Comparing the Health-Related Quality of Life at Two Years After Successful Treatment of Relapsed Graves' Disease With Radiofrequency Ablation, Surgery, or Radioiodine.

Abstract

Conventional definitive treatments of relapsed Graves' disease (GD) include surgery and radioiodine therapy (RAI). Recently, radiofrequency ablation (RFA) has emerged as a potential novel treatment option. This study compared the health-related quality of life (HRQOL) at 2 years after treatment of relapsed GD with RFA, surgery, and RAI. Patients with persistent/relapsed GD who underwent RFA, surgery (total thyroidectomy), or RAI at the same tertiary endocrine surgery unit from 2020 to 2022 were recruited to complete the disease-specific (ThyPRO-39) and generic (SF-12V2, SF-6D and EQ-5D-5L) HRQOL questionnaires at two years after each of the above respective treatments. Composite and domain specific scores were compared after propensity score matching for baseline age, sex, thyroid function, and comorbidities. Patients with moderate to severe Graves ophthalmopathy were excluded. Eighty-five patients completed the questionnaires. In the matched cohort, 45 patients (RFA: 15, Surgery: 15, RAI: 15) were analyzed. Their median age was 34 (30 - 44), and majority were female patients (91%). For the thyroid disease-specific ThyPRO-39 questionnaire, the RFA group had significantly lower (better) scores for depressive symptoms than the RAI and surgery groups (p = 0.046 and 0.009, respectively). The RFA group also had lower (better) scores for anxiety symptoms, hypothyroid symptoms, tiredness, overall quality of life impact scale, and composite scale, albeit differences being not statistically significant. In generic questionnaires, comparable composite scores were observed. These include the physical component score and mental component score in SF-12v2, the SF-6D utility score, EQ-5D-5L utility score, and EQ-VAS score. Sensitivity analysis with inverse probability of treatment weighting yielded consistent results. At 2 years after treatment of relapsed GD, single-session RFA achieved significantly better outcomes in terms of less depressive symptoms and at least comparable outcomes in most HRQOL domains when compared to surgery and RAI, when a disease-specific questionnaire (ThyPRO-39) was used. Comparable outcomes from generic HRQOL questionnaires were noted across RFA, surgery, and RAI.