Quality of life in patients with benign non-toxic goiter: impact of disease, treatment response, and comparison with the general population

<b>Background</b> While health-related quality of life (HRQoL) issues often prompt treatment of benign non-toxic goiter (NTG), few clinical studies have systematically assessed HRQoL in patients with this condition. The purpose of the present study was to evaluate thyroid-related and generic HRQoL in patients with benign NTG, as compared to the general population, before and 6 months after treatment. <b>Methods</b> Thyroid-related and generic HRQoL were assessed with ThyPRO and SF-36, respectively. Baseline and 6 month post-treatment HRQoL assessments were obtained from 111 patients with NTG who underwent radioiodine therapy (32%), hemithyroidectomy (53%), total thyroidectomy (12%), or cyst aspiration with ethanol application (4%). We enrolled euthyroid patients at baseline, 80% of whom remained euthyroid 6 months post-treatment with 20% experiencing subclinical thyroid dysfunction. Normative ThyPRO (n=739) and SF-36 (n=6,638) data were collected from representative general population samples. Score differences between patients and the general population were analysed with multivariate linear regression analysis, adjusting for age, gender, comorbidity and educational status. Changes in scores between baseline and follow-up were analysed with the paired t-test, and magnitudes of score changes were evaluated as effect-sizes (mean difference/SD_baseline; 0.2-0.5 indicating small, 0.5-0.8 moderate, and >0.8 large effects). <b>Results</b> Patients' baseline scores were significantly worse than those in the general population on nine of the 13 ThyPRO scales. Six months after treatment, the patients' ThyPRO scores had improved on 6 scales, with large/moderate effects on the Goiter Symptoms and Anxiety scales. However, on eight scales, the post-treatment patient scores were still significantly worse than the general population scores. At baseline, patients had worse scores than the general population on four of the eight SF-36 scales and the SF-36 Mental Component Summary, none of which improved after treatment. <b>Conclusions</b> Compared with the general population, patients with NTG had greatest HRQoL impairment at baseline on the Goiter Symptoms and Anxiety scales, which also demonstrated the largest post-treatment improvements. However, both disease-specific and generic HRQoL deficits persisted 6 months after treatment. In order to improve individualized care, future studies should focus on identifying risk factors for persistent HRQoL deficits and compare HRQoL effects of the various goiter treatment modalities in relation to thyroid phenotype.