Wole – Rokowania, prognozy i postęp choroby

Wole
Rokowania, prognozy i postęp choroby

Prognoza wola tarczycy jest zróżnicowana i zależy od typu oraz etiologii schorzenia. Wole proste (nietoksyczne) cechuje się zazwyczaj dobrą prognozą, choć może prowadzić do powiększenia i ucisku na struktury szyi, co wymaga czasem interwencji chirurgicznej. Wole wieloguzkowe (MNG) może ulegać stabilizacji lub regresji pod leczeniem zachowawczym, jednak istnieje ryzyko przejścia w toksyczne wole guzkowe z nadczynnością tarczycy, które leczy się m.in. jodem radioaktywnym. Monitorowanie woli obejmuje badania obrazowe i biopsje w celu wykluczenia transformacji nowotworowej, której ryzyko jest niskie, ale wzrasta u pacjentów z ekspozycją na promieniowanie. W przypadku chorób autoimmunologicznych, takich jak choroba Gravesa-Basedowa czy Hashimoto, rokowanie zależy od podstawowej patologii, a narzędzie prognostyczne GREAT umożliwia ocenę ryzyka nawrotu po terapii tyreostatykami.

Prognoza wola (Goiter Prognosis)

Prognoza w przypadku wola zależy od jego typu oraz przyczyny powstania. Ocena przewidywanego przebiegu choroby powinna być dokonywana indywidualnie dla każdego pacjenta przez lekarza znającego pełną historię medyczną, typ schorzenia, jego zaawansowanie oraz odpowiedź na dotychczasowe leczenie.¹²

Prognoza w wolu prostym

Wole proste (nietoksyczne) charakteryzuje się dobrą prognozą. W niektórych przypadkach wole może samoistnie ustąpić, jednak istnieje również ryzyko jego powiększania się. Jeśli tarczyca nadal się powiększa, może dojść do ucisku na otaczające struktury, co prowadzi do trudności w oddychaniu, trudności w połykaniu oraz chrypki. Gdy wole ulega dalszemu powiększeniu, należy rozważyć leczenie chirurgiczne.³⁴⁵

Z czasem, w wolu prostym może rozwinąć się niedoczynność tarczycy (hipotyroza) z powodu destrukcji prawidłowej tkanki tarczycowej. Stan ten można skutecznie leczyć za pomocą leków zastępujących hormon tarczycy.⁶

Prognoza w wolu guzkowym

W przypadku wola wieloguzkowego (MNG) niektóre wola zmniejszają tempo wzrostu lub mogą nawet zmniejszyć swoje rozmiary przy leczeniu zachowawczym. Leczenie wola wieloguzkowego może być podjęte, jeśli tarczyca wykazuje nadczynność lub gdy wole powoduje miejscowy efekt masy.⁷

Okazjonalnie wole może przekształcić się w toksyczne wole guzkowe, gdy guzek autonomicznie produkuje hormon tarczycy. Może to prowadzić do nadczynności tarczycy (hipertyreozy), którą można leczyć jodem radioaktywnym w celu zniszczenia guzka.⁸

Wszystkie wola powinny być monitorowane poprzez badania oraz biopsje w kierunku możliwej transformacji nowotworowej, na którą mogą wskazywać nagłe zmiany rozmiaru, ból lub konsystencji. Na szczęście ryzyko złośliwej transformacji jest niskie. U pacjentów narażonych na niskie poziomy promieniowania ryzyko to wzrasta.⁹

Badania Wickham wykazały, że nieliczne wola zwiększyły swoją wielkość, a niewielki odsetek woli wieloguzkowych może powodować nadczynność tarczycy. Dlatego konieczny jest dożywotni nadzór medyczny.¹⁰

Prognoza w chorobach autoimmunologicznych

Gdy wole jest objawem innej choroby tarczycy, takiej jak choroba Gravesa-Basedowa lub zapalenie tarczycy Hashimoto, prognoza zależy od podstawowej przyczyny powiększenia tarczycy.¹¹¹²

U pacjentów z przewlekłym limfocytarnym zapaleniem tarczycy (choroba Hashimoto) gruczoły zazwyczaj ulegają atrofii.¹³

Prognoza w chorobie Gravesa-Basedowa

W przypadku choroby Gravesa-Basedowa, będącej najczęstszą przyczyną nadczynności tarczycy, opracowano narzędzie prognostyczne zwane Graves Recurrent Events After Therapy (GREAT), które pozwala przewidzieć wynik leczenia tyreostatykami (ATD). Wyższy wynik GREAT prognozuje wyższe ryzyko nawrotu po zakończeniu terapii lekami przeciwtarczycowymi. Skala GREAT może być łatwo obliczona w momencie diagnozy i pomaga lekarzom przewidzieć sukces terapii ATD. W konsekwencji pacjenci mogą zdecydować się na inne opcje leczenia już od samego początku.¹⁴

Wpływ leczenia na prognozę

Wyniki leczenia chirurgicznego

Badanie przeprowadzone przez Sorensena i współpracowników wykazało, że pacjenci z objawowym łagodnym wolem guzkowym, którzy przeszli tyreoidektomię, doświadczyli poprawy anatomii tchawicy, przepływu wdechowego oraz jakości życia związanej ze zdrowiem. Badanie wykazało średnią 26% poprawę zwężenia tchawicy i 33% zmniejszenie odchylenia tchawicy 6 miesięcy po operacji. Ponadto badanie wykazało 1% poprawę zwężenia tchawicy na każde 10% zmniejszenie objętości wola. Również wymuszony przepływ wdechowy przy 50% wymuszonej pojemności życiowej wykazał niewielką poprawę.¹⁵

Badanie Chavesa i współpracowników przy użyciu kwestionariusza ThyPRO (Thyroid-Specific Patient-Reported Outcome Measure) wykazało, że liczne aspekty jakości życia związanej ze zdrowiem ulegają poprawie po operacji u pacjentów z łagodnym nieaktywnym wolem. Szczególną poprawę odnotowano w zakresie ogólnej jakości życia, objawów wola i zmęczenia.¹⁶

Całkowita lub subtotalna tyreoidektomia mają podobne wyniki i powikłania, które zależą od dobrego i właściwego przygotowania przedoperacyjnego oraz zastosowania skrupulatnej techniki chirurgicznej. Zakres tyreoidektomii w leczeniu chorób tarczycy jest kwestią sporną wśród badaczy i nadal nie ma konsensusu co do tego, ile tkanki tarczycy powinno zostać zachowane.¹⁷

Badania wykazały, że pooperacyjne krwawienie i tworzenie się krwiaka wystąpiło u 2,5% pacjentów w grupie subtotalnej tyreoidektomii (ST), a u 3,3% pacjentów w grupie całkowitej tyreoidektomii (T), przy nieistotnej statystycznie różnicy. Częstość występowania hipokalcemii zależy od rodzaju przeprowadzonej operacji.¹⁸

Trudności związane z udrożnieniem dróg oddechowych

Rola powiększonego wola w zarządzaniu drogami oddechowymi u pacjentów poddawanych tyreoidektomii była rzadko badana. Częstość występowania trudnej laryngoskopii (Cormack Lehane III, IV) wynosi 13,2%. Częstość intubacji z IDS ≥5 (umiarkowana do dużej trudność intubacji) wynosi 14,3%, podczas gdy odsetek łatwej intubacji tchawicy (IDS=0) i niewielkich trudności z intubacją (IDS 1-5) wynosi odpowiednio 39,6% i 46,2%.¹⁹

Analiza wieloczynnikowa wykazała, że odchylenie tchawicy jest silnym predyktorem trudnej laryngoskopii Cormack Lehane III/IV (P≤0,001, OR=0,069). Badania wykazały, że powiększenie tarczycy wraz z deformacją dróg oddechowych stanowi czynnik ryzyka zarówno dla trudnej laryngoskopii, jak i intubacji.²⁰

Powikłania immunoterapii

Terapia niwolumabem jest związana ze zwiększonym ryzykiem działań niepożądanych ze strony układu endokrynnego, szczególnie dysfunkcji tarczycy. Badania wykazały, że wystąpienie powikłań endokrynologicznych statystycznie znacząco zmniejsza ryzyko progresji choroby (HR = 0,415; 95% CI: 0,196-0,878; p = 0,0214). W zakresie przeżycia całkowitego (OS), pacjenci z powikłaniami endokrynologicznymi wykazali nieznacznie dłuższe medianę OS (54,5 miesiąca) w porównaniu z pacjentami bez działań niepożądanych ze strony układu endokrynnego (33,5 miesiąca).²¹

Prognoza w raku tarczycy

Typ guza jest najważniejszym czynnikiem prognostycznym w raku tarczycy. Rak brodawkowaty tarczycy ma najlepsze rokowanie i najbardziej korzystną prognozę. Zazwyczaj dobrze odpowiada na leczenie. Rak pęcherzykowy tarczycy lub rak rdzeniasty tarczycy mają dobre rokowanie, ale mniej korzystne niż rak brodawkowaty. Rak anaplastyczny tarczycy ma bardzo złe rokowanie.²²

Wiek jest ważnym czynnikiem prognostycznym dla raka brodawkowatego i pęcherzykowego tarczycy. Osoby poniżej 40 roku życia mają bardziej korzystne rokowanie. Im niższe stadium zaawansowania w momencie diagnozy, tym lepsza prognoza. Guzy większe niż 4 cm lub takie, które przeniknęły przez tarczycę do otaczających tkanek i struktur, mają mniej korzystne rokowanie. Rak tarczycy, który rozprzestrzenił się do innych części ciała (przerzuty odległe), również ma mniej korzystne rokowanie.²³

Osoby z rakiem rdzeniastym tarczycy związanym z dziedzicznym schorzeniem MEN2B zwykle mają złe rokowanie. Często diagnozuje się u nich bardziej zaawansowany rak tarczycy.²⁴

Modele prognostyczne w raku tarczycy

Opracowano i zwalidowano modele nomogramów prognostycznych dla pacjentów, którzy przeszli terapię jodem radioaktywnym 131I z powodu raka tarczycy z przerzutami odległymi. Pacjenci z grupy niskiego ryzyka mieli znacznie dłuższe przeżycie wolne od progresji (PFS) i przeżycie całkowite (OS) w porównaniu z pacjentami z grupy wysokiego ryzyka, z 10-letnimi wskaźnikami PFS wynoszącymi 81,1% vs. 51,9% i 10-letnimi wskaźnikami OS wynoszącymi 86,2% vs. 37,4%.²⁵

Nomogram opracowany w tym badaniu służy jako skuteczny model statystyczny do wizualizacji prognostycznej, podkreślając czynniki wpływające na przeżycie i przewidując indywidualne prawdopodobieństwo przeżycia. Znaczące różnice zaobserwowano między grupami wysokiego i niskiego ryzyka w zestawach treningowych, walidacyjnych i kompletnych pod względem 3-, 5- i 10-letniego OS i PFS.²⁶

Prognozowane przez nomogram PFS i OS ściśle pokrywały się z obserwowanymi wartościami na wykresach kalibracyjnych, a wartości C-indeksu były podobne między kohortami treningowymi i walidacyjnymi, co wskazuje na silną zdolność dyskryminacyjną i dokładność kalibracji.²⁷

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Materiały źródłowe

#1 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/12625-goiter
The prognosis (outlook) for goiter depends on its type and what caused it. […] Simple goiter has a good prognosis. If your thyroid continues to enlarge, it may compress the surrounding structures and may cause difficulty in breathing and swallowing and hoarseness. […] If the goiter is a sign of another thyroid disease, like Graves disease or Hashimotos disease, the prognosis depends on the underlying cause of your thyroid enlargement.
#2 Prognosis and survival for thyroid cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/thyroid/prognosis-and-survival
If you have thyroid cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The type of tumour is the most important prognostic factor for thyroid cancer. Papillary thyroid cancer has the best outcome and most favourable prognosis. It tends to respond well to treatment. Follicular thyroid cancer or medullary thyroid cancer has a good prognosis, but less favourable than papillary thyroid cancer. Anaplastic thyroid cancer has a very poor prognosis.
#3 Goiter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562161/
Prognosis: Simple goiter has good prognosis. If thyroid continues to enlarge it may compress the surrounding structures and may cause difficulty in breathing, difficulty in swallowing, and hoarseness. It is important to differentiate between benign and malignant causes of thyroid enlargement. If the goiter continues to enlarge, surgical treatment should be considered. If the goiter is a sign of another thyroid disease like Graves disease or Hashimoto thyroiditis, the prognosis depends on the underlying cause of thyroid enlargement.
#4 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/12625-goiter
The prognosis (outlook) for goiter depends on its type and what caused it. […] Simple goiter has a good prognosis. If your thyroid continues to enlarge, it may compress the surrounding structures and may cause difficulty in breathing and swallowing and hoarseness. […] If the goiter is a sign of another thyroid disease, like Graves disease or Hashimotos disease, the prognosis depends on the underlying cause of your thyroid enlargement.
#5 Thyroid Goiter – Endocrine Surgery | UCLA Health
https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/thyroid-goiter
Expectations (prognosis): A goiter is a benign (harmless) process. A simple goiter may disappear on its own, or may become large. Over time, hypothyroidism (not enough thyroid hormone) may develop due to destruction of the normal thyroid tissue. This can be treated with medications to replace the thyroid hormone. […] Occasionally, a goiter may progress to a toxic nodular goiter when a nodule is making thyroid hormone on its own. This can cause hyperthyroidism (too much thyroid hormone) and can be treated with radioactive iodine to destroy the nodule.
#6 Thyroid Goiter – Endocrine Surgery | UCLA Health
https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/thyroid-goiter
Expectations (prognosis): A goiter is a benign (harmless) process. A simple goiter may disappear on its own, or may become large. Over time, hypothyroidism (not enough thyroid hormone) may develop due to destruction of the normal thyroid tissue. This can be treated with medications to replace the thyroid hormone. […] Occasionally, a goiter may progress to a toxic nodular goiter when a nodule is making thyroid hormone on its own. This can cause hyperthyroidism (too much thyroid hormone) and can be treated with radioactive iodine to destroy the nodule.
#7 Multinodular goiter | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/multinodular-goiter-1?lang=us
Multinodular goiter (MNG) is defined as an enlarged thyroid gland (i.e. goiter) due to multiple nodules which may have normal, decreased or increased function. […] Treatment of multinodular goiter may be pursued if the thyroid is hyperfunctioning, or if the goiter is causing local mass effect. There is no standard treatment and choice of treatment depends on local practice patterns, the activity of the goiter, and the results of FNA of any suspicious nodules. […] Conservative management is also an option as some goiters decrease their rate of growth or may even decrease in size.
#8 Thyroid Goiter – Endocrine Surgery | UCLA Health
https://www.uclahealth.org/medical-services/surgery/endocrine-surgery/patient-resources/patient-education/endocrine-surgery-encyclopedia/thyroid-goiter
Expectations (prognosis): A goiter is a benign (harmless) process. A simple goiter may disappear on its own, or may become large. Over time, hypothyroidism (not enough thyroid hormone) may develop due to destruction of the normal thyroid tissue. This can be treated with medications to replace the thyroid hormone. […] Occasionally, a goiter may progress to a toxic nodular goiter when a nodule is making thyroid hormone on its own. This can cause hyperthyroidism (too much thyroid hormone) and can be treated with radioactive iodine to destroy the nodule.
#9 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of this is low. In patients exposed to low levels of radiation the risk rises. […] Based on the Wickham study, a few of the goiters increased in size. […] A small percentage of multinodular goiters do cause hyperthyroidism. Lifelong surveillance is necessary. […] Patients with chronic lymphocytic thyroiditis generally have glands that become atrophic. […] A study by Sorensen et al found that patients with symptomatic benign nodular goiter who underwent thyroidectomy experienced improvements in tracheal anatomy, inspiratory flow, and health-related quality of life. The investigators found a median 26% improvement in tracheal narrowing and 33% diminishment in tracheal deviation, at 6 months postsurgery. The study also reported a 1% improvement in tracheal narrowing for each 10% reduction in goiter volume. In addition, forced inspiratory flow at 50% of forced vital capacity showed a small improvement. With regard to quality of life, the Impaired Daily Life scale from the Thyroid-Specific Patient-Reported Outcome Measure (ThyPRO) improved by 0.33-points for every 1% reduction in tracheal narrowing. […] A study by Chaves et al using the ThyPRO questionnaire indicated that multiple aspects of health-related quality of life improve following surgery in patients with benign non-toxic goiter. Particular improvement was found with regard to overall quality of life, goiter symptoms, and tiredness.
#10 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of this is low. In patients exposed to low levels of radiation the risk rises. […] Based on the Wickham study, a few of the goiters increased in size. […] A small percentage of multinodular goiters do cause hyperthyroidism. Lifelong surveillance is necessary. […] Patients with chronic lymphocytic thyroiditis generally have glands that become atrophic. […] A study by Sorensen et al found that patients with symptomatic benign nodular goiter who underwent thyroidectomy experienced improvements in tracheal anatomy, inspiratory flow, and health-related quality of life. The investigators found a median 26% improvement in tracheal narrowing and 33% diminishment in tracheal deviation, at 6 months postsurgery. The study also reported a 1% improvement in tracheal narrowing for each 10% reduction in goiter volume. In addition, forced inspiratory flow at 50% of forced vital capacity showed a small improvement. With regard to quality of life, the Impaired Daily Life scale from the Thyroid-Specific Patient-Reported Outcome Measure (ThyPRO) improved by 0.33-points for every 1% reduction in tracheal narrowing. […] A study by Chaves et al using the ThyPRO questionnaire indicated that multiple aspects of health-related quality of life improve following surgery in patients with benign non-toxic goiter. Particular improvement was found with regard to overall quality of life, goiter symptoms, and tiredness.
#11 Goiter – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK562161/
Prognosis: Simple goiter has good prognosis. If thyroid continues to enlarge it may compress the surrounding structures and may cause difficulty in breathing, difficulty in swallowing, and hoarseness. It is important to differentiate between benign and malignant causes of thyroid enlargement. If the goiter continues to enlarge, surgical treatment should be considered. If the goiter is a sign of another thyroid disease like Graves disease or Hashimoto thyroiditis, the prognosis depends on the underlying cause of thyroid enlargement.
#12 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/12625-goiter
The prognosis (outlook) for goiter depends on its type and what caused it. […] Simple goiter has a good prognosis. If your thyroid continues to enlarge, it may compress the surrounding structures and may cause difficulty in breathing and swallowing and hoarseness. […] If the goiter is a sign of another thyroid disease, like Graves disease or Hashimotos disease, the prognosis depends on the underlying cause of your thyroid enlargement.
#13 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of this is low. In patients exposed to low levels of radiation the risk rises. […] Based on the Wickham study, a few of the goiters increased in size. […] A small percentage of multinodular goiters do cause hyperthyroidism. Lifelong surveillance is necessary. […] Patients with chronic lymphocytic thyroiditis generally have glands that become atrophic. […] A study by Sorensen et al found that patients with symptomatic benign nodular goiter who underwent thyroidectomy experienced improvements in tracheal anatomy, inspiratory flow, and health-related quality of life. The investigators found a median 26% improvement in tracheal narrowing and 33% diminishment in tracheal deviation, at 6 months postsurgery. The study also reported a 1% improvement in tracheal narrowing for each 10% reduction in goiter volume. In addition, forced inspiratory flow at 50% of forced vital capacity showed a small improvement. With regard to quality of life, the Impaired Daily Life scale from the Thyroid-Specific Patient-Reported Outcome Measure (ThyPRO) improved by 0.33-points for every 1% reduction in tracheal narrowing. […] A study by Chaves et al using the ThyPRO questionnaire indicated that multiple aspects of health-related quality of life improve following surgery in patients with benign non-toxic goiter. Particular improvement was found with regard to overall quality of life, goiter symptoms, and tiredness.
#14 The „GREAT” score, a clinical tool that predicts the success of antithyroid drug therapy for Graves’ disease
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/may-2017/vol-10-issue-5-p-11-12/
Graves disease is an autoimmune condition that affects the thyroid and is the most common cause of hyperthyroidism. […] A recent study from the Netherlands established a prediction tool called the Graves Recurrent Events After Therapy (GREAT) score. […] The present study seeks to validate the GREAT score and to predict the outcome of ATD treatment in large group of patients with Graves disease. […] Thus a higher GREAT score predicted a higher risk of relapse after stopping ATDs. […] The current study supports using the GREAT score, which can be easily calculated at the time of diagnosis, to predict the success of ATD therapy to treat Graves disease. […] Consequently, they may decide to pursue other treatment options from the outset.
#15 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of this is low. In patients exposed to low levels of radiation the risk rises. […] Based on the Wickham study, a few of the goiters increased in size. […] A small percentage of multinodular goiters do cause hyperthyroidism. Lifelong surveillance is necessary. […] Patients with chronic lymphocytic thyroiditis generally have glands that become atrophic. […] A study by Sorensen et al found that patients with symptomatic benign nodular goiter who underwent thyroidectomy experienced improvements in tracheal anatomy, inspiratory flow, and health-related quality of life. The investigators found a median 26% improvement in tracheal narrowing and 33% diminishment in tracheal deviation, at 6 months postsurgery. The study also reported a 1% improvement in tracheal narrowing for each 10% reduction in goiter volume. In addition, forced inspiratory flow at 50% of forced vital capacity showed a small improvement. With regard to quality of life, the Impaired Daily Life scale from the Thyroid-Specific Patient-Reported Outcome Measure (ThyPRO) improved by 0.33-points for every 1% reduction in tracheal narrowing. […] A study by Chaves et al using the ThyPRO questionnaire indicated that multiple aspects of health-related quality of life improve following surgery in patients with benign non-toxic goiter. Particular improvement was found with regard to overall quality of life, goiter symptoms, and tiredness.
#16 Goiter: Practice Essentials, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/120034-overview
Benign goiters have a good prognosis. However, all goiters should be monitored by examination and biopsy for possible malignant transformation, which may be signaled by a sudden change in size, pain, or consistency. Fortunately, the risk of this is low. In patients exposed to low levels of radiation the risk rises. […] Based on the Wickham study, a few of the goiters increased in size. […] A small percentage of multinodular goiters do cause hyperthyroidism. Lifelong surveillance is necessary. […] Patients with chronic lymphocytic thyroiditis generally have glands that become atrophic. […] A study by Sorensen et al found that patients with symptomatic benign nodular goiter who underwent thyroidectomy experienced improvements in tracheal anatomy, inspiratory flow, and health-related quality of life. The investigators found a median 26% improvement in tracheal narrowing and 33% diminishment in tracheal deviation, at 6 months postsurgery. The study also reported a 1% improvement in tracheal narrowing for each 10% reduction in goiter volume. In addition, forced inspiratory flow at 50% of forced vital capacity showed a small improvement. With regard to quality of life, the Impaired Daily Life scale from the Thyroid-Specific Patient-Reported Outcome Measure (ThyPRO) improved by 0.33-points for every 1% reduction in tracheal narrowing. […] A study by Chaves et al using the ThyPRO questionnaire indicated that multiple aspects of health-related quality of life improve following surgery in patients with benign non-toxic goiter. Particular improvement was found with regard to overall quality of life, goiter symptoms, and tiredness.
#17 Total Versus Subtotal Thyroidectomy for Benign Multinodular Goiter: Outcome and Complications | Rifaat | Journal of Current Surgery
https://www.currentsurgery.org/index.php/jcs/article/view/224/159
Total or subtotal thyroidectomy outcomes and complications are similar and depend on good and proper preoperative preparation and the use of a meticulous surgical technique. […] The extent of thyroidectomy in the management of thyroid diseases is a disputed issue among researchers and there is still no consensus as to how much thyroid tissue should be left behind. […] Our study showed that postoperative hemorrhage and hematoma formation were seen in three patients (2.5%) in ST group while four patients (3.3%) in T group with insignificance statistical difference that came in concordance with many reports. […] The incidence of hypocalcemia depends on the type of surgery performed. […] Total or subtotal thyroidectomy outcomes and complications are similar depending on good and proper preoperative preparation and the use of a meticulous surgical technique can reduce the incidence of postoperative complications in thyroid surgery.
#18 Total Versus Subtotal Thyroidectomy for Benign Multinodular Goiter: Outcome and Complications | Rifaat | Journal of Current Surgery
https://www.currentsurgery.org/index.php/jcs/article/view/224/159
Total or subtotal thyroidectomy outcomes and complications are similar and depend on good and proper preoperative preparation and the use of a meticulous surgical technique. […] The extent of thyroidectomy in the management of thyroid diseases is a disputed issue among researchers and there is still no consensus as to how much thyroid tissue should be left behind. […] Our study showed that postoperative hemorrhage and hematoma formation were seen in three patients (2.5%) in ST group while four patients (3.3%) in T group with insignificance statistical difference that came in concordance with many reports. […] The incidence of hypocalcemia depends on the type of surgery performed. […] Total or subtotal thyroidectomy outcomes and complications are similar depending on good and proper preoperative preparation and the use of a meticulous surgical technique can reduce the incidence of postoperative complications in thyroid surgery.
#19 Magnitude and Predictive Factors of Difficult Airway in Patients
https://www.longdom.org/open-access/magnitude-and-predictive-factors-of-difficult-airway-in-patientsundergoing-thyroid-surgery-from-a-goiter-endemic-area-50558.html
The role of an enlarged goiter for the airway management in patient populations undergoing thyroidectomy has rarely been studied. The main objective of this study was to assess the incidence and predictive factors of difficult airway in patients undergoing thyroidectomy. […] We conclude that thyroid enlargement accompanied by airway deformity constitutes a risk factor for both difficult laryngoscopy and intubation. […] The incidence of difficult laryngoscopy (Cormack Lehane III, IV) was 13.2%. The incidence of intubation with an IDS (intubation difficulty scale)5 (moderate to major difficulty of intubation) was 14.3% (13 of 91), while the rate of easy tracheal intubation (IDS=0) and minor difficulty with intubation (IDS 1-5) were 39.6% and 46.2% respectively. […] The multivariate analysis shows deviation of the trachea to be a strong predictor of Cormack Lehane III/IV (P0.001, OR=0.069). […] We conclude that thyroid enlargement accompanied by airway deformity is a risk factor for both difficult laryngoscopy and intubation. Usual pre-anesthetic airway parameters cannot be relied upon to rule out difficulty in these segments of population.
#20 Magnitude and Predictive Factors of Difficult Airway in Patients
https://www.longdom.org/open-access/magnitude-and-predictive-factors-of-difficult-airway-in-patientsundergoing-thyroid-surgery-from-a-goiter-endemic-area-50558.html
The role of an enlarged goiter for the airway management in patient populations undergoing thyroidectomy has rarely been studied. The main objective of this study was to assess the incidence and predictive factors of difficult airway in patients undergoing thyroidectomy. […] We conclude that thyroid enlargement accompanied by airway deformity constitutes a risk factor for both difficult laryngoscopy and intubation. […] The incidence of difficult laryngoscopy (Cormack Lehane III, IV) was 13.2%. The incidence of intubation with an IDS (intubation difficulty scale)5 (moderate to major difficulty of intubation) was 14.3% (13 of 91), while the rate of easy tracheal intubation (IDS=0) and minor difficulty with intubation (IDS 1-5) were 39.6% and 46.2% respectively. […] The multivariate analysis shows deviation of the trachea to be a strong predictor of Cormack Lehane III/IV (P0.001, OR=0.069). […] We conclude that thyroid enlargement accompanied by airway deformity is a risk factor for both difficult laryngoscopy and intubation. Usual pre-anesthetic airway parameters cannot be relied upon to rule out difficulty in these segments of population.
#21 Do endocrine adverse events predict longer progression-free survival among patients with non-small-cell lung cancer receiving nivolumab? | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257484
Nivolumab therapy is associated with an increased risk of endocrine adverse effects, particularly thyroid dysfunction. […] The relationship between a better cancer prognosis in patients who developed endocrine irAE has not been found. […] The occurrence of endocrine complications statistically significantly reduced the risk of disease progression (HR = 0.415; 95% CI: 0.1960.878; p = 0.0214). […] In the term of overall survival (OS), patients with endocrine events had shown insignificantly longer OS median (54.5 months), when compared with those without endocrine adverse events (33.5 months). […] The conducted analysis did not show that the proposed model explain the variability of the time to progression. It has not been shown that subjects with endocrine complications experienced progression later than subjects without them.
#22 Prognosis and survival for thyroid cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/thyroid/prognosis-and-survival
If you have thyroid cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] The type of tumour is the most important prognostic factor for thyroid cancer. Papillary thyroid cancer has the best outcome and most favourable prognosis. It tends to respond well to treatment. Follicular thyroid cancer or medullary thyroid cancer has a good prognosis, but less favourable than papillary thyroid cancer. Anaplastic thyroid cancer has a very poor prognosis.
#23 Prognosis and survival for thyroid cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/thyroid/prognosis-and-survival
Age is an important prognostic factor for papillary and follicular thyroid cancer. People under 40 years of age have a more favourable prognosis. […] The lower the stage at diagnosis, the better the prognosis. Tumours that are larger than 4 cm or have grown through the thyroid to surrounding tissues and structures have a less favourable prognosis. Thyroid cancer that has spread to other parts of the body (called distant metastases) also has a less favourable prognosis. […] People who have medullary thyroid cancer associated with the hereditary condition MEN2B tend to have a poor prognosis. They are often diagnosed with more advanced thyroid cancer.
#24 Prognosis and survival for thyroid cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/thyroid/prognosis-and-survival
Age is an important prognostic factor for papillary and follicular thyroid cancer. People under 40 years of age have a more favourable prognosis. […] The lower the stage at diagnosis, the better the prognosis. Tumours that are larger than 4 cm or have grown through the thyroid to surrounding tissues and structures have a less favourable prognosis. Thyroid cancer that has spread to other parts of the body (called distant metastases) also has a less favourable prognosis. […] People who have medullary thyroid cancer associated with the hereditary condition MEN2B tend to have a poor prognosis. They are often diagnosed with more advanced thyroid cancer.
#25 Nomogram models for predicting outcomes in thyroid cancer patients with distant metastasis receiving 131iodine therapy | Scientific Reports
https://www.nature.com/articles/s41598-025-86169-7
This study aimed to establish and validate prognostic nomogram models for patients who underwent 131I therapy for thyroid cancer with distant metastases. […] Nomograms were developed based on these predictors, and Kaplan-Meier curves were constructed for validation. […] Low-risk patients had significantly longer PFS and OS compared to high-risk patients, with 10-year PFS rates of 81.1% vs. 51.9% and 10-year OS rates of 86.2% vs. 37.4%. […] These predictors were used to construct nomograms for predicting PFS and OS. […] The nomogram developed in this study serves as an effective statistical model for prognostic visualization, highlighting factors that impact survival and predicting individual survival probabilities. […] Significant differences were observed between the high- and low-risk groups across the training, validation, and complete sets in terms of 3-, 5-, and 10-year OS and PFS. […] The nomogram-predicted PFS and OS closely aligned with observed values on calibration plots, and C-index values were similar between training and validation cohorts, indicating strong discriminative ability and calibration accuracy.
#26 Nomogram models for predicting outcomes in thyroid cancer patients with distant metastasis receiving 131iodine therapy | Scientific Reports
https://www.nature.com/articles/s41598-025-86169-7
This study aimed to establish and validate prognostic nomogram models for patients who underwent 131I therapy for thyroid cancer with distant metastases. […] Nomograms were developed based on these predictors, and Kaplan-Meier curves were constructed for validation. […] Low-risk patients had significantly longer PFS and OS compared to high-risk patients, with 10-year PFS rates of 81.1% vs. 51.9% and 10-year OS rates of 86.2% vs. 37.4%. […] These predictors were used to construct nomograms for predicting PFS and OS. […] The nomogram developed in this study serves as an effective statistical model for prognostic visualization, highlighting factors that impact survival and predicting individual survival probabilities. […] Significant differences were observed between the high- and low-risk groups across the training, validation, and complete sets in terms of 3-, 5-, and 10-year OS and PFS. […] The nomogram-predicted PFS and OS closely aligned with observed values on calibration plots, and C-index values were similar between training and validation cohorts, indicating strong discriminative ability and calibration accuracy.
#27 Nomogram models for predicting outcomes in thyroid cancer patients with distant metastasis receiving 131iodine therapy | Scientific Reports
https://www.nature.com/articles/s41598-025-86169-7
This study aimed to establish and validate prognostic nomogram models for patients who underwent 131I therapy for thyroid cancer with distant metastases. […] Nomograms were developed based on these predictors, and Kaplan-Meier curves were constructed for validation. […] Low-risk patients had significantly longer PFS and OS compared to high-risk patients, with 10-year PFS rates of 81.1% vs. 51.9% and 10-year OS rates of 86.2% vs. 37.4%. […] These predictors were used to construct nomograms for predicting PFS and OS. […] The nomogram developed in this study serves as an effective statistical model for prognostic visualization, highlighting factors that impact survival and predicting individual survival probabilities. […] Significant differences were observed between the high- and low-risk groups across the training, validation, and complete sets in terms of 3-, 5-, and 10-year OS and PFS. […] The nomogram-predicted PFS and OS closely aligned with observed values on calibration plots, and C-index values were similar between training and validation cohorts, indicating strong discriminative ability and calibration accuracy.