Public Release: 

Thyroidectomy more effective than medication for Hashimoto disease

American College of Physicians

1. Thyroidectomy more effective than medication for Hashimoto disease

Abstract: http://annals.org/aim/article/doi/10.7326/M18-0284

URLs go live when the embargo lifts

Complete surgical removal of the thyroid improved health-related quality of life and fatigue in patients with Hashimoto disease, whereas medical therapy with levothyroxine did not. Thyroidectomy also normalized serum antithyroid peroxidase (anti-TPO) antibodies. Findings from a randomized trial are published in Annals of Internal Medicine.

Hashimoto disease is the most prevalent autoimmune disease worldwide. The disease affects thyroid function and ultimately leads to hypothyroidism. Hormone substitution is effective for some patients, but some suffer from persistent symptoms, such as profound fatigue, poor sleep quality, muscle and joint tenderness, and dry mouth and eyes, despite medical therapy. To date, no specific treatment exists for such patients.

Researchers from Telemark Hospital sought to determine whether thyroidectomy could improve symptoms in patients with Hashimoto thyroiditis who still had symptoms despite having normal thyroid gland function while receiving medical therapy. The researchers studied health outcomes at for 150 patients with confirmed Hashimoto disease seen at a secondary care hospital in Norway. The patients had either complete thyroidectomy or medical management. During follow-up, only the surgical group demonstrated improvement in measures of health and fatigue. Median serum anti-TPO antibody titers also decreased in the surgical group but not in the medical therapy group. These findings suggest that surgery should be considered in patients with normal hormone function and Hashimoto disease.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. The lead author, Ivar Guldvog, MD, can be contacted directly via email at ivaguld@online.no.

2. Lack of coordination between health care systems associated with fatal opioid overdose

Veterans who received opioid prescriptions from both the VA and Medicare Part D had 2 to 3 times higher risk for fatal overdose than those who received prescriptions from one source only

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2574

Editorial: http://annals.org/aim/article/doi/10.7326/M19-0492

URLs go live when the embargo lifts

Among veterans enrolled in the Veterans Affairs (VA) health system and Medicare Part D, dual use of opioid prescriptions was independently associated with death from prescription opioid overdose. This risk factor for fatal overdose among veterans underscores the importance of care coordination across health care systems to improve opioid prescribing safety. Findings from a nested case-control study are published in Annals of Internal Medicine.

More than half of enrollees in the VA are also covered by Medicare and can choose to receive their prescriptions from VA or from Medicare-participating providers. If the two systems do not coordinate care and track prescription use, then it may lead to unsafe opioid use.

Researchers from VA Pittsburgh Healthcare System sought to evaluate the association between dual-system opioid prescribing and death from prescription opioid overdose. The researchers matched each case participant (veterans who died of an accidental overdose) with four closely matched control participants on the basis of clinical, demographic, and social factors. They found that dual-system users had significantly higher odds of death from prescription opioid overdose than those who received opioids from only one source. According to the researchers, these findings suggest that lack of coordination between health systems may have potentially deadly consequences.

The authors of an accompanying editorial from the U.S. Department of Veterans Affairs; Washington, DC say that the study was meticulously conducted and agree that addressing systems issues that arise from dual use are vital. They also suggest that identifying nonnarcotic alternatives for pain, reducing semiautomatic prescribing for minor procedures, and enhancing our ability to predict which patients are likely to have difficulty using opioids for a short time are also essential.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Walid F. Gellad, MD, MPH, please contact Allison Hydzik at hydzikam@upmc.edu.

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