Background:

The thyroid gland plays a crucial role in regulating metabolism, impacting all organs and bodily functions. Thyroid nodules are common, particularly in women over 50, and are increasingly detected through scans. Most of these nodules are benign, but symptomatic nodules or goiter often require surgery, such as hemithyroidectomy (HT) or total thyroidectomy (TT). TT invariably leads to hypothyroidism (hypoT), necessitating lifelong thyroid hormone replacement. HT can also result in hypoT if the remaining thyroid tissue is insufficient, with up to 20% of patients requiring lifelong medication. Subclinical hypoT, a milder form, is also common but its implications are unclear.

HypoT has significant health impacts, including increased morbidity, mortality, and reduced quality of life. Recent studies suggest an association between hypoT and chronic kidney disease (CKD), but data on CKD risk post-HT are limited. In addition to hypoT, thyroid surgery can result in complications such as nerve damage, voice changes, scarring, and reduced quality of life, along with financial costs from hospital stays and follow-up visits.

Minimally invasive treatments (MIT), such as radiofrequency ablation (RFA) and alcohol ablation (AA), have emerged as alternatives to surgery. RFA effectively reduces benign thyroid nodule volume and symptoms, while AA treats cystic nodules, which constitute 15-25% of all nodules. Both procedures avoid the scarring and risks associated with surgery. However, no studies have assessed patient satisfaction with scarring post-surgery.

To aid in shared decision-making between patients and physicians, it is essential to understand the risks of hypoT, CKD, quality of life impacts, and scarring after HT versus MIT.

A previous study estimated a 20% risk of hypoT after HT. However, in Denmark, iodine fortification has increased thyroid-antibody levels, potentially raising hypoT risk. Therefore, the exact hypoT risk post-HT in a Danish population remains unknown.

Studies:

Study 1: How many patients who receive a HT will get hypoT?
We will identify all patients who underwent HT using the Danish National Patient Registry (DNPR). Linking these data with prescription and thyroid hormone measurement databases will allow us to estimate hypoT rates. A comparison with a matched cohort from the general population (1:10) will be performed.

Study 2: Does hypothyroidism after hemithyroidectomy increases the risk of chronic kidney disease (CKD)?

HT patients will be linked with mortality and laboratory databases to assess all-cause mortality and CKD incidence. These outcomes will be compared with the general population.

Study 3: Is RFA and AA safe and sufficient treatments of nodules in the thyroid gland?

A prospective single-arm study will be conducted on patients undergoing RFA or AA. Inclusion criteria include symptomatic benign nodules/cysts visible on ultrasound, with exclusion for malignancy suspicion or pregnancy. Primary outcomes include changes in quality of life measured by the ThyPro-39 score. Secondary outcomes include volume reduction rate, adverse events, and thyroid function changes.

Study 4: Are patients satisfied with their cervical neck scar after thyroidectomy?

Patients undergoing thyroidectomy at Aarhus University Hospital will be prospectively included. They will complete the Patient Scar Assessment Questionnaire (PSAQ) 6 and 12 months post-surgery. Data on age, race, extent of surgery, gland weight, complications, and suture technique will be collected.

Perspective: We aim to identify preoperative factors predicting scar dissatisfaction, focusing on PSAQ subscales for overall assessment and cosmetic outcomes.

Perspectives:

MIT offers patients alternatives to surgery, potentially improving satisfaction by reducing the risks associated with thyroidectomy, including hypoT and scarring. Shared decision-making will enhance patient outcomes.