title: Quality of life in patients with benign nontoxic goiter: impact of disease and treatment response, and comparison with the general population.
abstract: BACKGROUND
  While health-related quality of life (HRQoL) issues often prompt treatment of benign nontoxic 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 six months after treatment.
  
  
  METHODS
  Thyroid-related and generic HRQoL were assessed with Thyroid Patient-Reported Outcome (ThyPRO) and Medical Outcomes Study 36-item Short Form (SF-36), respectively. Baseline and six-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 sclerotherapy (4%). Euthyroid patients were enrolled at baseline, 80% of whom remained euthyroid six months post-treatment, with 20% experiencing subclinical thyroid dysfunction. Normative ThyPRO (n=739) and SF-36 (n=6638) data were collected from representative general population samples. Score differences between patients and the general population were analyzed with multivariate linear regression analysis, adjusting for age, sex, comorbidity, and educational status. Changes in scores between baseline and follow-up were analyzed with the paired t-test, and magnitudes of score changes were evaluated as effect sizes (mean difference/SDbaseline; 0.2-0.5 indicating small, 0.5-0.8 moderate, and >0.8 large effects).
  
  
  RESULTS
  Patients' baseline scores were significantly worse than those in the general population on 9 of the 13 ThyPRO scales. Six months after treatment, the patients' ThyPRO scores had improved on six 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.
  
  
  CONCLUSIONS
  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 six 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.
authors.affiliation: 1 Department of Medical Endocrinology, Copenhagen University Hospital Rigshospitalet , Copenhagen, Denmark .
authors.forename: Per
authors.initials: P
authors.lastname: Cramon
authors.forename: Steen Joop
authors.initials: SJ
authors.lastname: Bonnema
authors.forename: Jakob Bue
authors.initials: JB
authors.lastname: Bjorner
authors.forename: Ola
authors.initials: O
authors.lastname: Ekholm
authors.forename: Ulla
authors.initials: U
authors.lastname: Feldt-Rasmussen
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Frendl
authors.forename: Mogens
authors.initials: M
authors.lastname: Groenvold
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hegedüs
authors.forename: Åse Krogh
authors.initials: ÅK
authors.lastname: Rasmussen
authors.forename: Torquil
authors.initials: T
authors.lastname: Watt
mesh_terms: D001007:Anxiety / Q000150:complications; D015897:Comorbidity; D003718:Denmark; D005260:Female; D006042:Goiter / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010641:Phenotype; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D015911:Sclerotherapy / Q000379:methods; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes