(A314) Thyroidectomy Outcomes in Hashimoto’s Thyroiditis: Evaluating Symptom Persistence and Hormonal Management

Introduction: Hashimoto’s thyroiditis (HT) is managed with levothyroxine (LT4) therapy, yet some patients remain symptomatic despite achieving biochemical euthyroid state. In these patients, symptoms may arise from both a hormone deficiency as well as autoimmune factors, including increased anti-thyroperoxidase (anti-TPO) antibodies.

Methods: A retrospective cohort study of patients at the University of Missouri who underwent thyroidectomy in the context of known or pathologically discovered HT was conducted. Data on weight, LT4 dose, and hypothyroid symptoms, along with TSH and anti-TPO values, were collected pre- and postoperatively. Patients were divided into high and low anti-TPO groups based on the median anti-TPO antibody level of 552.3 IU/mL. Postoperative symptom reduction was evaluated as a binary outcome, and statistical analyses were performed to compare changes in symptom count, LT4 dosage, and weight between groups.

Results: A total of 25 patients with HT were identified, 19 (76%) presented with preoperative symptoms. Following thyroidectomy, symptom reduction occurred in 58.3% of patients in the high anti-TPO group (n=12) compared to 38.5% of patients in the low anti-TPO group (n=13). However, there was no statistically significant difference between the two groups (χ² test, p = 0.55). The mean postoperative LT4 dose increase was 75.3 mcg in the high anti-TPO group and 93.2 mcg in the low anti-TPO group (p = 0.47), with 21 patients (84%) requiring an increase in their LT4 dose and only 1 patient (4%) with a decreased dose. The mean weight change was +1.15 kg in the high anti-TPO group and -4.13 kg in the low anti-TPO group (p = 0.32). The average reduction in symptom count was 1.08 for the high anti-TPO group compared to 0.85 for the low anti-TPO group (p = 0.75).

Conclusions: Thyroidectomy may relieve symptoms of clinical hypothyroidism in patients with HT who remain symptomatic despite achieving a biochemical euthyroid state. Notably, differences in preoperative anti-TPO levels were not significantly associated with postoperative symptom reduction, levothyroxine dose changes, or weight changes.