dc.contributor.author | Guldvog, Ivar | |
dc.contributor.author | Reitsma, Laurens Cornelus | |
dc.contributor.author | Johnsen, Lene Cathrin | |
dc.contributor.author | Lauzike, Andromeda | |
dc.contributor.author | Gibbs, Charlotte Christine | |
dc.contributor.author | Carlsen, Eivind | |
dc.contributor.author | Lende, Tone Hoel | |
dc.contributor.author | Narvestad, Jon | |
dc.contributor.author | Omdal, Roald | |
dc.contributor.author | Kvaløy, Jan Terje | |
dc.contributor.author | Hoff, Geir | |
dc.contributor.author | Bernklev, Tomm | |
dc.contributor.author | Søiland, Håvard | |
dc.coverage.spatial | Norway | en_US |
dc.date.accessioned | 2021-04-12T13:53:46Z | |
dc.date.available | 2021-04-12T13:53:46Z | |
dc.date.created | 2019-03-13T12:28:15Z | |
dc.date.issued | 2019-04 | |
dc.identifier.citation | Guldvog, I., Reitsma, L.C, Johnsen, L.C. et al. (2019) Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial. Annals of Internal Medicine, 170 (7), 453-464. | en_US |
dc.identifier.issn | 0003-4819 | |
dc.identifier.uri | https://hdl.handle.net/11250/2737370 | |
dc.description.abstract | Background:
Hashimoto disease is a chronic autoimmune thyroiditis. Despite adequate hormone substitution, some patients have persistent symptoms that may be the result of immunologic pathophysiology.
Objective:
To determine whether thyroidectomy improves symptoms in patients with Hashimoto thyroiditis who still have symptoms despite having normal thyroid gland function while receiving medical therapy.
Design:
Randomized trial. (ClinicalTrials.gov: NCT02319538)
Setting:
Secondary care hospital in Norway.
Patients:
150 patients aged 18 to 79 years with persistent Hashimoto-related symptoms despite euthyroid status while receiving hormone replacement therapy and with serum antithyroid peroxidase (anti-TPO) antibody titers greater than 1000 IU/mL.
Intervention:
Total thyroidectomy or medical management with hormone substitution to secure euthyroid status in both groups.
Measurements:
The primary outcome was general health score on the Short Form-36 Health Survey (SF-36) at 18 months. Secondary outcomes were adverse effects of surgery, the other 7 SF-36 subscores, fatigue questionnaire scores, and serum anti-TPO antibody titers at 6, 12, and 18 months.
Results:
During follow-up, only the surgical group demonstrated improvement: Mean general health score increased from 38 to 64 points, for a between-group difference of 29 points (95% CI, 22 to 35 points) at 18 months. Fatigue score decreased from 23 to 14 points, for a between-group difference of 9.3 points (CI, 7.4 to 11.2 points). Chronic fatigue frequency decreased from 82% to 35%, for a between-group difference of 39 percentage points (CI, 23 to 53 percentage points). Median serum anti-TPO antibody titers decreased from 2232 to 152 IU/mL, for a between-group difference of 1148 IU/mL (CI, 1080 to 1304 IU/mL). In multivariable regression analyses, the adjusted treatment effects remained similar to the unadjusted effects.
Limitation:
Results are applicable only to a subgroup of patients with Hashimoto disease, and follow-up was limited to 18 months.
Conclusion:
Total thyroidectomy improved health-related quality of life and fatigue, whereas medical therapy did not. This improvement, along with concomitant elimination of serum anti-TPO antibodies, may elucidate disease mechanisms. | en_US |
dc.language.iso | eng | en_US |
dc.subject | Hashimotos sykdom | en_US |
dc.subject | Hashimotos tyreoiditt | en_US |
dc.subject | skjoldbrukskjertelen | en_US |
dc.subject | autoimmun sykdom | en_US |
dc.title | Thyroidectomy Versus Medical Management for Euthyroid Patients With Hashimoto Disease and Persisting Symptoms: A Randomized Trial | en_US |
dc.type | Peer reviewed | en_US |
dc.type | Journal article | en_US |
dc.description.version | acceptedVersion | en_US |
dc.rights.holder | © 2019 American College of Physicians. | en_US |
dc.subject.nsi | VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Generell indremedisin: 770 | en_US |
dc.source.pagenumber | 453-464 | en_US |
dc.source.volume | 170 | en_US |
dc.source.journal | Annals of Internal Medicine | en_US |
dc.source.issue | 7 | en_US |
dc.identifier.doi | 10.7326/M18-0284 | |
dc.identifier.cristin | 1684438 | |
cristin.unitcode | 217,8,2,0 | |
cristin.unitname | Institutt for matematikk og fysikk | |
cristin.ispublished | true | |
cristin.fulltext | postprint | |
cristin.qualitycode | 2 | |