Predictability of symptom changes following hemithyroidectomy due to thyroid nodules/goitre causing local symptoms - a prospective multicentre study

Abstract Introduction Benign thyroid nodules/goitre are very common. When associated with local symptoms including dysphagia, dyspnoea, dysphonia and pharyngeal discomfort, patients often undergo hemithyroidectomy to improve their symptoms. Whether the improvement of the local symptoms can be predicted is poorly investigated. Method In this prospective multicentre study, patients filled in four validated questionnaires before, six weeks and one year after hemithyroidectomy. Furthermore, the size of the thyroid nodule/goitre, the size of the isthmus and its distance to the jugulum were registered. Result A total of 119 consecutive patients were offered to participate in the study. Of these, 72 patients completed the preoperative and postoperative questionnaires after six weeks and 70 patients completed the 1-year follow-up. Of interest, the reported preoperative symptoms did not correlate at all with the objective measurements. Six weeks after surgery, the majority (95%) of patients reported some sort of dysphonia despite the absence of objective findings like laryngeal nerve palsy. In contrast, a significant proportion (73%) of patients noted symptomatic improvements regarding all other symptoms already six weeks postoperatively. Of note, symptom improvements were even reported of patients with thyroid nodules as small as 1 cm in size. After 1 year, 13% of the patients still experienced some sort of dysphonia. Nevertheless, 89% of the patients would recommend the procedure to other patients with similar symptoms. Discussion The vast majority of patients with local symptoms due to benign thyroid nodules/goitre noticed an improvement of their symptoms after hemithyroidectomy. The symptomatic improvements were not predictable based on objective preoperative measurements.