Long-Term Fatigue Is Common After Total Thyroidectomy

Long-term fatigue should be a consideration when there is an option to choose between total thyroidectomy and thyroid lobectomy.

Approximately two-thirds of patients who undergo total thyroidectomy (TT) report new-onset fatigue within the first year after surgery, with only one-third reporting significant improvement over time, according to study results presented at the 89th Annual Meeting of the American Thyroid Association, held October 30 to November 3, 2019, in Chicago, Illinois.

As there is a continuous debate about the association between long-term fatigue and TT, the goal of this study was to explore the issue in patients after TT in a large statewide central data repository from 2004 to 2017. Fatigue was assessed using the Brief Fatigue Inventory, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, and novel questions.

Of 3143 eligible patients, 70% were contacted and 13% responded. The cohort included 228 patients who had undergone TT and 53 patients who had undergone thyroid lobectomy. Approximately half (49%) of the patients who underwent lobectomy reported current thyroid replacement therapy.

New fatigue was evident in 61% of respondents within a year after TT or lobectomy. While current fatigue based on PROMIS measures was similar between patients who underwent TT and those who underwent lobectomy (P =.209), new fatigue was more common among patients after TT (70% vs 47%, respectively; P =.004). Furthermore, in patients who underwent TT, average Brief Fatigue Inventory score was higher compared with patients who underwent lobectomy (4.7 vs 2.1; P =.006).

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There was no difference in new-onset fatigue between patients who had radioactive iodine ablation after TT and those who did not (68% vs 70%, respectively; P =.87).

Fatigue significantly improved in approximately a quarter of patients (67 patients; 24%), and this improvement was commonly seen within 1 year (19 patients; 28%) or 1 to 2 years (35 patients; 52%). In a small minority (11 patients; 16%), improvement in fatigue was seen after 2 years.

“Long-term fatigue should be a consideration when considering thyroidectomy, especially when there is an option to choose between TT and [thyroid lobectomy],” said the researchers, adding that the Brief Fatigue Inventory “may be more sensitive in detecting long-term fatigue after thyroidectomy compared to PROMIS measures.”

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Lumpkin ST, Button JL, Stratton L, Strassle PD, Kim LT. Chronic fatigue after thyroidectomy. Presented at: American Thyroid Association 2019 Annual Meeting; October 30-November 3, 2019; Chicago, IL. Poster 135.