The Year in Thyroidology: Surgical Science

Triumph Over Butchery: Guest Editorial for Indian Journal of Surgical Oncology

While once considered "butchery," thyroid cancer surgery is now considered a safe surgery in the setting of the increasing incidence of thyroid nodules. Several changes in the approach to patients and advancements in technology have paved the way for the technical feasibility of thyroid surgery. International guidelines have enabled a personalized, and less invasive approach to patients and thus reducing the morbidity attributed tumors from potential injury to the recurrent laryngeal nerve or long-term thyroid hormone replacement- particularly for papillary microcarcinomas. Morbidity from hypocalcemia and nerve injury have further been improved by advancements including parathyroid localizing technology, nerve monitoring, molecular testing, and improved diagnostic imaging. As we continue to improve our understanding of the thyroid, so will the outcomes of patients who undergo thyroid cancer surgery. Advancements in the safety and feasibility of thyroid surgery remind us of the statement made by William Halsted: "thyroid surgery is a supreme triumph of the surgeon's heart."

Effect of thyroid-stimulating hormone suppression on quality of life in thyroid lobectomy patients: interim analysis of a multicenter, randomized controlled trial in low- to intermediate-risk thyroid cancer patients (MASTER study)

Purpose

Current clinical practices favor less or no thyroid-stimulating hormone (TSH) suppression for low- to intermediate-risk thyroid cancer patients who receive thyroid lobectomy. The association of TSH suppression on health-related quality of life (HR-QoL) in patients after thyroid lobectomy is not well studied. This study aimed to evaluate the effect of TSH suppression on patient HR-QoL after thyroid lobectomy.

Methods

This study included patients enrolled in an ongoing, multicenter, randomized controlled study investigating the effects of TSH suppression. Patients were randomized to either the low-TSH group (TSH target range, 0.3-1.99 µIU/mL) or the high-TSH group (TSH target range, 2.0-7.99 µIU/mL). The HR-QoL, hyperthyroidism symptom, and depression symptom questionnaires performed preoperatively and 2 weeks and 3 months postoperatively were evaluated.

Results

Total of 669 patients (low-TSH group, 340; high-TSH group, 329) were included. Although total HR-QoL score changes were not different between the 2 groups, the high-TSH group had a significantly higher score in the physical domain at postoperative 3 months (P = 0.046). The 2 groups did not have significant differences in hyperthyroidism and depression scores.

Conclusion

In the short-term postoperative period, the physical HR-QoL scores in thyroid lobectomy patients were better when they did not receive TSH suppression. This study suggests the importance of considering HR-QoL when setting TSH suppression targets in thyroid lobectomy patients.