Patient-reported somatic symptoms and lifestyle factors associated with psychological distress in patients with papillary thyroid carcinoma: a cross-sectional analysis

Psychological distress is common among patients with papillary thyroid carcinoma (PTC), yet the relative associations of clinicopathological characteristics and patient-reported somatic symptoms and lifestyle factors to preoperative distress remain insufficiently understood. This study aimed to examine the associations of these two dimensions with preoperative psychological distress in patients with PTC. In this cross-sectional analysis, 1,211 patients with fine-needle aspiration (FNA)-confirmed PTC were recruited between May 2023 and December 2025. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS). Seven predefined somatic symptoms and lifestyle factors were systematically evaluated. Multivariable logistic regression was performed to identify factors associated with anxiety and depression. Forest plots were used to visually contrast the associations of the two dimensions with psychological distress. An internally validated nomogram was developed to estimate the probability of elevated anxiety symptoms. Preoperative anxiety and depression were prevalent, affecting 24.4% and 19.0% of patients, respectively. Fatigue, palpitations, and irregular meals were independently associated with both elevated anxiety and depressive symptoms (adjusted ORs, 1.63–2.14; all P < 0.01). Musculoskeletal pain, cold/heat intolerance, and sleep duration < 7 h were additionally associated with elevated anxiety symptoms (adjusted ORs, 1.42–1.79; all P < 0.05). Conventional clinicopathological characteristics showed no significant associations with either outcome. The nomogram showed moderate discrimination (C-index: 0.720, 95% CI: 0.686–0.755) and good calibration. Preoperative psychological distress was common in patients with PTC and showed stronger associations with patient-reported somatic symptoms and lifestyle factors than with conventional clinicopathological characteristics. These findings support integrating symptom and lifestyle assessment and psychological screening in preoperative care.