by the thyroid gland [1]. The most common causes of hyperthyroidism are Graves disease (GD), toxic multinodular goiter (TMNG), and toxic adenoma (TA) [2]. GD is an autoimmune disorder in which thyrotropin receptor
* Corresponding author. Visegradska 26, 11000 Belgrade, Serbia. Tel.: þ381641885341; fax: þ381113615768. E-mail address: [email protected] (B. Bukvic). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.07.061
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 7 2 4 e7 3 0
antibodies (TRAb) stimulate the thyrotropin (TSH) receptors on the thyroid gland, increasing the production of thyroid hormones. Hyperthyroidism with elevated serum TRAb levels, diffuse goiter, and ophthalmopathy are the main characteristics of GD [3]. It is a frequent cause of hyperthyroidism in the younger population and in high iodine intake areas [4]. Toxic nodular goiter (TNG), which includes both TA and TMNG, is a nonautoimmune disorder, characterized by the presence of one or more autonomously hyperfunctioning thyroid nodules [5]. It is a prevalent cause of hyperthyroidism in areas of low iodine intake and in the elderly. The incidence rate of hyperthyroidism in Europe is 51 per 100,000 per year [6]. Quality of life (QoL) represents an individual’s perceptions of her and/or his physical, emotional, social, and cognitive functions, in addition to disease symptoms and side effects of treatment. It is an important outcome measure in the treatment of diseases, such as benign thyroid disorders, that are not life threatening. The ultimate goal of health care is to improve, restore, or preserve QoL [7]. There are two types of questionnaires used in QoL assessments: generic and disease specific. Generic measures are designed to be relevant to the general population. In contrast, disease-specific measures target those with a particular disease. Disease-specific questionnaires are more sensitive to smaller changes in QoL domains over time than generic ones [8]. ThyPRO is a recently developed, validated, and standardized disease-specific questionnaire and the first and only questionnaire designed to measure QoL in patients with benign thyroid disorders [9e13]. The influence of hyperthyroidism on physical and mental health and on QoL has been studied [14e17]. Many published studies have suggested that QoL in non-treated patients with GD is impaired and that it improves after treatment to restore a euthyroid state [18e20]. Research has also demonstrated that QoL is impaired in patients with TNG [16]. However, studies comparing the QoL in patients with autoimmune (GD) and nonautoimmune (TMNG and TA) hyperthyroidism, longitudinal studies on the QoL in patients with hyperthyroidism, and studies of the influence of different treatments on the QoL of patients with hyperthyroidism are missing. The aims of our study were to analyze QoL in patients with GD and TNG, to compare QoL in patients with autoimmune and nonautoimmune hyperthyroidism, and to analyze influence of surgical treatment on QoL in GD patients and TNG patients whose metabolic state was restored with antithyroid drugs, preoperatively.
2.
Material and methods
2.1.
Patients
The study was performed at a tertiary care referral center for surgical treatments of endocrine diseases, the Center for Endocrine Surgery, Clinical Center of Serbia in Belgrade. Patients who were admitted to the center, for previously scheduled thyroidectomy, between April 2012 and August 2013 were asked to participate in the study if they met inclusion and exclusion criteria. The patients were divided into a GD and TNG group. Laboratory findings, socio-demographic,
725
and clinical data were collected from their medical records. The patients were asked whether their parents and/or their siblings have or had any kind of thyroid disease (positive family history) or not (negative family history). The patients were asked about previous smoking habits (whether they were active smokers or ex-smokers and non-smokers) and consumption of alcohol (whether they used to drink alcohol less than few times a year or often). This study was approved by the Ethics Committee of the School of Medicine, University of Belgrade. Informed consent was obtained from all the participants before commencing the study.
2.2.
Inclusion and exclusion criteria
Inclusion criteria were aged between 18 and 75 y, a clinical diagnosis of GD, TMNG or TA, and current treatment with antithyroid drugs. Exclusion criteria were Hashimoto thyroiditis, malignant thyroid disease on final histologic examination, overt hyperthyroidism (elevated serum thyroxin [T4] and triiodothyronine [T3] or free T4 [fT4] and free T3 [fT3] levels and suppressed TSH levels), a history of radioiodine treatment, psychiatric disorders, and a history of brain injuries.
2.3.
Questionnaire
ThyPRO, a disease-specific QoL measure, was used for assessing QoL. The questionnaire was developed by Watt et al. [9e13] in Denmark. It consists of 85 questions, divided into 13 domains (goiter symptoms, hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, cognitive impairment, anxiety, depression, emotional susceptibility, impaired social life, impaired daily life, impaired sex life, and cosmetic complaints), and one separate question that relates to overall QoL. It covers physical and mental symptoms, wellbeing, and functioning, as well as the impact of thyroid disease on participation (i.e., social and daily life) and on overall QoL. Each of the 13 ThyPRO scales is scored as a summary score and linearly transformed to a range of 0e100, with increasing scores indicating decreasing QoL (i.e., more symptoms or a greater impact of disease) and lower scores indicating better QoL. We developed a Serbian language version of ThyPRO according to the internationally accepted methodology for translation and cultural adaptation of a QoL questionnaire and the guidelines of the European Organization for Research and Treatment of Cancer group [21], in collaboration with the developer of the questionnaire. One day before the surgery and 6 months later, the patients completed the questionnaire on paper in the presence, and if necessary with the help, of a physician who deals with endocrine surgery, as well as the QoL assessment. All the surveys were stored until the finalization of the study.
2.4.
Follow-up
All the patients were informed that they would be contacted by telephone 6 months after the surgery and asked to complete the ThyPRO questionnaire one more time. Thus, they were all asked to provide their phone numbers and/or cell phone numbers. The physician who interviewed the patients
726
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 7 2 4 e7 3 0
postoperatively did not have access to the preoperative questionnaire or scores.
2.5.
Statistical analysis
Statistical analysis was performed using SPSS. Continuous data are expressed as the mean standard deviation and median. Categorical data are expressed by total numbers and percentages. QoL improvement after surgery was calculated as the difference between preoperative and postoperative scores of each domain of ThyPRO and overall QoL, with higher results presenting greater improvement and lower results presenting less improvement. The one-sample KolmogoroveSmirnov test was used to determine whether a continuous variable was normally distributed. If a normal distribution was confirmed, the Student t-test was used for comparison of two independent variables. If the variables were continuous without a normal distribution or if the data were categorical, the ManneWhitney U-test was used to compare two independent variables. The Wilcoxon-signed ranks test was used for comparing two related variables (preoperative versus postoperative ThyPRO scores). Spearman rho (r) was used for correlation analysis. The level of statistical significance accepted was P < 0.05 (two-tailed significance).
3.
Results
3.1.
Patients’ characteristics
Fifty-nine patients completed the study. The patients’ characteristics are shown in Table 1. Patients with GD were significantly younger than TNG patients. The total duration of the disease (i.e., the duration between the emergence of the index disease and enrollment of the patients in this study) was significantly shorter in GD patients than in TNG patients. All the patients in both groups were taking antithyroid drugs
before the surgery, and none of the patients were overtly toxic at the time of completing the preoperative ThyPRO. At the time of enrollment in the study, 8 (28.6%) and 19 (61.3%) patients in the TNG and GD groups, respectively, were subclinically hyperthyroid, despite antithyroid therapy. The patients with GD had significantly lower TSH levels and significantly higher antithyroid peroxidase antibodies and TRAb serum levels than those with TNG. Seven (25%) TNG patients underwent hemithyroidectomy (all for TA). The remaining TNG patients and GD patients underwent total thyroidectomy. Two (6.5%) patients who underwent thyroidectomy for GD had transient hypocalcemia, and they took calcium replacement therapy for less than 6 months. None of the patients developed long-term complications, recurrent laryngeal nerve palsy, or permanent hypoparathyroidism. Lthyroxin replacement therapy was initiated on the third postoperative day in all patients who underwent total thyroidectomy. Six months after the surgery, all but two patients were euthyroid. One patient from each group was subclinically hyperthyroid, representing 3.6% of the patients surgically treated for TNG and 3.2 % of those surgically treated for GD.
3.2.
Preoperative QoL
In both groups, the most affected QoL domain was tiredness. The least affected domain in the TNG group was eye symptoms, and the least affected in the GD group was cognitive impairment. The preoperative QoL was worse in patients with GD than in those with TNG in all but one ThyPRO domain, cognitive impairment, with significant differences between the groups in eye symptoms, anxiety, and sex life (P < 0.001, P ¼ 0.005, and P ¼ 0.004, respectively) (Table 2). When the patients with TA were excluded from the TNG group, still the same ThyPRO domains were significantly more affected in the GD group than in the TMNG group; eye symptoms, anxiety, and sex life (P < 0.001, P ¼ 0.011, and P ¼ 0.011, respectively).
Table 1 e Characteristics of the patients. Characteristic Gender (female/male) Age (y) Education level (primary school/secondary or high school/college or faculty) Marital status (couple/single) Duration of disease (y) TSH (mIU/L) T4 (nmol/L)/fT4 (pmol/L) T3 (nmol/L)/fT3 (pmol/l) TG-Ab (IU/mL) TPO-Ab (IU/mL) TRAb (IU/L) Family history (positive/negative) Smoking habits (yes/no and ex) Alcohol consumption (yes/no) Weight of the specimen (g)
TNG group
GD group
25 (89.3)/3 (10.7) 55.9 12.7 5 (17.9)/13 (46.4)/10 (35.7)
29 (93.5)/2 (6.5) 42.9 13.4 7 (22.6)/13 (41.9)/11 (35.5)
21 (75.0)/7 (25.0) 10.5 10.7 1.0 1.1 118.2 22.0/15.0 3.6 2.2 0.4/4.9 0.8 16.7 17.5 27.3 61.2 0.9 1.2 11 (39.3)/17 (60.7) 6 (21.4)/22 (78.6) 13 (46.4)/15 (53.6) 78.3 101.3
23 (74.2)/8 (25.8) 5.6 6.6 0.6 0.9 110.3 35.6/12.9 2.3 2.2 1.0/5.0 1.7 288.8 498.7 506.5 762.2 13.4 13.3 11 (35.5)/20 (64.5) 13 (41.9)/18 (58.1) 8 (25.8)/23 (74.2) 63.1 42.8
Bold P-values indicate significant differences. Continuous data are presented as mean standard deviation; categorical data are presented as number (percentage).
P value 0.561
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Improved quality of life in hyperthyroidism patients after surgery Branka Bukvic, MD,a,b,* Vladan Zivaljevic, MD, PhD,c Sandra Sipetic, MD, PhD,a Aleksandar Diklic, MD, PhD,c Katarina Tausanovic, MD,c Dragos Stojanovic, MD, PhD,d Dejan Stevanovic, MD, PhD,d and Ivan Paunovic, MD, PhDc a
Department for Doctoral Studies, Institute for Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia b Department of Gynecology and Obstetrics, General Hospital Uzice, Health Center Uzice, Uzice, Serbia c Department of Surgery, Faculty of Medicine, University of Belgrade, Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia d Department of Surgery, Zemun Hospital, Belgrade, Serbia
article info
abstract
Article history:
Background: The most common causes of hyperthyroidism are Graves disease (GD) and
Received 20 June 2014
toxic nodular goiter (TNG). GD and TNG might influence patients’ quality of life (QoL). The
Received in revised form
aim of our study was to analyze and compare the QoL of patients with GD with that of TNG
16 July 2014
patients and to evaluate the influence of surgical treatment on their QoL.
Accepted 23 July 2014
Materials and methods: A prospective case-control study was conducted at the Center for
Available online 30 July 2014
Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively.
Keywords:
Results: All patients were receiving antithyroid drugs, and none of the patients were overtly
Graves disease
hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD
Toxic goiter
patients was worse than that of the TNG patients, with significant differences in eye symp-
Surgery
toms, anxiety, and sex life domains (P < 0.001, P ¼ 0.005, and P ¼ 0.004, respectively), preop-
QoL
eratively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P ¼ 0.001,
ThyPRO
P ¼ 0.027, P ¼ 0.005 and P ¼ 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P ¼ 0.066). Conclusions: The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Hyperthyroidism is a type of thyroid dysfunction that is characterized by elevated synthesis and secretion of thyroid
hormones by the thyroid gland [1]. The most common causes of hyperthyroidism are Graves disease (GD), toxic multinodular goiter (TMNG), and toxic adenoma (TA) [2]. GD is an autoimmune disorder in which thyrotropin receptor
* Corresponding author. Visegradska 26, 11000 Belgrade, Serbia. Tel.: þ381641885341; fax: þ381113615768. E-mail address: [email protected] (B. Bukvic). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2014.07.061
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 7 2 4 e7 3 0
antibodies (TRAb) stimulate the thyrotropin (TSH) receptors on the thyroid gland, increasing the production of thyroid hormones. Hyperthyroidism with elevated serum TRAb levels, diffuse goiter, and ophthalmopathy are the main characteristics of GD [3]. It is a frequent cause of hyperthyroidism in the younger population and in high iodine intake areas [4]. Toxic nodular goiter (TNG), which includes both TA and TMNG, is a nonautoimmune disorder, characterized by the presence of one or more autonomously hyperfunctioning thyroid nodules [5]. It is a prevalent cause of hyperthyroidism in areas of low iodine intake and in the elderly. The incidence rate of hyperthyroidism in Europe is 51 per 100,000 per year [6]. Quality of life (QoL) represents an individual’s perceptions of her and/or his physical, emotional, social, and cognitive functions, in addition to disease symptoms and side effects of treatment. It is an important outcome measure in the treatment of diseases, such as benign thyroid disorders, that are not life threatening. The ultimate goal of health care is to improve, restore, or preserve QoL [7]. There are two types of questionnaires used in QoL assessments: generic and disease specific. Generic measures are designed to be relevant to the general population. In contrast, disease-specific measures target those with a particular disease. Disease-specific questionnaires are more sensitive to smaller changes in QoL domains over time than generic ones [8]. ThyPRO is a recently developed, validated, and standardized disease-specific questionnaire and the first and only questionnaire designed to measure QoL in patients with benign thyroid disorders [9e13]. The influence of hyperthyroidism on physical and mental health and on QoL has been studied [14e17]. Many published studies have suggested that QoL in non-treated patients with GD is impaired and that it improves after treatment to restore a euthyroid state [18e20]. Research has also demonstrated that QoL is impaired in patients with TNG [16]. However, studies comparing the QoL in patients with autoimmune (GD) and nonautoimmune (TMNG and TA) hyperthyroidism, longitudinal studies on the QoL in patients with hyperthyroidism, and studies of the influence of different treatments on the QoL of patients with hyperthyroidism are missing. The aims of our study were to analyze QoL in patients with GD and TNG, to compare QoL in patients with autoimmune and nonautoimmune hyperthyroidism, and to analyze influence of surgical treatment on QoL in GD patients and TNG patients whose metabolic state was restored with antithyroid drugs, preoperatively.
2.
Material and methods
2.1.
Patients
The study was performed at a tertiary care referral center for surgical treatments of endocrine diseases, the Center for Endocrine Surgery, Clinical Center of Serbia in Belgrade. Patients who were admitted to the center, for previously scheduled thyroidectomy, between April 2012 and August 2013 were asked to participate in the study if they met inclusion and exclusion criteria. The patients were divided into a GD and TNG group. Laboratory findings, socio-demographic,
725
and clinical data were collected from their medical records. The patients were asked whether their parents and/or their siblings have or had any kind of thyroid disease (positive family history) or not (negative family history). The patients were asked about previous smoking habits (whether they were active smokers or ex-smokers and non-smokers) and consumption of alcohol (whether they used to drink alcohol less than few times a year or often). This study was approved by the Ethics Committee of the School of Medicine, University of Belgrade. Informed consent was obtained from all the participants before commencing the study.
2.2.
Inclusion and exclusion criteria
Inclusion criteria were aged between 18 and 75 y, a clinical diagnosis of GD, TMNG or TA, and current treatment with antithyroid drugs. Exclusion criteria were Hashimoto thyroiditis, malignant thyroid disease on final histologic examination, overt hyperthyroidism (elevated serum thyroxin [T4] and triiodothyronine [T3] or free T4 [fT4] and free T3 [fT3] levels and suppressed TSH levels), a history of radioiodine treatment, psychiatric disorders, and a history of brain injuries.
2.3.
Questionnaire
ThyPRO, a disease-specific QoL measure, was used for assessing QoL. The questionnaire was developed by Watt et al. [9e13] in Denmark. It consists of 85 questions, divided into 13 domains (goiter symptoms, hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, cognitive impairment, anxiety, depression, emotional susceptibility, impaired social life, impaired daily life, impaired sex life, and cosmetic complaints), and one separate question that relates to overall QoL. It covers physical and mental symptoms, wellbeing, and functioning, as well as the impact of thyroid disease on participation (i.e., social and daily life) and on overall QoL. Each of the 13 ThyPRO scales is scored as a summary score and linearly transformed to a range of 0e100, with increasing scores indicating decreasing QoL (i.e., more symptoms or a greater impact of disease) and lower scores indicating better QoL. We developed a Serbian language version of ThyPRO according to the internationally accepted methodology for translation and cultural adaptation of a QoL questionnaire and the guidelines of the European Organization for Research and Treatment of Cancer group [21], in collaboration with the developer of the questionnaire. One day before the surgery and 6 months later, the patients completed the questionnaire on paper in the presence, and if necessary with the help, of a physician who deals with endocrine surgery, as well as the QoL assessment. All the surveys were stored until the finalization of the study.
2.4.
Follow-up
All the patients were informed that they would be contacted by telephone 6 months after the surgery and asked to complete the ThyPRO questionnaire one more time. Thus, they were all asked to provide their phone numbers and/or cell phone numbers. The physician who interviewed the patients
726
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 3 ( 2 0 1 5 ) 7 2 4 e7 3 0
postoperatively did not have access to the preoperative questionnaire or scores.
2.5.
Statistical analysis
Statistical analysis was performed using SPSS. Continuous data are expressed as the mean standard deviation and median. Categorical data are expressed by total numbers and percentages. QoL improvement after surgery was calculated as the difference between preoperative and postoperative scores of each domain of ThyPRO and overall QoL, with higher results presenting greater improvement and lower results presenting less improvement. The one-sample KolmogoroveSmirnov test was used to determine whether a continuous variable was normally distributed. If a normal distribution was confirmed, the Student t-test was used for comparison of two independent variables. If the variables were continuous without a normal distribution or if the data were categorical, the ManneWhitney U-test was used to compare two independent variables. The Wilcoxon-signed ranks test was used for comparing two related variables (preoperative versus postoperative ThyPRO scores). Spearman rho (r) was used for correlation analysis. The level of statistical significance accepted was P < 0.05 (two-tailed significance).
3.
Results
3.1.
Patients’ characteristics
Fifty-nine patients completed the study. The patients’ characteristics are shown in Table 1. Patients with GD were significantly younger than TNG patients. The total duration of the disease (i.e., the duration between the emergence of the index disease and enrollment of the patients in this study) was significantly shorter in GD patients than in TNG patients. All the patients in both groups were taking antithyroid drugs
before the surgery, and none of the patients were overtly toxic at the time of completing the preoperative ThyPRO. At the time of enrollment in the study, 8 (28.6%) and 19 (61.3%) patients in the TNG and GD groups, respectively, were subclinically hyperthyroid, despite antithyroid therapy. The patients with GD had significantly lower TSH levels and significantly higher antithyroid peroxidase antibodies and TRAb serum levels than those with TNG. Seven (25%) TNG patients underwent hemithyroidectomy (all for TA). The remaining TNG patients and GD patients underwent total thyroidectomy. Two (6.5%) patients who underwent thyroidectomy for GD had transient hypocalcemia, and they took calcium replacement therapy for less than 6 months. None of the patients developed long-term complications, recurrent laryngeal nerve palsy, or permanent hypoparathyroidism. Lthyroxin replacement therapy was initiated on the third postoperative day in all patients who underwent total thyroidectomy. Six months after the surgery, all but two patients were euthyroid. One patient from each group was subclinically hyperthyroid, representing 3.6% of the patients surgically treated for TNG and 3.2 % of those surgically treated for GD.
3.2.
Preoperative QoL
In both groups, the most affected QoL domain was tiredness. The least affected domain in the TNG group was eye symptoms, and the least affected in the GD group was cognitive impairment. The preoperative QoL was worse in patients with GD than in those with TNG in all but one ThyPRO domain, cognitive impairment, with significant differences between the groups in eye symptoms, anxiety, and sex life (P < 0.001, P ¼ 0.005, and P ¼ 0.004, respectively) (Table 2). When the patients with TA were excluded from the TNG group, still the same ThyPRO domains were significantly more affected in the GD group than in the TMNG group; eye symptoms, anxiety, and sex life (P < 0.001, P ¼ 0.011, and P ¼ 0.011, respectively).
Table 1 e Characteristics of the patients. Characteristic Gender (female/male) Age (y) Education level (primary school/secondary or high school/college or faculty) Marital status (couple/single) Duration of disease (y) TSH (mIU/L) T4 (nmol/L)/fT4 (pmol/L) T3 (nmol/L)/fT3 (pmol/l) TG-Ab (IU/mL) TPO-Ab (IU/mL) TRAb (IU/L) Family history (positive/negative) Smoking habits (yes/no and ex) Alcohol consumption (yes/no) Weight of the specimen (g)
TNG group
GD group
25 (89.3)/3 (10.7) 55.9 12.7 5 (17.9)/13 (46.4)/10 (35.7)
29 (93.5)/2 (6.5) 42.9 13.4 7 (22.6)/13 (41.9)/11 (35.5)
21 (75.0)/7 (25.0) 10.5 10.7 1.0 1.1 118.2 22.0/15.0 3.6 2.2 0.4/4.9 0.8 16.7 17.5 27.3 61.2 0.9 1.2 11 (39.3)/17 (60.7) 6 (21.4)/22 (78.6) 13 (46.4)/15 (53.6) 78.3 101.3
23 (74.2)/8 (25.8) 5.6 6.6 0.6 0.9 110.3 35.6/12.9 2.3 2.2 1.0/5.0 1.7 288.8 498.7 506.5 762.2 13.4 13.3 11 (35.5)/20 (64.5) 13 (41.9)/18 (58.1) 8 (25.8)/23 (74.2) 63.1 42.8
Bold P-values indicate significant differences. Continuous data are presented as mean standard deviation; categorical data are presented as number (percentage).
P value 0.561
