Recurrent goiter: risk factors, patient quality of life, and efficacy of radioiodine therapy.

Abstract

INTRODUCTION Goiter reoccurs in a substantial number of patients after thyroid resection. OBJECTIVES We aimed to investigate the prevalence and risk factors of recurrent goiters, influence of goiter recurrence on patient quality of life, and the efficacy of therapy with radioiodine (RAI). PATIENTS AND METHODS This was a case‑control study. A total of 481 thyroidectomized patients admitted to the outpatient department within the past year were included in the study and their medical records were analyzed. Also, 30 healthy controls were recruited for comparison. Recurrence was defined as nodular lesions present within the remnant tissue or enlargement of the remaining thyroid tissue that required therapy (reoperation or RAI therapy). Clinical and biochemical data were collected. Randomly selected patients were asked to answer the Polish version of Thyroid‑Related Quality‑of‑Life Patient‑Reported Outcome measure (ThyPROpl). RESULTS A total of 68 patients had recurrent goiter and in 413 patients the recurrence did not occur. Higher thyroid‑stimulating hormone at follow‑up and lobectomy were the strongest risk factors for goiter recurrence, followed by a longer follow-up. Postoperative levothyroxine therapy was associated with a lower risk of recurrence. Efficacy of RAI was similar to secondary thyroidectomy. Scores in all comparable scales for patients with recurrent goiters were significantly worse than those in the general population sample. CONCLUSIONS Lobectomies should be avoided as a primary surgical treatment for patients with benign thyroid diseases, and levothyroxine therapy should be considered individually in each patient. RAI therapy seems to be a safe and effective treatment option for patients with recurrent goiters. Recurrent goiters, even if successfully treated, have a negative impact on the quality of life.