Skip to main content

Advertisement

SpringerLink
Log in

Post-thyroidectomy chronic asthenia: self-deception or disease?

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

There is clinical evidence that post-total thyroidectomy (TT) patients can present persistent asthenia. The aim of this study was to evaluate the prevalence of asthenia symptoms in such patients, assess whether a chronic asthenia syndrome could be caused by TT or become evident after it. An observational study was carried out comparing two groups of 100 patients each, all with homogeneous characteristics. Group A was treated with total lobectomy (TL), Group B with TT. All patients presented normal thyroid hormone levels. The patients were interviewed in order to identify the ones affected by post-operative asthenia persisting for at least six months, with reduced ability to perform physical and mental work, not showing improvement with rest. The severity of the symptoms has been measured by means of the brief fatigue inventory (BFI). Statistical analysis was performed to evaluate statistically significative differences between groups and prognostic factors in TT group. The incidence of post-operative asthenia was 0 % after TL and 25 % after TT, with the operation being the only significant variable. Asthenia is well known as symptom of post-thyroidectomy, but it has not been adequately investigated as consequence of surgery. We demonstrated that the complete removal of the thyroid gland could determine chronic post-thyroidectomy asthenia, although with intensity limited to low/moderate. Post-thyroidectomy asthenia is a relevant sequela interfering with quality of life of at least 25 % of patients operated, suggesting the need to identify its real causes and limit the indication to TT only when strictly required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. T.R. Mendoza, X.S. Wang, C.S. Cleeland, M. Morrissey, B.A. Johnson, J.K. Wendt, S.L. Huber, The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5), 1186–1196 (1999)

    Article  CAS  PubMed  Google Scholar 

  2. A. Puzziello, L. Rosato, N. Innaro, G. Orlando, N. Avenia, G. Perigli, P.G. Calò, M. De Palma, Hypocalcemia following thyroid surgery: incidence and risk factors. A longitudinal multi center study comprising 2,631 patients. Endocrine (2014). doi:10.1007/s12020-014-0209-y

    PubMed  Google Scholar 

  3. L. Rosato, N. Avenia, P. Bernante, M. De Palma, G. Gulino, P.G. Nasi, M.R. Pelizzo, L. Pezzullo, Complications of thyroid surgery: analysis of a multicentric study on 14.934 patients operated on in Italy over 5 years. World J. Surg. 28(3), 271–276 (2004)

    Article  PubMed  Google Scholar 

  4. A. Alberti, A. Dattola, A. Parisi, P. Miccarone, P. Dattola, S. Celi, M. Basile, Short- and long-term monitoring with high-resolution ultrasonography of postoperative thyroid residue. Personal experience with 200 thyroidectomies. Ann. Ital. Chir. 71(5), 547–556 (2000)

    CAS  PubMed  Google Scholar 

  5. L.A. Jason, M. Evans, M. Brown, N. Porter, What is fatigue? Pathological and non-pathological fatigue. P.M. R. 2(5), 327–331 (2010)

    Article  Google Scholar 

  6. E. Smith, J.S. Lai, D. Cella, Building a measure of fatigue: the functional assessment of chronic illness therapy fatigue scale. P.M. R 2, 359–363 (2010)

    Article  Google Scholar 

  7. B. Sesboüé, J.Y. Guincestre, Muscular fatigue. Ann. Readapt. Med. Phys. 49(6), 348–354 (2006)

    Article  Google Scholar 

  8. I. Nijrolder, D. van der Windt, H. de Vries, H. van der Horst, Diagnoses during follow-up of patients presenting with fatigue in primary care. C.M.A.J. 181(10), 683–687 (2009)

    Google Scholar 

  9. W. Hamilton, J. Watson, A. Round, Investigating fatigue in primary care. B.M.J. 341, 502–504 (2010)

    Article  Google Scholar 

  10. M. Sharpe, D. Wilks, Fatigue. B.M.J. 325(7362), 480-483 (2002)

  11. W.H. Prioleau, Results of thyroidectomy in hyperthyroidism associated with neurocirculatory asthenia. Ann. Surg. 109(5), 729–734 (1939)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. J. Ott, R. Promberger, F. Kober, N. Neuhold, M. Tea, J.C. Huber, M. Hermann, Hashimoto’s thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid 21(2), 161–167 (2011)

    Article  PubMed  Google Scholar 

  13. http://www.druginformer.com/~mark/druginformer/side_effect_details/tiroxina/asthenia.html. Accessed 31st December 2013

  14. http://www.inspire.com/groups/thyca-thyroid-cancer-survivors-association/discussion/full-thyroidectomy-and-wicked-fatigue/. Accessed 31st December 2013

  15. http://www.healthboards.com/boards/thyroid-disorders/733977-dizziness-muscle-weakness-after-thyroidectomy.html. Accessed 31st December 2013

  16. http://www.healthshare.com.au/questions/47369-why-am-so-tired-all-the-time-after-having-a-thyroidectomy. Accessed 31st December 2013

  17. http://www.medicitalia.it/consulti/archivio/206370-stanchezza_dopo_tiroidectomia_totale.html. Accessed 31st December 2013

  18. http://www.forum-thyroide.net/index.html?http://www.forum-thyroide.net/phpBB/ftopic29544. html. Accessed 31st December 2013

  19. S.M. Huang, C.H. Lee, L.Y. Chien, H.E. Liu, C.J. Tai, Postoperative quality of life among patients with thyroid cancer. J. Adv. Nurs. 47(5), 492–499 (2004)

    Article  PubMed  Google Scholar 

  20. M. Sabaretnam, A. Mishra, G. Chand, G. Agarwal, A. Agarwal, A.K. Verma, S.K. Mishra, Assessment of swallowing function impairment in patients with benign goiters and impact of thyroidectomy: a case control study. World J. Surg. 36(6), 1293–1299 (2012)

    Article  PubMed  Google Scholar 

  21. F.H. Schmitz-Winnenthal, S. Schimmack, B. Lawrence, U. Maier, M. Heidmann, M.W. Buchler, M. von Frankenberg, Quality of life is not influenced by the extent of surgery in patients with benign goiter. Langenbecks Arch. Surg. 396(8), 1157–1163 (2011)

    Article  PubMed  Google Scholar 

  22. K.O. Adeniyi, O.O. Ogunkeye, S.S. Senok, F.U. Udoh, The effect of thyroidectomy and thyroxine on the reactivity of rat diaphragm muscle to electrical stimulation in vitro. Acta Physiol. Hung. 79(4), 389–393 (1992)

    CAS  PubMed  Google Scholar 

  23. I.U.Ia. Hrinevych, H.D. Bendiuh, N.M. Khranovs’ka, LuM Bilokin’, O.M. Ostapenko, Effect of thyroxin and thymalin on proliferation and apoptosis of thymocytes in rats after thyroidectomy. Fiziol. Zh. 50(3), 39–43 (2004)

    Google Scholar 

  24. E. Mocchegiani, L. Santarelli, L. Costarelli, C. Cipriano, E. Muti, R. Giacconi, M. Malavolta, Plasticity of neuroendocrine-thymus interactions during ontogeny and ageing: role of zinc and arginine. Ageing Res. Rev. 5(3), 281–309 (2006)

    Article  CAS  PubMed  Google Scholar 

  25. K. Fukuda, S.E. Straus, I. Hickie, M.C. Sharpe, J.G. Dobbins, A. Komaroff, The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann. Intern. Med. 121(12), 953–959 (1994)

    Article  CAS  PubMed  Google Scholar 

  26. S. Wessely, Chronic fatigue: symptom and syndrome. Ann. Intern. Med. 134(9 Pt 2), 838–843 (2001)

    Article  CAS  PubMed  Google Scholar 

  27. T.D. Hoang, C.H. Olsen, V.Q. Mai, P.W. Clyde, M.K. Shakir, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J. Clin. Endocrinol. Metab. 98(5), 1982–1990 (2013)

    Article  CAS  PubMed  Google Scholar 

  28. http://clinicaltrials.gov/ct2/show/NCT01739972. Accessed 31st December 2013

  29. M. Bononi, G. De Toma, M. Scarpini, M. Miccini, A. De Cesare, M. Meucci, S. Amore Bonapasta, A. Celotto, A. Tocchi, Hormone replacement therapy after total thyroidectomy. Can the combined treatment be considered effective to get metabolic adequacy? Preliminary results. G. Chir. 31(6–7), 303–307 (2010)

    CAS  PubMed  Google Scholar 

  30. C. Ma, J. Xie, X. Huang, G. Wang, Y. Wang, X. Wang, S. Zuo, Thyroxine alone or thyroxine plus triiodothyronine replacement therapy for hypothyroidism. Nucl. Med. Commun. 30(8), 586–593 (2009)

    Article  CAS  PubMed  Google Scholar 

  31. M.T. McDermott, Does combination T4 and T3 therapy make sense? Endocr. Pract. 18(5), 750–757 (2012)

    Article  PubMed  Google Scholar 

  32. L. Rosato, G. De Toma, R. Bellantone, N. Avenia, G. Cavallaro, C. Dobrinja, M.G. Chiofalo, C. De Crea, M. De Palma, G. Gasparri, A. Gurrado, C.P. Lombardi, P. Miccoli, B. Mullineris, P.G. Nasi, M.R. Pelizzo, L. Pezzullo, G. Perigli, M. Testini, Diagnostic, therapeutic and healthcare management protocols in thyroid surgery: 3rd consensus conference of the Italian association of endocrine surgery units (U.E.C. CLUB). Minerva Chir. 67(5), 365–379 (2012)

    CAS  PubMed  Google Scholar 

  33. J-L. Reverdin, Note sur vingt-deux opérations de goitre, avec 3 pl. photographiques. Revue Médicale de la Suisse Romande 3, 169–198, 233–278, 309–364 (1883)

  34. T. Kocher, Contribution to the discussion on “Exstirpation des Kropfes”. Verhandlungen der Deutschen Gesellschaft für Chirurgie 12(I), 37–38 (1883)

    Google Scholar 

  35. U. Tröhler, Treatment error or erroneous treatment? Theodor Kocher and total excision of the thyroid gland 1883-1914. Praxis (Bern 1994). 90(36), 1556–1560 (2001)

    Google Scholar 

  36. D.S. Cooper, B. Biondi, Subclinical thyroid disease. Lancet 379(9821), 1142–1154 (2012)

    Article  PubMed  Google Scholar 

  37. C.G. Roberts, P.W. Ladenson, Hypothyroidism. Lancet 363(9411), 793–803 (2004)

    Article  CAS  PubMed  Google Scholar 

  38. M.R. Pelizzo, M. Variolo, C. Bernardi, M. Izuzquiza, A. Piotto, G. Grassetto, P.M. Colletti, I. Merante Boschin, D. Rubello, Complications in thyroid resurgery: a single institutional experience on 233 patients from a whole series of 4,752 homogeneously treated patients. Endocrine (2014). doi:10.1007/s12020-014-0225-y

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery – Endocrine Surgical Unit, Ivrea Hospital, School of Medicine, ASL TO4, University of Turin, Turin, Italy

    Lodovico Rosato

  2. Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy

    Furio Pacini

  3. Department of Surgery – Endocrine Surgical Unit, Ivrea Hospital, ASL TO4, Piazza della Credenza, 2 - 10015, Ivrea (TO), Italy

    Luca Panier Suffat, Guido Mondini & Adriana Ginardi

  4. Department of Medicine – Neuropsychology Unit, Ivrea Hospital, ASL TO4, Ivrea, Italy

    Maurizio Maggio

  5. Health Department, Ivrea Hospital, ASL TO4, Ivrea, Italy

    Maria Cristina Bosco

  6. Department of Drug Science and Technology, School of Medicine, University of Turin, Turin, Italy

    Carlo Della Pepa

Authors
  1. Lodovico Rosato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Furio Pacini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Panier Suffat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido Mondini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adriana Ginardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maurizio Maggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Cristina Bosco
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Carlo Della Pepa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guido Mondini.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosato, L., Pacini, F., Panier Suffat, L. et al. Post-thyroidectomy chronic asthenia: self-deception or disease?. Endocrine 48, 615–620 (2015). https://doi.org/10.1007/s12020-014-0353-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-014-0353-4

Keywords

Search

Navigation